hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|WY,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Memorial Hospital of Carbon County,2024-06-25,2.0.0,Memorial Hospital of Carbon County,"2221 W Elm St, Rawlins, WY 82301",Wyoming 15399,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,modifiers,standard_charge|BCBS|Commercial|negotiated_dollar,standard_charge|BCBS|Commercial|negotiated_percentage,standard_charge|BCBS|Commercial|negotiated_algorithm,estimated_amount|BCBS|Commercial,standard_charge|BCBS|Commercial|methodology,additional_payer_notes|BCBS|Commercial,standard_charge|BCBS_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|BCBS_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|BCBS_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|BCBS_MEDICARE|MEDICARE,standard_charge|BCBS_MEDICARE|MEDICARE|methodology,additional_payer_notes|BCBS_MEDICARE|MEDICARE,standard_charge|CIGNA|commercial|negotiated_dollar,standard_charge|CIGNA|commercial|negotiated_percentage,standard_charge|CIGNA|commercial|negotiated_algorithm,estimated_amount|CIGNA|commercial,standard_charge|CIGNA|commercial|methodology,additional_payer_notes|CIGNA|commercial,standard_charge|CORECHOICE|commercial|negotiated_dollar,standard_charge|CORECHOICE|commercial|negotiated_percentage,standard_charge|CORECHOICE|commercial|negotiated_algorithm,estimated_amount|CORECHOICE|commercial,standard_charge|CORECHOICE|commercial|methodology,additional_payer_notes|CORECHOICE|commercial,standard_charge|FIRST_CHOICE_HEALTH|COMMERCIAL|negotiated_dollar,standard_charge|FIRST_CHOICE_HEALTH|COMMERCIAL|negotiated_percentage,standard_charge|FIRST_CHOICE_HEALTH|COMMERCIAL|negotiated_algorithm,estimated_amount|FIRST_CHOICE_HEALTH|COMMERCIAL,standard_charge|FIRST_CHOICE_HEALTH|COMMERCIAL|methodology,additional_payer_notes|FIRST_CHOICE_HEALTH|COMMERCIAL,standard_charge|INTERWESTS_PPO_NETWORK|COMMERCIAL|negotiated_dollar,standard_charge|INTERWESTS_PPO_NETWORK|COMMERCIAL|negotiated_percentage,standard_charge|INTERWESTS_PPO_NETWORK|COMMERCIAL|negotiated_algorithm,estimated_amount|INTERWESTS_PPO_NETWORK|COMMERCIAL,standard_charge|INTERWESTS_PPO_NETWORK|COMMERCIAL|methodology,additional_payer_notes|INTERWESTS_PPO_NETWORK|COMMERCIAL,standard_charge|LHI|COMMERCIAL|negotiated_dollar,standard_charge|LHI|COMMERCIAL|negotiated_percentage,standard_charge|LHI|COMMERCIAL|negotiated_algorithm,estimated_amount|LHI|COMMERCIAL,standard_charge|LHI|COMMERCIAL|methodology,additional_payer_notes|LHI|COMMERCIAL,standard_charge|MEDICAID|MEDICAID|negotiated_dollar,standard_charge|MEDICAID|MEDICAID|negotiated_percentage,standard_charge|MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|MEDICAID|MEDICAID,standard_charge|MEDICAID|MEDICAID|methodology,additional_payer_notes|MEDICAID|MEDICAID,standard_charge|MEDICARE|MEDICARE|negotiated_dollar,standard_charge|MEDICARE|MEDICARE|negotiated_percentage,standard_charge|MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|MEDICARE|MEDICARE,standard_charge|MEDICARE|MEDICARE|methodology,additional_payer_notes|MEDICARE|MEDICARE,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_dollar,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_percentage,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_algorithm,estimated_amount|MULTIPLAN|COMMERCIAL,standard_charge|MULTIPLAN|COMMERCIAL|methodology,additional_payer_notes|MULTIPLAN|COMMERCIAL,standard_charge|THREE_RIVERS|commercial|negotiated_dollar,standard_charge|THREE_RIVERS|commercial|negotiated_percentage,standard_charge|THREE_RIVERS|commercial|negotiated_algorithm,estimated_amount|THREE_RIVERS|commercial,standard_charge|THREE_RIVERS|commercial|methodology,additional_payer_notes|THREE_RIVERS|commercial,standard_charge|UHC|COMMERCIAL|negotiated_dollar,standard_charge|UHC|COMMERCIAL|negotiated_percentage,standard_charge|UHC|COMMERCIAL|negotiated_algorithm,estimated_amount|UHC|COMMERCIAL,standard_charge|UHC|COMMERCIAL|methodology,additional_payer_notes|UHC|COMMERCIAL,standard_charge|VACCN|MEDICARE|negotiated_dollar,standard_charge|VACCN|MEDICARE|negotiated_percentage,standard_charge|VACCN|MEDICARE|negotiated_algorithm,estimated_amount|VACCN|MEDICARE,standard_charge|VACCN|MEDICARE|methodology,additional_payer_notes|VACCN|MEDICARE,standard_charge|WISE_PROVIDER_NETWORKS|COMMERCIAL|negotiated_dollar,standard_charge|WISE_PROVIDER_NETWORKS|COMMERCIAL|negotiated_percentage,standard_charge|WISE_PROVIDER_NETWORKS|COMMERCIAL|negotiated_algorithm,estimated_amount|WISE_PROVIDER_NETWORKS|COMMERCIAL,standard_charge|WISE_PROVIDER_NETWORKS|COMMERCIAL|methodology,additional_payer_notes|WISE_PROVIDER_NETWORKS|COMMERCIAL,standard_charge|ZELIS|COMMERCIAL|negotiated_dollar,standard_charge|ZELIS|COMMERCIAL|negotiated_percentage,standard_charge|ZELIS|COMMERCIAL|negotiated_algorithm,estimated_amount|ZELIS|COMMERCIAL,standard_charge|ZELIS|COMMERCIAL|methodology,additional_payer_notes|ZELIS|COMMERCIAL,standard_charge|min,standard_charge|max,additional_generic_notes
XR FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT - STATISTIC,71800466S,CDM,999,RC,36415,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.6,29.1,
CT ABDOMEN  PELVIS W/CONTRAST MATERIAL: ADD ON,72300053,CDM,352,RC,97597,HCPCS,Outpatient,,,5156,3867,,4743.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2681.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4795.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4640.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4640.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5001.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5156,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2681.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5001.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3867,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4949.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2681.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3867,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3867,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2681.12,5156,
CT ABDOMEN  PELVIS W  W/O CONT:  ADD ON,72300054,CDM,352,RC,87637,HCPCS,Outpatient,,,5320,3990,,4894.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2766.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4947.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4788,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4788,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5160.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5320,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2766.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5160.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3990,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2766.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3990,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3990,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2766.4,5320,
CT ABDOMEN  PELVIS W/O CONT:  ADD ON,72300052,CDM,352,RC,93000,HCPCS,Outpatient,,,3341,2505.75,,3073.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1737.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3107.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3006.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3006.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3240.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3341,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1737.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3240.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2505.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3207.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1737.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2505.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2505.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1737.32,3341,
CT ANGIO ABDOMEN:  ADD ON,72300051,CDM,352,RC,83037,HCPCS,Outpatient,,,3331,2498.25,,3064.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1732.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3097.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2997.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2997.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3231.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3331,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1732.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3231.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2498.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1732.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2498.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2498.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1732.12,3331,
CT GUIDANCE NEEDLE PLACEMENT: ADD ON,72300059,CDM,350,RC,87804,HCPCS,Outpatient,,,1834,1375.5,,1687.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,953.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1705.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1650.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1650.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1778.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1834,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,953.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1778.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1375.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1760.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,953.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1375.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1375.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,953.68,1834,
CT LUMBAR SPINE W/O  and  W/CONTRAST MATERIAL: ADD ON,72300028,CDM,352,RC,87804,HCPCS,Outpatient,,,4099,3074.25,,3771.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2131.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3812.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3689.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3689.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3976.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4099,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2131.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3976.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3074.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3935.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2131.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3074.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3074.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2131.48,4099,
CT LUMBAR SPINE W/CONTRAST MATERIAL: ADD ON,72300027,CDM,352,RC,87880,HCPCS,Outpatient,,,3186,2389.5,,2931.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1656.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2962.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2867.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2867.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3090.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3186,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1656.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3090.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2389.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3058.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1656.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2389.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2389.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1656.72,3186,
CT LUMBAR SPINE W/O CONTRAST MATERIAL: ADD ON,72300026,CDM,352,RC,87635,HCPCS,Outpatient,,,3061,2295.75,,2816.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1591.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2846.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2754.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2754.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2969.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3061,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1591.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2969.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2295.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2938.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1591.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2295.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2295.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1591.72,3061,
MG DIAGNOSTIC TOMO BILATERAL:  ADD ON,71800509,CDM,401,RC,87635,HCPCS,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.8,40,
MG DIAGNOSTIC TOMO LEFT:  ADD ON,71800507,CDM,401,RC,88104,HCPCS,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.8,40,
MG DIAGNOSTIC TOMO RIGHT:  ADD ON,71800507,CDM,401,RC,88108,HCPCS,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.8,40,
MG SCREENING TOMO BILAT:  ADD ON,71800511,CDM,403,RC,88172,HCPCS,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.8,40,
MG SCREENING TOMO LEFT:  ADD ON,71800513,CDM,403,RC,,,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.8,40,
MG SCREENING TOMO RIGHT:  ADD ON,71800513,CDM,403,RC,,,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.8,40,
BLOOD TYPING SEROLOGIC RH (D),70200862,CDM,300,RC,,,Outpatient,,,59,44.25,,54.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,53.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,53.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.68,59,
US GUIDANCE NEEDLE PLACEMENT:  ADD ON,72600031,CDM,402,RC,,,Outpatient,,,1141,855.75,,1049.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,593.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1061.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1026.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1026.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1106.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1141,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,593.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1106.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,855.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1095.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,593.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,855.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,855.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,593.32,1141,
US PREG UTERUS DETAILED EXAM EACH GESTAT: ADD ON,72600017,CDM,402,RC,,,Outpatient,,,697,522.75,,641.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,362.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,648.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,627.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,627.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,676.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,697,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,362.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,676.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,522.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,669.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,362.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,522.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,522.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,362.44,697,
US PREG UTERUS > 1ST TRIMESTER EA ADDL GEST:  ADD ON,72600015,CDM,402,RC,,,Outpatient,,,518,388.5,,476.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,481.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,466.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,466.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,502.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,518,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,502.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,497.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.36,518,
US PREG UTERUS 14 WK TRANSABDL EA GEST:  ADD ON,72600013,CDM,402,RC,,,Outpatient,,,211,158.25,,194.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,109.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,196.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,189.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,189.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,204.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,211,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,109.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,204.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,158.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,109.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,158.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,211,
INJECTION CERVICAL/THORACIC 1ST LEVEL LEFT:  ADD ON,78001756,CDM,361,RC,,,Outpatient,,,1558,1168.5,,1433.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,810.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1448.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1402.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1402.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1511.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1558,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,810.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1511.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1168.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1495.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,810.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1168.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1168.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,810.16,1558,
INJECTION CERVICAL/THORACIC 1ST LEVEL RIGHT:  ADD ON,78001756,CDM,361,RC,,,Outpatient,,,1558,1168.5,,1433.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,810.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1448.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1402.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1402.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1511.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1558,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,810.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1511.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1168.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1495.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,810.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1168.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1168.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,810.16,1558,
INJECTION CERVICAL/THORACIC 2ND LEVEL LEFT:  ADD ON,78001758,CDM,361,RC,,,Outpatient,,,853,639.75,,784.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,793.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,767.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,767.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,827.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,853,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,827.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,818.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,443.56,853,
INJECTION CERVICAL/THORACIC 2ND LEVEL RIGHT:  ADD ON,78001758,CDM,361,RC,,,Outpatient,,,853,639.75,,784.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,793.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,767.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,767.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,827.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,853,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,827.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,818.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,443.56,853,
INJECTION LUMBRAL/SACRAL 1ST LEVEL LEFT:  ADD ON,78001762,CDM,361,RC,,,Outpatient,,,1584,1188,,1457.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1473.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1425.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1425.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1536.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1584,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1536.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1520.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,823.68,1584,
INJECTION LUMBRAL/SACRAL 1ST LEVEL RIGHT:  ADD ON,78001762,CDM,361,RC,,,Outpatient,,,1584,1188,,1457.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1473.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1425.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1425.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1536.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1584,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1536.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1520.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,823.68,1584,
INJECTION LUMBRAL/SACRAL 2ND LEVEL RIGHT:  ADD ON,78001764,CDM,361,RC,,,Outpatient,,,2059,1544.25,,1894.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1914.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2059,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1976.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1070.68,2059,
INJECTION LUMBRAL/SACRAL 2ND LEVEL LEFT:  ADD ON,78001764,CDM,361,RC,,,Outpatient,,,2059,1544.25,,1894.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1914.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2059,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1976.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1070.68,2059,
XR FLUOROC GUIDANCE NEEDLE PLACEMENT:  PRO FEE ADD ON (PC/TC,71800466G,CDM,320,RC,,,Outpatient,,,552,414,,507.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,513.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,496.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,496.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,535.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,552,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,535.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,529.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,287.04,552,
XR FLUOROC GUIDANCE NEEDLE PLACEMENT:  ADD ON,71800466,CDM,320,RC,,,Outpatient,,,552,414,,507.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,513.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,496.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,496.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,535.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,552,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,535.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,529.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,287.04,552,
COLLECTION VENOUS BLOOD VENIPUNCTURE,78001297,CDM,300,RC,,,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.6,30,
DEBRIDEMENT OPEN WOUND 20 SQ CM/<,78001862G,CDM,361,RC,,,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,363,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.76,363,
RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET,78002114,CDM,300,RC,,,Outpatient,,,452,339,,415.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,235.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,420.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,406.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,406.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,438.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,452,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,235.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,339,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,433.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,235.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,339,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,235.04,452,
ECG ROUTINE ECG W/LEAST 12 LDS W/I and R,78001838G,CDM,730,RC,,,Outpatient,,,237,177.75,,218.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,220.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,229.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,237,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.24,237,
HEMAGLOBIN A1C CLINIC POC,78002849,CDM,300,RC,,,Outpatient,,,29,21.75,,26.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,28.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.08,29,
INFLUENZA AB ID NOW,70200981,CDM,300,RC,,,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.84,142,
INFLUENZA A and B ID NOW,70200981,CDM,300,RC,,,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.84,142,
STREP SCREEN RAPID,70200984,CDM,300,RC,,,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,
SARS COV-2 COVID-19 AMPLIFIED PROBE,70200966,CDM,300,RC,,,Outpatient,,,130,97.5,,119.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,124.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.6,130,
CYTOPATH NON-GYN SMEAR,70200996,CDM,310,RC,,,Outpatient,,,191,143.25,,175.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,99.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,171.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,171.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,191,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,99.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,143.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,183.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,99.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,143.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.32,191,
CYTOPATH CONCENTRATION SMEARS & INTERPRETATION,70200997,CDM,310,RC,,,Outpatient,,,112,84,,103.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,100.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.24,112,
CYTOPATHOLOGY EVAL OF FINE NEEDLE ASPIRATION FIRST EACH SITE,70201146,CDM,310,RC,,,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
Sendout Miscellaneous,PATH99,CDM,310,RC,,,Outpatient,,,0.01,0.01,,0.01,92,,,percent of total billed charges,92% of total billed charges,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,93,,,percent of total billed charges,93% of total billed charges,0.01,90,,,percent of total billed charges,90% of total billed charges,0.01,90,,,percent of total billed charges,90% of total billed charges,0.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,97,,,percent of total billed charges,97% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,96,,,percent of total billed charges,96% of total billed charges,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,0.01,
ANESTHESIA LOCAL BLOCK NO US GUIDE,73700002,CDM,370,RC,,,Outpatient,,,491,368.25,,451.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,255.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,456.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,441.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,441.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,476.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,491,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,255.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,476.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,368.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,471.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,255.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,368.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,368.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,255.32,491,
INSERT NON-INDWELLING BLADDER CATHETER,78001532G,CDM,361,RC,51701,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
BLOOD TYPING SEROLOGIC ABO,70200859,CDM,300,RC,86900,HCPCS,Outpatient,,,349,261.75,,321.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,349,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,335.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.48,349,
BLOOD TYPING SEROLOGIC ABO AND RH,70200860,CDM,300,RC,86900,HCPCS,Outpatient,,,349,261.75,,321.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,349,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,335.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.48,349,
ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE,70200850,CDM,300,RC,86850,HCPCS,Outpatient,,,109,81.75,,100.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.68,109,
ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE,70200850,CDM,300,RC,86850,HCPCS,Outpatient,,,109,81.75,,100.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.68,109,
CROSSMATCH COMPATIBILITY SPIN TECHNIQUE,70200868,CDM,300,RC,86920,HCPCS,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
CROSSMATCH EACH UNIT,71000008,CDM,300,RC,86922,HCPCS,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
CROSSMATCH EACH UNIT,71000008,CDM,300,RC,86922,HCPCS,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
COMPATIBILITY TEST ELECTRONIC EACH,71000015,CDM,300,RC,86923,HCPCS,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
BLOOD TYPING SEROLOGIC ABO AND RH,70200860,CDM,300,RC,86900,HCPCS,Outpatient,,,349,261.75,,321.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,349,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,335.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.48,349,
BLOOD TYPING SEROLOGIC ABO AND RH,70200860,CDM,300,RC,86900,HCPCS,Outpatient,,,349,261.75,,321.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,349,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,335.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.48,349,
DIRECT ANTIGLOBULIN TEST (DAT),70200857,CDM,300,RC,86880,HCPCS,Outpatient,,,173,129.75,,159.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,173,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.96,173,
DIRECT ANTIGLOBULIN TEST (DAT),70200857,CDM,300,RC,86880,HCPCS,Outpatient,,,173,129.75,,159.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,173,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.96,173,
DIRECT ANTIGLOBULIN TEST (DAT),70200857,CDM,300,RC,86880,HCPCS,Outpatient,,,173,129.75,,159.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,173,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.96,173,
DIRECT ANTIGLOBULIN TEST (DAT),70200857,CDM,300,RC,86880,HCPCS,Outpatient,,,173,129.75,,159.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,173,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.96,173,
E0336 ARBC CPD AS1 500 LR,71000003,CDM,390,RC,P9016,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
E0336 RBC CPD AS1 500 LR,71000003,CDM,390,RC,P9016,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
E0382 ARBC CP2D AS3 500 LR,710000031,CDM,390,RC,P9016,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
E0382 RBC CP2D AS3 500 LR,710000031,CDM,390,RC,P9016,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
E2701 Thawed Plasma CPD <24h,71000016,CDM,390,RC,P9059,HCPCS,Outpatient,,,267,200.25,,245.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,267,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,256.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.84,267,
E2737 Thawed Plasma CP2D <24h,710000161,CDM,390,RC,P9059,HCPCS,Outpatient,,,267,200.25,,245.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,267,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,256.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.84,267,
E3088 Aph Plt ACDA LR 2,71000005,CDM,390,RC,P9035,HCPCS,Outpatient,,,1799,1349.25,,1655.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,935.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1673.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1619.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1619.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1745.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1799,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,935.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1745.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1349.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1727.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,935.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1349.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1349.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,935.48,1799,
E4532 Aph ARBC ACDA AS1 LR 1,710000032,CDM,390,RC,P9016,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
E4532 Aph RBC ACDA AS1 LR 1,710000032,CDM,390,RC,P9016,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
E4544 Aph ARBC ACDA AS3 LR 1,710000033,CDM,390,RC,P9016,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
E4544 Aph RBC ACDA AS3 LR 1,710000033,CDM,390,RC,P9016,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
E4545 Aph ARBC ACDA AS3 LR 2,710000034,CDM,390,RC,P9016,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
E4545 Aph RBC ACDA AS3 LR 2,710000034,CDM,390,RC,P9016,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
E5031 Aph Plt ACDA LR Bm 1,710000051,CDM,390,RC,P9035,HCPCS,Outpatient,,,1799,1349.25,,1655.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,935.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1673.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1619.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1619.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1745.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1799,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,935.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1745.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1349.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1727.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,935.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1349.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1349.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,935.48,1799,
E5032 Aph Plt ACDA LR Bm 2,710000052,CDM,390,RC,P9035,HCPCS,Outpatient,,,1799,1349.25,,1655.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,935.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1673.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1619.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1619.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1745.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1799,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,935.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1745.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1349.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1727.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,935.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1349.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1349.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,935.48,1799,
E7731 Thawed Aph Plasma ACDA RT<24Fr<24,710000162,CDM,390,RC,P9059,HCPCS,Outpatient,,,267,200.25,,245.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,267,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,256.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.84,267,
E7750 Thawed Aph Plasma ACDA RT <24Fr<24,710000163,CDM,390,RC,P9059,HCPCS,Outpatient,,,267,200.25,,245.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,267,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,256.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.84,267,
E7751 Thawed Aph Plasma RT <24Fr<24 2,710000164,CDM,390,RC,P9059,HCPCS,Outpatient,,,267,200.25,,245.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,267,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,256.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.84,267,
CROSSMATCH COMPATIBILITY SPIN TECHNIQUE,70200868,CDM,300,RC,86920,HCPCS,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
CROSSMATCH EACH UNIT,71000008,CDM,300,RC,86922,HCPCS,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
CROSSMATCH EACH UNIT,71000008,CDM,300,RC,86922,HCPCS,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
CROSSMATCH EACH UNIT,71000008,CDM,300,RC,86922,HCPCS,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
BLOOD TYPING SEROLOGIC ABO AND RH,70200860,CDM,300,RC,86900,HCPCS,Outpatient,,,349,261.75,,321.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,349,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,335.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.48,349,
ALLOADSORPTION,71000007,CDM,300,RC,86978,HCPCS,Outpatient,,,184,138,,169.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,171.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,165.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,165.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,178.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,184,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,178.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,176.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.68,184,
ADSORPTION,70200872,CDM,300,RC,86978,HCPCS,Outpatient,,,198,148.5,,182.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,184.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,178.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,178.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,192.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,192.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,190.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.96,198,
ADSORPTION,70200872,CDM,300,RC,86978,HCPCS,Outpatient,,,198,148.5,,182.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,184.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,178.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,178.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,192.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,192.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,190.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.96,198,
ANTIBODY IDENTIFICATION,70200852,CDM,300,RC,86870,HCPCS,Outpatient,,,973,729.75,,895.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,505.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,904.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,875.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,875.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,943.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,973,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,505.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,943.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,729.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,934.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,505.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,729.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,729.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,505.96,973,
ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE,70200850,CDM,300,RC,86850,HCPCS,Outpatient,,,109,81.75,,100.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.68,109,
USB ANTIBODY TITER,70200858,CDM,300,RC,86886,HCPCS,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
USB EXTENDED PHENOTYPE,70200866,CDM,300,RC,86905,HCPCS,Outpatient,,,973,729.75,,895.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,505.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,904.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,875.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,875.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,943.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,973,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,505.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,943.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,729.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,934.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,505.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,729.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,729.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,505.96,973,
COLD AGGLUTININ SCREEN,70200679,CDM,300,RC,86156,HCPCS,Outpatient,,,176,132,,161.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,91.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,163.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,170.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,176,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,91.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,170.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,132,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,168.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,91.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91.52,176,
CROSSMATCH EACH UNIT,71000008,CDM,300,RC,86922,HCPCS,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
DIRECT ANTIGLOBULIN TEST (DAT),70200857,CDM,300,RC,86880,HCPCS,Outpatient,,,173,129.75,,159.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,173,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.96,173,
ANTIBODY ELUTION (RBC) EACH,71000009,CDM,300,RC,86860,HCPCS,Outpatient,,,472,354,,434.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.44,472,
FETAL SCREEN,71000010,CDM,300,RC,85461,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.12,106,
INDIRECT ANTIGLOBULIN,71000011,CDM,300,RC,86850,HCPCS,Outpatient,,,133,99.75,,122.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,127.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.16,133,
KLEIHAUER-BETKE,71000012,CDM,300,RC,85460,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
WEAK D,71000013,CDM,300,RC,86901,HCPCS,Outpatient,,,91,68.25,,83.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,88.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.32,91,
PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH,74000006,CDM,410,RC,94642,HCPCS,Outpatient,,,403,302.25,,370.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,374.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,362.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,362.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,390.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,403,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,390.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,386.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,209.56,403,
CONTINUOUS INHALATION TREATMENT 1ST HR,74000007,CDM,410,RC,94644,HCPCS,Outpatient,,,411,308.25,,378.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,382.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,369.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,398.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,411,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,398.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.72,411,
CONTINUOUS INHALATION TREATMENT EA ADDL HR,74000008,CDM,410,RC,94645,HCPCS,Outpatient,,,235,176.25,,216.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,122.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,218.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,211.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,211.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,227.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,235,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,122.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,227.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,176.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,122.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,176.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,176.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.2,235,
ECG ROUTINE W/LEAST 12 LDS TRCG ONLY W/O IR,78001840,CDM,730,RC,93005,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,354,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,339.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.08,354,
INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,66100019,CDM,450,RC,96360,HCPCS,Outpatient,,,388,291,,356.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,360.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,388,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,372.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.76,388,
INFUSION HYDRATION EACH ADDITIONAL HOUR,66100020,CDM,450,RC,96361,HCPCS,Outpatient,,,140,105,,128.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,140,
INFUSION FIRST DRUG INITIAL HOUR,66100021,CDM,450,RC,96365,HCPCS,Outpatient,,,486,364.5,,447.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,252.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,451.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,437.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,437.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,471.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,486,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,252.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,471.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,466.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,252.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,252.72,486,
INFUSION EACH ADDITIONAL HOUR,66100022,CDM,450,RC,96366,HCPCS,Outpatient,,,139,104.25,,127.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.28,139,
INFUSION ADDL SEQUENTIAL NEW DRUG FIRST HOUR,66100023,CDM,450,RC,96367,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
INFUSION IV CONCURRENT,66100024,CDM,450,RC,96368,HCPCS,Outpatient,,,410,307.5,,377.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,381.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,369,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,410,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,397.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.2,410,
INJECTION SUBQ OR IM,66100025,CDM,450,RC,96372,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
INJECTION INTRA-ARTERIAL,66100026,CDM,450,RC,96373,HCPCS,Outpatient,,,287,215.25,,264.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,266.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,258.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,278.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,287,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,278.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,275.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.24,287,
INJECTION IV PUSH SINGLE OR INITIAL DRUG,66100027,CDM,450,RC,96374,HCPCS,Outpatient,,,287,215.25,,264.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,266.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,258.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,278.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,287,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,278.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,275.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.24,287,
INJECTION IV PUSH EACH NEW DRUG,66100028,CDM,450,RC,96375,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
INJECTION EACH ADD'L SEQ IV PUSH SAME DRUG,66100029,CDM,450,RC,96376,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
ER VISIT LEVEL 1 PROBLEM FOCUSED,68500030,CDM,450,RC,99281,HCPCS,Outpatient,,,259,194.25,,238.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,233.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,233.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,251.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,259,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,248.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.68,259,
ER VISIT LEVEL 2 EXPANDED PROBLEM FOCUSED,68500033,CDM,450,RC,99282,HCPCS,Outpatient,,,423,317.25,,389.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,219.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,380.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,380.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,410.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,423,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,219.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,410.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,317.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,406.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,219.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,317.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,219.96,423,
ER VISIT LEVEL 3 MOD SEVERITY,68500036,CDM,450,RC,99283,HCPCS,Outpatient,,,747,560.25,,687.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,694.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,672.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,672.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,724.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,747,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,724.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,717.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,388.44,747,
ER VISIT LEVEL 4 HIGH SEVERITY,68500039,CDM,450,RC,99284,HCPCS,Outpatient,,,1216,912,,1118.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,632.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1130.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1094.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1094.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1179.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1216,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,632.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1179.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1167.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,632.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,912,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.32,1216,
ER VISIT LEVEL 5 HIGH SEVERITY,68500042,CDM,450,RC,99285,HCPCS,Outpatient,,,1797,1347.75,,1653.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,934.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1671.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1617.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1617.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1743.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1797,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,934.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1743.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1347.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1725.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,934.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1347.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1347.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,934.44,1797,
CRITICAL CARE FIRST 30-74 MIN,68500046,CDM,450,RC,99291,HCPCS,Outpatient,,,2500,1875,,2300,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1300,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2325,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2250,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2250,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2425,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1300,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2425,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1875,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2400,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1300,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1875,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1875,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1300,2500,
CRITICAL CARE EA ADDL 30 MIN,68500049,CDM,450,RC,99292,HCPCS,Outpatient,,,800,600,,736,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,416,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,744,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,720,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,720,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,776,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,800,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,416,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,776,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,600,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,768,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,416,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,600,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,600,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,416,800,
TRAUMA ACTIVATION FULL,68500052,CDM,684,RC,G0390,HCPCS,Outpatient,,,5557,4167.75,,5112.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2889.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5168.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5001.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5001.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5390.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5557,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2889.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5390.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4167.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5334.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2889.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4167.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4167.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2889.64,5557,
TRAUMA ACTIVATION MODIFIED,68500064,CDM,684,RC,G0390,HCPCS,Outpatient,,,3910,2932.5,,3597.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2033.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3636.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3519,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3519,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3792.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3910,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2033.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3792.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2932.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3753.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2033.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2932.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2932.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2033.2,3910,
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE,78001334,CDM,450,RC,36591,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.36,143,
CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA,78001018G,CDM,450,RC,27840,HCPCS,Outpatient,,,1105,828.75,,1016.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,574.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1027.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,994.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,994.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1071.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1105,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,574.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1071.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,828.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1060.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,574.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,828.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,828.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,574.6,1105,
ED FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESN,78000003G,CDM,450,RC,10021,HCPCS,Outpatient,,,923,692.25,,849.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,479.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,858.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,830.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,830.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,895.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,923,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,479.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,895.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,692.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,886.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,479.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,692.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,692.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,479.96,923,
ED INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE,78000005G,CDM,450,RC,10060,HCPCS,Outpatient,,,484,363,,445.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,251.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,450.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,435.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,435.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,469.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,484,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,251.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,469.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,363,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,464.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,251.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,363,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,363,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,251.68,484,
ED INCISION  and  DRAINAGE ABSCESS COMPLICATED/MULT,78000007G,CDM,450,RC,10061,HCPCS,Outpatient,,,627,470.25,,576.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,326.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,583.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,564.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,564.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,608.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,627,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,326.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,608.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,470.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,601.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,326.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,470.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,470.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.04,627,
ED INCISION AND DRAINAGE PILONIDAL CYST SIMPLE,78000009G,CDM,450,RC,10080,HCPCS,Outpatient,,,457,342.75,,420.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,237.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,425.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,411.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,411.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,443.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,457,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,237.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,443.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,342.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,438.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,237.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,342.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.64,457,
ED INCISION AND DRAINAGE PILONIDAL CYST COMPLICATED,78000011G,CDM,450,RC,10081,HCPCS,Outpatient,,,1479,1109.25,,1360.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,769.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1375.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1331.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1331.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1434.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1479,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,769.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1434.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1109.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1419.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,769.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1109.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1109.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,769.08,1479,
ED INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,78000013G,CDM,450,RC,10120,HCPCS,Outpatient,,,319,239.25,,293.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,165.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,296.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,287.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,287.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,309.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,319,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,165.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,309.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,239.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,306.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,165.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,165.88,319,
ED INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPLETE,78000015G,CDM,450,RC,10121,HCPCS,Outpatient,,,4529,3396.75,,4166.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2355.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4211.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4076.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4076.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4393.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4529,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2355.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4393.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3396.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4347.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2355.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3396.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3396.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2355.08,4529,
ED I & D HEMATOMA SEROMA/FLUID COLLECTION,78000017G,CDM,450,RC,10140,HCPCS,Outpatient,,,2345,1758.75,,2157.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1219.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2180.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2110.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2110.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2274.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2345,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1219.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2274.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1758.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2251.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1219.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1758.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1758.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1219.4,2345,
ED PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,78000019G,CDM,450,RC,10160,HCPCS,Outpatient,,,541,405.75,,497.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,281.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,503.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,486.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,486.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,524.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,541,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,281.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,524.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,405.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,519.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,281.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,405.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,405.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,281.32,541,
ED INCISION & DRAIN POST OP WOUND INFECTION COMPLEX,78000021G,CDM,450,RC,10180,HCPCS,Outpatient,,,3844,2883,,3536.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1998.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3574.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3459.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3459.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3728.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3844,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1998.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3728.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2883,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3690.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1998.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2883,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2883,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1998.88,3844,
ED DEBRIDE W/FOREIGN BODY REMOVAL SKIN & SUBC TISS,78000026G,CDM,450,RC,11010,HCPCS,Outpatient,,,1444,1083,,1328.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1342.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1299.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1299.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1400.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1444,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1400.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1386.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,750.88,1444,
ED DEBRIDE W/FOREIGN BODY RMVL SKIN SUBQ TISS MUSC,78000028G,CDM,450,RC,11011,HCPCS,Outpatient,,,1128,846,,1037.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,586.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1049.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1015.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1015.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1094.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1128,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,586.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1094.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,846,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1082.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,586.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,846,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,846,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,586.56,1128,
ED DEBRIDEMENT WFB REMOVAL AT OPEN FX/DISLOCATION,78000030G,CDM,450,RC,11012,HCPCS,Outpatient,,,3811,2858.25,,3506.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1981.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3544.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3429.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3429.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3696.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3811,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1981.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3696.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2858.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3658.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1981.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2858.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2858.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1981.72,3811,
ED DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,78000032G,CDM,450,RC,11042,HCPCS,Outpatient,,,1246,934.5,,1146.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,647.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1158.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1121.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1121.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1208.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1246,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,647.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1208.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,934.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1196.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,647.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,934.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,934.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,647.92,1246,
ED DEBRIDE MUSCLE AND/OR FASCIA FIRST 20 SQCM OR <,78000034G,CDM,450,RC,11043,HCPCS,Outpatient,,,1459,1094.25,,1342.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,758.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1356.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1313.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1313.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1415.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1459,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,758.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1415.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1094.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1400.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,758.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1094.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1094.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,758.68,1459,
ED DEBRIDEMENT BONE FIRST 20 SQ CM OR LESS,78000036G,CDM,450,RC,11044,HCPCS,Outpatient,,,2183,1637.25,,2008.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1135.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2030.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1964.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1964.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2117.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2183,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1135.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2117.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1637.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2095.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1135.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1637.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1637.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1135.16,2183,
ED DEBRIDE SUBCUTANEOUS TISSUE EACH ADDL 20 SQ CM,78000038G,CDM,450,RC,11045,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
ED DEBRIDE MUSCLE AND/OR FASCIA EACH ADDL 20 SQ CM,78000040G,CDM,450,RC,11046,HCPCS,Outpatient,,,503,377.25,,462.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,467.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,452.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,452.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,487.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,503,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,487.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,482.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.56,503,
ED DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM,78000042G,CDM,450,RC,11047,HCPCS,Outpatient,,,902,676.5,,829.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,469.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,838.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,811.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,811.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,874.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,902,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,469.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,874.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,676.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,865.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,469.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,676.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,469.04,902,
ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,78000044G,CDM,450,RC,11055,HCPCS,Outpatient,,,228,171,,209.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,221.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,228,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,221.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,218.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,118.56,228,
ED PARING/CUTTING BENIGN HYPERKERATOTC LESIONS 2-4,78000046G,CDM,450,RC,11056,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,286,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,274.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.72,286,
ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,78000048G,CDM,450,RC,11057,HCPCS,Outpatient,,,422,316.5,,388.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,219.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,392.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,379.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,379.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,409.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,422,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,219.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,316.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,405.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,219.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,316.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,219.44,422,
ED TANGENTIAL BIOPSY SKIN SINGLE LESION,78000050G,CDM,450,RC,11102,HCPCS,Outpatient,,,232,174,,213.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.64,232,
ED PUNCH BIOPSY SKIN SINGLE LESION,78000054G,CDM,450,RC,11104,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,288,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.76,288,
ED PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000056G,CDM,450,RC,11105,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
ED INCISIONAL BIOPSY SKIN SINGLE LESION,78000058G,CDM,450,RC,11106,HCPCS,Outpatient,,,1113,834.75,,1023.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,578.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1035.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1001.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1001.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1079.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,578.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1079.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,834.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1068.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,578.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,834.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,834.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,578.76,1113,
ED INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000060G,CDM,450,RC,11107,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,162,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.24,162,
ED REMOVAL OF SKIN TAGS UP TO 15 LESIONS,78000062G,CDM,450,RC,11200,HCPCS,Outpatient,,,371,278.25,,341.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,192.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,345.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,359.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,371,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,192.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,359.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,278.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,356.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,192.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,278.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,278.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192.92,371,
ED REMOVAL OF SKIN TAGS ANY AREA EACH ADD 10 LESN,78000064G,CDM,450,RC,11201,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.28,114,
ED SHAVING SKIN LESN 1 TRUNK/ARM/LEG DIAM 0.5CM/<,78000066G,CDM,450,RC,11300,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.16,233,
ED SHAVE SKIN LESN 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,78000068G,CDM,450,RC,11301,HCPCS,Outpatient,,,278,208.5,,255.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,144.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,250.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,250.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,269.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,278,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,144.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,269.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,208.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,266.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,144.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,208.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,208.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.56,278,
ED SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<,78000072G,CDM,450,RC,11310,HCPCS,Outpatient,,,265,198.75,,243.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,137.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,246.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,238.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,238.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,257.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,265,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,137.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,257.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,198.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,254.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,137.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,198.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,198.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.8,265,
ED EXCISE BENIGN LESION MRGN XCP SK TG T/A/L 0.5 CM/<,78000076G,CDM,450,RC,11400,HCPCS,Outpatient,,,965,723.75,,887.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,501.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,897.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,868.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,868.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,936.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,965,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,501.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,936.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,723.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,926.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,501.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,723.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,723.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,501.8,965,
ED EXCISE BENIGN LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM,78000078G,CDM,450,RC,11401,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,354,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,339.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.08,354,
ED EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 1.1-2.0 CM,78000080G,CDM,450,RC,11402,HCPCS,Outpatient,,,1113,834.75,,1023.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,578.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1035.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1001.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1001.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1079.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,578.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1079.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,834.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1068.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,578.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,834.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,834.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,578.76,1113,
ED EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 2.1-3.0 CM,78000082G,CDM,450,RC,11403,HCPCS,Outpatient,,,858,643.5,,789.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,446.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,797.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,772.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,772.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,832.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,858,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,446.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,832.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,643.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,823.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,446.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,643.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,643.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,446.16,858,
ED EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 3.1-4.0 CM,78000084G,CDM,450,RC,11404,HCPCS,Outpatient,,,1474,1105.5,,1356.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,766.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1370.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1326.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1326.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1429.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1474,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,766.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1429.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1105.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1415.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,766.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1105.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1105.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,766.48,1474,
ED EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS >4.0 CM,78000086G,CDM,450,RC,11406,HCPCS,Outpatient,,,2167,1625.25,,1993.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1126.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2015.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1950.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1950.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2101.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2167,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1126.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2101.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1625.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2080.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1126.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1625.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1625.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1126.84,2167,
ED EXCISE BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,78000088G,CDM,450,RC,11420,HCPCS,Outpatient,,,2049,1536.75,,1885.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1065.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1905.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1844.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1844.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1987.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2049,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1065.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1987.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1536.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1967.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1065.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1536.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1536.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1065.48,2049,
ED EXCISE BENIGN LESN MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM,78000090G,CDM,450,RC,11421,HCPCS,Outpatient,,,633,474.75,,582.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,329.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,588.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,569.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,569.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,614.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,633,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,329.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,614.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,474.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,607.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,329.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,474.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,474.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,329.16,633,
ED EXCISE BENIGN LESN MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM,78000092G,CDM,450,RC,11422,HCPCS,Outpatient,,,2855,2141.25,,2626.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1484.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2655.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2569.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2569.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2769.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2855,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1484.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2769.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2141.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2740.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1484.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2141.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2141.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1484.6,2855,
ED EXCISE BENIGN LESION MGN XCP SK TG S/N/H/F/G 2.1-3.0CM,78000094G,CDM,450,RC,11423,HCPCS,Outpatient,,,1444,1083,,1328.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1342.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1299.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1299.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1400.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1444,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1400.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1386.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,750.88,1444,
ED EXCISE BENIGN LESION MGN XCP SK TG S/N/H/F/G 3.1-4.0CM,78000096G,CDM,450,RC,11424,HCPCS,Outpatient,,,1621,1215.75,,1491.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,842.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1507.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1458.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1458.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1572.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1621,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,842.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1572.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1215.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1556.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,842.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1215.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1215.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.92,1621,
ED EXCISE BENIGN LESION SCALP NECK HANDS FT GENIT > 4.0CM,78000098G,CDM,450,RC,11426,HCPCS,Outpatient,,,2552,1914,,2347.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1327.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2373.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2296.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2296.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2475.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2552,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1327.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2475.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1914,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2449.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1327.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1914,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1914,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1327.04,2552,
ED EXCISE BENIGN LESION FACE EAR EYELID NOSE LIP MOUTH 0.5CM,78000100G,CDM,450,RC,11440,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,298.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,533.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,516.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,516.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,556.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,574,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,298.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,556.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,430.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,551.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,298.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,430.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,430.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,298.48,574,
ED EXCISE BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM,78000102G,CDM,450,RC,11441,HCPCS,Outpatient,,,557,417.75,,512.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,289.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,518.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,501.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,501.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,540.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,557,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,289.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,540.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,417.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,534.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,289.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,417.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,417.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,289.64,557,
ED EXCISE BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM,78000104G,CDM,450,RC,11442,HCPCS,Outpatient,,,730,547.5,,671.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,678.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,730,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,700.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.6,730,
ED EXCISE BENIGN LESION MGN XCP SK TG F/E/E/N/L/M > 4.0CM,78000106G,CDM,450,RC,11446,HCPCS,Outpatient,,,2925,2193.75,,2691,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1521,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2720.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2632.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2632.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2837.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2925,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1521,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2837.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2193.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2808,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1521,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2193.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2193.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1521,2925,
ED EXCISION MALIGNAT LESION TRUNK ARMS LEGS 0.5 CM/<,78000108G,CDM,450,RC,11600,HCPCS,Outpatient,,,799,599.25,,735.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,415.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,743.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,719.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,719.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,775.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,799,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,415.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,775.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,599.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,767.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,415.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,599.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,599.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,415.48,799,
ED EXCISION MALIGNANT LESION TRUNK ARMS LEGS 0.6-1.0CM,78000110G,CDM,450,RC,11601,HCPCS,Outpatient,,,517,387.75,,475.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,480.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,517,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,496.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,268.84,517,
ED EXCISION MALIGNANT LESION TRUNK ARMS LEGS 1.1-2.0CM,78000112G,CDM,450,RC,11602,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,286.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,512.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,495.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,495.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,534.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,551,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,286.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,534.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,413.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,528.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,286.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,413.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,413.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,286.52,551,
ED EXCISION MALIGNANT LESION TRUNK ARMS LEGS > 4.0CM,78000116G,CDM,450,RC,11606,HCPCS,Outpatient,,,2560,1920,,2355.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1331.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2380.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2304,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2304,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2483.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2560,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1331.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2483.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1920,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2457.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1331.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1920,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1920,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1331.2,2560,
ED EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT 0.6-1.0CM,78000118G,CDM,450,RC,11621,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
ED EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT 1.1-2.0CM,78000120G,CDM,450,RC,11622,HCPCS,Outpatient,,,688,516,,632.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,357.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,619.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,619.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,667.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,688,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,357.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,667.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,516,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,660.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,357.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,516,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,516,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357.76,688,
ED EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM,78000122G,CDM,450,RC,11623,HCPCS,Outpatient,,,1304,978,,1199.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,678.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1212.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1173.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1173.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1264.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1304,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,678.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1264.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,978,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1251.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,678.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,978,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,978,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,678.08,1304,
ED EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT >4CM,78000124G,CDM,450,RC,11626,HCPCS,Outpatient,,,3135,2351.25,,2884.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1630.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2915.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2821.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2821.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3040.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3135,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1630.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3040.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2351.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3009.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1630.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2351.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2351.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1630.2,3135,
ED EXCISE MALIGNANT LESION FACE EAR EYELID NOSE LIP 0.5CM/<,78000126G,CDM,450,RC,11640,HCPCS,Outpatient,,,771,578.25,,709.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,400.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,717.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,693.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,693.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,747.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,771,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,400.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,747.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,578.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,740.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,400.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,578.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,578.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,400.92,771,
ED EXCISE MALIGNANT LESN FACE EAR EYELID NOSE LIP 0.6-1.0CM,78000128G,CDM,450,RC,11641,HCPCS,Outpatient,,,678,508.5,,623.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,630.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,610.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,610.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,678,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,657.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,650.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,352.56,678,
ED EXCISE MALIGNANT LESN FACE EAR EYELID NOSE LIP 1.1-2.0CM,78000130G,CDM,450,RC,11642,HCPCS,Outpatient,,,716,537,,658.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,372.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,665.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,644.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,644.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,694.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,716,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,372.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,694.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,537,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,687.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,372.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,537,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,537,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,372.32,716,
ED EXCISE MALIGNANT LESN FACE EAR EYELID NOSE LIP 2.1-3.0CM,78000132G,CDM,450,RC,11643,HCPCS,Outpatient,,,1802,1351.5,,1657.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,937.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1675.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1621.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1621.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1747.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1802,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,937.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1747.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1351.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1729.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,937.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1351.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1351.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,937.04,1802,
ED TRIMMING NONDYSTROPHIC NAILS ANY NUMBER,78000136G,CDM,450,RC,11719,HCPCS,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.84,142,
DEBRIDEMENT NAIL ANY METHOD 1-5,78000138G,CDM,450,RC,11720,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.56,103,
AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1,78000142G,CDM,450,RC,11730,HCPCS,Outpatient,,,345,258.75,,317.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,179.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,310.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,310.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,334.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,345,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,179.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,334.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,258.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,179.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,258.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,179.4,345,
AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL,78000144G,CDM,450,RC,11732,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,103.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.16,108,
EVACUATION SUBUNGUAL HEMATOMA,78000146G,CDM,450,RC,11740,HCPCS,Outpatient,,,215,161.25,,197.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,111.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,193.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,193.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,208.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,215,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,111.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,208.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,161.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,206.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,111.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,161.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,161.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.8,215,
EXCISION NAIL MATRIX PERMANENT REMOVAL,78000148G,CDM,450,RC,11750,HCPCS,Outpatient,,,1373,1029.75,,1263.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,713.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1276.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1235.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1235.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1331.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1373,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,713.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1331.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1029.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1318.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,713.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1029.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1029.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,713.96,1373,
REPAIR OF NAIL BED,78000150G,CDM,450,RC,11760,HCPCS,Outpatient,,,1381,1035.75,,1270.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,718.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1284.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1242.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1242.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1339.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1381,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,718.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1339.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1035.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1325.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,718.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1035.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1035.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,718.12,1381,
WEDGE EXCISION SKIN NAIL FOLD,78000152G,CDM,450,RC,11765,HCPCS,Outpatient,,,438,328.5,,402.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,407.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,438,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,420.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.76,438,
EXCISION PILONIDAL CYST/SINUS COMPLICATED,78000154G,CDM,450,RC,11772,HCPCS,Outpatient,,,6249,4686.75,,5749.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3249.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5811.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5624.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5624.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6061.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6249,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3249.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6061.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4686.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5999.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3249.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4686.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4686.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3249.48,6249,
INJECTION INTRALESIONAL UP TO  and  INCLUD 7 LESION,78000156G,CDM,450,RC,11900,HCPCS,Outpatient,,,165,123.75,,151.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,153.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,148.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,148.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,165,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,158.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.8,165,
SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 2.5CM/<,78000166G,CDM,450,RC,12001,HCPCS,Outpatient,,,440,330,,404.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,228.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,396,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,396,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,426.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,440,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,228.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,426.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,330,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,422.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,228.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,330,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,228.8,440,
SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 2.6-7.5CM,78000168G,CDM,450,RC,12002,HCPCS,Outpatient,,,463,347.25,,425.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,240.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,430.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,416.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,416.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,449.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,463,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,240.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,449.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,347.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,444.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,240.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,347.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,347.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240.76,463,
SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM,78000170G,CDM,450,RC,12004,HCPCS,Outpatient,,,201,150.75,,184.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,104.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,180.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,194.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,104.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,150.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,104.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.52,201,
SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM,78000172G,CDM,450,RC,12005,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,296.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,531.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,513.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,513.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,553.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,571,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,296.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,553.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,428.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,548.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,296.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,428.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,428.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,296.92,571,
SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM,78000174G,CDM,450,RC,12006,HCPCS,Outpatient,,,703,527.25,,646.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,365.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,653.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,632.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,632.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,681.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,703,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,365.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,681.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,527.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,674.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,365.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,527.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,527.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,365.56,703,
SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM,78000176G,CDM,450,RC,12007,HCPCS,Outpatient,,,532,399,,489.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,276.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,478.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,478.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,516.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,532,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,276.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,516.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,399,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,510.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,276.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,399,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,399,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.64,532,
SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<,78000178G,CDM,450,RC,12011,HCPCS,Outpatient,,,478,358.5,,439.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,248.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,444.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,430.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,430.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,463.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,478,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,248.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,463.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,358.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,458.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,248.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,358.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,358.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,248.56,478,
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM,78000180G,CDM,450,RC,12013,HCPCS,Outpatient,,,501,375.75,,460.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,260.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,465.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,450.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,450.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,485.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,501,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,260.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,485.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,375.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,480.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,260.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,375.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,375.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,260.52,501,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 5.1-7.5CM,78000182G,CDM,450,RC,12014,HCPCS,Outpatient,,,540,405,,496.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,280.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,502.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,486,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,486,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,523.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,540,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,280.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,523.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,405,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,518.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,280.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,405,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,405,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,280.8,540,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 7.6-12.5CM,78000184G,CDM,450,RC,12015,HCPCS,Outpatient,,,576,432,,529.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,535.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,518.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,518.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,558.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,576,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,558.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,552.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,299.52,576,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 12.6-20CM,78000186G,CDM,450,RC,12016,HCPCS,Outpatient,,,747,560.25,,687.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,694.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,672.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,672.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,724.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,747,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,724.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,717.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,388.44,747,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 20.1-30CM,78000188G,CDM,450,RC,12017,HCPCS,Outpatient,,,741,555.75,,681.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,385.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,689.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,666.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,666.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,718.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,741,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,385.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,718.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,555.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,711.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,385.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,555.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,555.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,385.32,741,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE >30CM,78000190G,CDM,450,RC,12018,HCPCS,Outpatient,,,358,268.5,,329.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,186.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,322.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,322.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,347.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,358,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,186.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,347.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,268.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,343.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,186.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,268.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.16,358,
TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE,78000192G,CDM,450,RC,12020,HCPCS,Outpatient,,,2131,1598.25,,1960.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1108.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1981.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1917.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1917.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2067.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2131,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1108.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2067.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1598.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2045.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1108.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1598.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1598.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1108.12,2131,
REPAIR INTERMEDIATE SCALP UNDERARMS TRUNK ARM LEG 2.5 CM/<,78000194G,CDM,450,RC,12031,HCPCS,Outpatient,,,924,693,,850.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,480.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,859.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,831.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,831.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,896.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,924,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,480.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,896.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,693,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,887.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,480.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,693,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,693,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,480.48,924,
REPAIR INTERMEDIATE SCALP UNDERARMS TRUNK ARM LEG 2.6-7.5CM,78000196G,CDM,450,RC,12032,HCPCS,Outpatient,,,964,723,,886.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,501.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,896.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,867.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,867.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,935.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,964,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,501.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,935.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,723,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,925.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,501.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,723,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,723,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,501.28,964,
REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES 7.6-12.5CM,78000198G,CDM,450,RC,12034,HCPCS,Outpatient,,,1284,963,,1181.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,667.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1194.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1155.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1155.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1245.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1284,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,667.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1245.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,963,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1232.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,667.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,963,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,963,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,667.68,1284,
REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES 12.6-20CM,78000200G,CDM,450,RC,12035,HCPCS,Outpatient,,,1571,1178.25,,1445.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,816.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1461.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1413.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1413.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1523.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1571,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,816.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1523.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1178.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1508.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,816.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1178.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1178.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,816.92,1571,
REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES 20.1-30CM,78000202G,CDM,450,RC,12036,HCPCS,Outpatient,,,1857,1392.75,,1708.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1727.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1671.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1671.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1801.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1857,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1801.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1782.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.64,1857,
REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES >30CM,78000204G,CDM,450,RC,12037,HCPCS,Outpatient,,,1891,1418.25,,1739.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,983.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1758.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1701.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1701.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1834.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1891,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,983.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1834.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1418.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1815.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,983.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1418.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1418.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,983.32,1891,
REPAIR INTERMEDIATE NECK HAND FEET GENITALS 2.5CM/<,78000206G,CDM,450,RC,12041,HCPCS,Outpatient,,,753,564.75,,692.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,391.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,700.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,677.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,677.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,730.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,753,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,391.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,730.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,564.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,722.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,391.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,564.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,564.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,391.56,753,
REPAIR INTERMEDIATE NECK HAND FEET GENITALS 2.6-7.5CM,78000208G,CDM,450,RC,12042,HCPCS,Outpatient,,,839,629.25,,771.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,436.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,780.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,755.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,755.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,813.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,839,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,436.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,813.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,629.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,805.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,436.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,629.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,629.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,436.28,839,
REPAIR INTERMEDIATE NECK HAND FEET GENITALS 7.6-12.5CM,78000210G,CDM,450,RC,12044,HCPCS,Outpatient,,,1143,857.25,,1051.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,594.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1062.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1028.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1028.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1108.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1143,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,594.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1108.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,857.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1097.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,594.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,857.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,857.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,594.36,1143,
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM,78000212G,CDM,450,RC,12045,HCPCS,Outpatient,,,1070,802.5,,984.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,556.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,995.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,963,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,963,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1037.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1070,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,556.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1037.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,802.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1027.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,556.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,802.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,802.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,556.4,1070,
RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM,78000214G,CDM,450,RC,12046,HCPCS,Outpatient,,,713,534.75,,655.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,370.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,663.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,641.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,641.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,691.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,713,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,370.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,691.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,534.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,684.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,370.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,534.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,534.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,370.76,713,
REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM,78000216G,CDM,450,RC,12047,HCPCS,Outpatient,,,1665,1248.75,,1531.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,865.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1548.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1498.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1498.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1615.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1665,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,865.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1615.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1248.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1598.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,865.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1248.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1248.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,865.8,1665,
REPAIR INTERMEDIATE F/E/E/N/L and /MUC 2.5 CM/<,78000218G,CDM,450,RC,12051,HCPCS,Outpatient,,,919,689.25,,845.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,477.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,854.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,827.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,827.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,891.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,919,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,477.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,891.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,689.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,882.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,477.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,689.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,689.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,477.88,919,
REPAIR INTERMEDIATE F/E/E/N/L and /MUC 2.6-5.0 CM,78000220G,CDM,450,RC,12052,HCPCS,Outpatient,,,774,580.5,,712.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,402.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,719.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,696.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,696.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,750.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,774,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,402.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,750.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,580.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,743.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,402.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,580.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,580.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,402.48,774,
REPAIR INTERMEDIATE F/E/E/N/L and /MUC 5.1-7.5 CM,78000222G,CDM,450,RC,12053,HCPCS,Outpatient,,,764,573,,702.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,397.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,710.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,687.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,687.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,741.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,764,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,397.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,741.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,573,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,733.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,397.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,573,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,573,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,397.28,764,
REPAIR INTERMEDIATE F/E/E/N/L and /MUC 7.6-12.5 CM,78000224G,CDM,450,RC,12054,HCPCS,Outpatient,,,969,726.75,,891.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,503.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,901.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,872.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,872.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,939.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,969,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,503.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,939.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,726.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,930.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,503.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,726.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,726.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,503.88,969,
REPAIR INTERM FACE EAR EYELD NOSE LIP MUCOUS MEMBR 12.6-20CM,78000226G,CDM,450,RC,12055,HCPCS,Outpatient,,,1493,1119.75,,1373.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,776.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1388.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1343.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1343.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1448.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1493,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,776.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1448.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1119.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1433.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,776.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1119.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1119.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,776.36,1493,
REPAIR INTERM FACE EAR EYELID NOSE LIP MUCOUS MEMB 20.1-30CM,78000228G,CDM,450,RC,12056,HCPCS,Outpatient,,,1031,773.25,,948.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,536.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,958.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,927.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,927.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1000.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1031,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,536.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1000.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,773.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,989.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,536.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,773.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,773.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,536.12,1031,
REPAIR INTERM FACE EAR EYELID NOSE LIP MUCOUS MEMBR >30CM,78000230G,CDM,450,RC,12057,HCPCS,Outpatient,,,698,523.5,,642.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,649.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,628.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,628.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,677.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,698,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,677.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,670.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,362.96,698,
REPAIR COMPLEX WOUND TRUNK 1.1-2.5 CM,78000232G,CDM,450,RC,13100,HCPCS,Outpatient,,,1006,754.5,,925.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,523.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,935.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,905.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,905.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,975.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1006,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,523.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,975.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,754.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,523.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,754.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,754.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,523.12,1006,
REPAIR COMPLEX WOUND TRUNK 2.6-7.5 CM,78000234G,CDM,450,RC,13101,HCPCS,Outpatient,,,2373,1779.75,,2183.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1233.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2206.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2135.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2135.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2301.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2373,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1233.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2301.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1779.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2278.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1233.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1779.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1779.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1233.96,2373,
REPAIR COMPLEX WOUND TRUNK EACH ADDITIONAL 5 CM/<,78000236G,CDM,450,RC,13102,HCPCS,Outpatient,,,697,522.75,,641.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,362.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,648.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,627.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,627.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,676.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,697,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,362.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,676.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,522.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,669.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,362.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,522.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,522.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,362.44,697,
REPAIR COMPLEX WOUND SCALP ARM LEG 1.1-2.5 CM,78000238G,CDM,450,RC,13120,HCPCS,Outpatient,,,1341,1005.75,,1233.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,697.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1247.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1206.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1206.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1300.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1341,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,697.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1300.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1005.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1287.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,697.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1005.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1005.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.32,1341,
REPAIR COMPLEX WOUND SCALP ARM LEG 2.6-7.5 CM,78000240G,CDM,450,RC,13121,HCPCS,Outpatient,,,1341,1005.75,,1233.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,697.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1247.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1206.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1206.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1300.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1341,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,697.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1300.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1005.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1287.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,697.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1005.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1005.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.32,1341,
REPAIR COMPLEX WOUND SCALP ARM LEG EACH ADDL 5 CM/<,78000242G,CDM,450,RC,13122,HCPCS,Outpatient,,,1019,764.25,,937.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,947.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,917.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,917.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,988.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1019,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,988.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,978.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,529.88,1019,
REPAIR COMP FOREHEAD CHEEK CHIN MOUTH NECK HAND 1.1-2.5CM,78000244G,CDM,450,RC,13131,HCPCS,Outpatient,,,1312,984,,1207.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,682.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1220.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1180.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1180.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1272.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1312,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,682.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1272.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,984,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1259.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,682.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,984,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,984,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,682.24,1312,
REPAIR COMP FOREHEAD CHEEK CHIN MOUTH NECK HAND 2.6-7.5CM,78000246G,CDM,450,RC,13132,HCPCS,Outpatient,,,1400,1050,,1288,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,728,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1302,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1260,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1260,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1358,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1400,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,728,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1358,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1050,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1344,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,728,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1050,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1050,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,728,1400,
REPAIR COMP FOREHEAD CHEEK CHIN MOUTH NECK HAND EA ADD 5CM,78000248G,CDM,450,RC,13133,HCPCS,Outpatient,,,1106,829.5,,1017.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,575.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1028.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,995.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,995.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1072.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1106,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,575.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1072.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,829.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1061.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,575.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,829.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,829.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,575.12,1106,
REPAIR COMPLEX WOUND EYELID NOSE EAR LIP 1.1-2.5CM,78000250G,CDM,450,RC,13151,HCPCS,Outpatient,,,1645,1233.75,,1513.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,855.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1529.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1480.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1480.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1595.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1645,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,855.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1595.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1233.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1579.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,855.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1233.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1233.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,855.4,1645,
REPAIR COMPLEX WOUND EYELID NOSE EAR LIP 2.6-7.5CM,78000252G,CDM,450,RC,13152,HCPCS,Outpatient,,,1736,1302,,1597.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,902.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1614.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1562.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1562.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1683.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1736,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,902.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1683.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1302,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1666.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,902.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1302,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,902.72,1736,
REPAIR COMPLEX WOUND EYELID NOSE EAR LIP EACH ADDL 5CM,78000254G,CDM,450,RC,13153,HCPCS,Outpatient,,,581,435.75,,534.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,302.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,540.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,522.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,522.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,563.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,581,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,302.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,563.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,435.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,557.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,302.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,435.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,435.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.12,581,
INITIAL TREATMENT 1ST DEGREE BURN LOCAL,78000302G,CDM,450,RC,16000,HCPCS,Outpatient,,,373,279.75,,343.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,193.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,346.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,335.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,335.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,361.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,373,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,193.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,361.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,279.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,358.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,193.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,279.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,193.96,373,
DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE (LESS THAN 5%,78000304G,CDM,450,RC,16020,HCPCS,Outpatient,,,372,279,,342.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,193.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,345.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,334.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,334.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,360.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,372,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,193.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,360.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,279,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,193.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,279,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,193.44,372,
DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/SBSQ MEDIUM,78000306G,CDM,450,RC,16025,HCPCS,Outpatient,,,643,482.25,,591.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,334.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,597.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,578.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,578.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,623.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,643,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,334.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,623.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,482.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,617.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,334.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,482.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,482.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,334.36,643,
DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/SBSQ LARGE,78000308G,CDM,450,RC,16030,HCPCS,Outpatient,,,807,605.25,,742.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,419.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,750.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,726.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,726.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,782.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,807,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,419.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,782.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,605.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,774.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,419.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,605.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,605.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,419.64,807,
DESTRUCTION PREMALIGNANT LESION 1ST,78000310G,CDM,450,RC,17000,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,151,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,146.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.52,151,
DESTRUCTION PREMALIGNANT LESION 2 TO 14,78000312G,CDM,450,RC,17003,HCPCS,Outpatient,,,50,37.5,,46,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,46.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,48.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26,50,
DESTRUCTION BENIGN LESIONS UP TO 14,78000316G,CDM,450,RC,17110,HCPCS,Outpatient,,,256,192,,235.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,133.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,230.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,230.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,248.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,256,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,133.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,192,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,133.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,192,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.12,256,
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE,78000320G,CDM,450,RC,17250,HCPCS,Outpatient,,,318,238.5,,292.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,295.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,286.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,286.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,308.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,318,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,308.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,305.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,165.36,318,
PF BIOPSY OF BREAST PERCUTANEOUS NEEDLE CORE W/O GUIDANCE,78002852G,CDM,450,RC,19100,HCPCS,Outpatient,,,2338,1753.5,,2150.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1215.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2174.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2104.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2104.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2267.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2338,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1215.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2267.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1753.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2244.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1215.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1753.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1753.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1215.76,2338,
PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNC,78000325G,CDM,450,RC,19281,HCPCS,Outpatient,,,1623,1217.25,,1493.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1509.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1460.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1460.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1574.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1623,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1574.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1558.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,843.96,1623,
EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK,78000330G,CDM,450,RC,20102,HCPCS,Outpatient,,,4398,3298.5,,4046.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2286.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4090.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3958.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3958.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4266.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4398,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2286.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4266.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3298.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4222.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2286.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3298.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3298.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2286.96,4398,
EXPLORATION PENETRATING WOUND SPX EXTREMITY,78000332G,CDM,450,RC,20103,HCPCS,Outpatient,,,1443,1082.25,,1327.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,750.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1341.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1298.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1298.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1399.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1443,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,750.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1399.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1082.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1385.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,750.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1082.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1082.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,750.36,1443,
BIOPSY MUSCLE DEEP,78000334G,CDM,450,RC,20205,HCPCS,Outpatient,,,4245,3183.75,,3905.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2207.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3947.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3820.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3820.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4117.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4245,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2207.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4117.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3183.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4075.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2207.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3183.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3183.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2207.4,4245,
REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE,78000342G,CDM,450,RC,20520,HCPCS,Outpatient,,,3432,2574,,3157.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1784.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3191.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3088.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3088.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3329.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3432,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1784.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3329.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2574,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3294.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1784.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2574,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2574,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1784.64,3432,
REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH COMPLICATED,78000344G,CDM,450,RC,20525,HCPCS,Outpatient,,,362,271.5,,333.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,336.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,325.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,325.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,351.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,362,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,351.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,271.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,347.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,271.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,271.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.24,362,
INJECTION THERAPEUTIC CARPAL TUNNEL,78000346G,CDM,450,RC,20526,HCPCS,Outpatient,,,301,225.75,,276.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,301,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.52,301,
INJECTION SINGLE TENDON ORIGIN/INSERTION,78000350G,CDM,450,RC,20551,HCPCS,Outpatient,,,250,187.5,,230,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,130,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,232.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,225,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,242.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,130,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,242.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,130,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130,250,
INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,78000352G,CDM,450,RC,20552,HCPCS,Outpatient,,,531,398.25,,488.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,276.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,493.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,477.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,477.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,515.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,531,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,276.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,515.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,398.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,509.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,276.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,398.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,398.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.12,531,
INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,78000354G,CDM,450,RC,20553,HCPCS,Outpatient,,,437,327.75,,402.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,227.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,406.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,393.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,393.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,423.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,437,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,227.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,423.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,327.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,419.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,227.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,327.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,327.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.24,437,
ARTHROCENTESIS ASPIR and /INJ SMALL JT/BURSA W/O US,78000356G,CDM,450,RC,20600,HCPCS,Outpatient,,,640,480,,588.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,332.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,595.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,576,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,576,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,620.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,640,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,332.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,620.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,480,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,614.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,332.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,480,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,480,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,332.8,640,
ARTHROCENTESIS ASPIR and /INJ SML JT/BURSAW/US REC RPRT,78000360G,CDM,450,RC,20604,HCPCS,Outpatient,,,871,653.25,,801.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,452.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,810.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,783.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,783.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,844.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,871,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,452.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,844.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,653.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,836.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,452.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,653.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,653.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,452.92,871,
ARTHROCENTESIS ASPIR and /INJ INTERM JT/BURS W/O US,78000362G,CDM,450,RC,20605,HCPCS,Outpatient,,,692,519,,636.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,643.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,692,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.84,692,
ARTHROCENTESIS ASPIR and /INJ INTERM JT/BURS W/US,78000366G,CDM,450,RC,20606,HCPCS,Outpatient,,,844,633,,776.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,438.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,784.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,759.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,759.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,818.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,844,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,438.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,818.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,633,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,810.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,438.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,633,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,633,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,438.88,844,
ARTHROCENTESIS ASPIR and /INJ MAJOR JT/BURSA W/O US,78000368G,CDM,450,RC,20610,HCPCS,Outpatient,,,854,640.5,,785.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,794.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,768.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,768.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,828.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,854,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,828.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,444.08,854,
ARTHROCENTESIS ASPIR and /INJ MAJOR JT/BURSA W/US,78000372G,CDM,450,RC,20611,HCPCS,Outpatient,,,993,744.75,,913.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,516.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,923.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,893.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,893.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,963.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,993,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,516.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,963.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,744.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,953.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,516.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,744.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,744.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,516.36,993,
CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION,78000390G,CDM,450,RC,21320,HCPCS,Outpatient,,,174,130.5,,160.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,161.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,168.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,174,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,168.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,167.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90.48,174,
CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ,78000392G,CDM,450,RC,21480,HCPCS,Outpatient,,,615,461.25,,565.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,319.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,571.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,553.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,553.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,596.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,615,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,319.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,596.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,461.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,590.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,319.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,461.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,461.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,319.8,615,
INCISION  and  DRAIN DEEP ABSC/HEMATOMA SOFT TISSUE NECK THO,78000394G,CDM,450,RC,21501,HCPCS,Outpatient,,,4226,3169.5,,3887.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2197.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3930.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3803.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3803.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4099.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4226,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2197.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4099.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4056.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2197.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2197.52,4226,
CLOSED TREATMENT STERNUM FRACTURE,78000400G,CDM,450,RC,21820,HCPCS,Outpatient,,,442,331.5,,406.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,411.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,397.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,442,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,428.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,424.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,229.84,442,
CLOSED TX VERT BODY FX W/O MANIP REQUIRES CASTING OR BRACING,78000406G,CDM,450,RC,22310,HCPCS,Outpatient,,,698,523.5,,642.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,649.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,628.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,628.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,677.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,698,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,677.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,670.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,362.96,698,
INCISION  and  DRAIN SHOULDER DEEP ABSCESS/HEMATOMA,78000413G,CDM,450,RC,23030,HCPCS,Outpatient,,,5085,3813.75,,4678.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2644.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4729.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4576.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4576.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4932.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5085,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2644.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4932.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3813.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4881.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2644.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3813.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3813.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2644.2,5085,
REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS,78000424G,CDM,450,RC,23330,HCPCS,Outpatient,,,1233,924.75,,1134.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,641.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1146.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1109.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1109.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1196.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,641.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1196.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,924.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1183.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,641.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,924.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,924.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,641.16,1233,
CLOSED TX CLAVICULAR FRACTURE W/O MANIPULATION,78000449G,CDM,450,RC,23500,HCPCS,Outpatient,,,505,378.75,,464.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,262.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,469.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,454.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,454.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,489.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,262.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,489.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,378.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,484.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,262.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,378.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,378.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.6,505,
CLOSED TX CLAVICULAR FRACTURE W/MANIPULATION,78000451G,CDM,450,RC,23505,HCPCS,Outpatient,,,1884,1413,,1733.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,979.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1752.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1695.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1695.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1827.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1884,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,979.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1827.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1413,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1808.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,979.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1413,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1413,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,979.68,1884,
CLOSED TX ACROMIOCLAVICULAR DISLOCATION W/O MANIP,78000455G,CDM,450,RC,23540,HCPCS,Outpatient,,,442,331.5,,406.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,411.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,397.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,442,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,428.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,424.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,229.84,442,
CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION,78000461G,CDM,450,RC,23570,HCPCS,Outpatient,,,442,331.5,,406.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,411.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,397.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,442,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,428.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,424.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,229.84,442,
CLOSED TX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION,78000466G,CDM,450,RC,23600,HCPCS,Outpatient,,,759,569.25,,698.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,705.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,683.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,683.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,736.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,759,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,736.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,728.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.68,759,
CLOSED TX SHOULDER DISLOCATION W/MANIPULATION W/O ANES,78000477G,CDM,450,RC,23650,HCPCS,Outpatient,,,890,667.5,,818.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,462.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,827.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,801,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,801,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,863.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,890,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,462.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,863.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,667.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,854.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,462.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,667.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,667.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,462.8,890,
CLOSED TX SUPRA/TRANSCONDYLAR HUMERAL FX W/MANIP,78000526G,CDM,450,RC,24535,HCPCS,Outpatient,,,1562,1171.5,,1437.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,812.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1452.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1405.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1405.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1515.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1562,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,812.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1515.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1171.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1499.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,812.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1171.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1171.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,812.24,1562,
CLOSED TX RADIAL HEAD SUBLXTJ CHLD NURSEMAID ELBOW W/MANIP,78000548G,CDM,450,RC,24640,HCPCS,Outpatient,,,708,531,,651.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,368.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,658.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,637.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,637.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,686.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,708,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,368.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,686.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,531,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,679.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,368.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,531,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,531,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,368.16,708,
EXPLORATION W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST,78000587G,CDM,450,RC,25248,HCPCS,Outpatient,,,5140,3855,,4728.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2672.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4780.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4626,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4626,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4985.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5140,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2672.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4985.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3855,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4934.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2672.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3855,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3855,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2672.8,5140,
REPAIR TENDON/MUSCLE EXTENSOR FOREARM WRIST PRIMARY EACH,78000590G,CDM,450,RC,25270,HCPCS,Outpatient,,,5953,4464.75,,5476.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3095.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5536.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5357.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5357.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5774.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5953,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3095.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5774.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4464.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5714.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3095.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4464.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4464.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3095.56,5953,
CLOSED TX RADIAL  and  ULNAR SHAFT FRACTURES W/MANIPULATION,78000618G,CDM,450,RC,25565,HCPCS,Outpatient,,,1084,813,,997.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,563.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1008.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,975.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,975.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1051.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1084,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,563.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1051.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,813,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1040.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,563.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,813,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,813,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,563.68,1084,
CL TX DISTAL RADIAL FRACTURE W/MANIPULATION,78000626G,CDM,450,RC,25605,HCPCS,Outpatient,,,1389,1041.75,,1277.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,722.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1291.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1250.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1250.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1347.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1389,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,722.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1347.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1041.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1333.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,722.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1041.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1041.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,722.28,1389,
DRAINAGE FINGER ABSCESS COMPLICATED,78000651G,CDM,450,RC,26011,HCPCS,Outpatient,,,3018,2263.5,,2776.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1569.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2806.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2716.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2716.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2927.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3018,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1569.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2927.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2263.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2897.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1569.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2263.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2263.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1569.36,3018,
CLOSED TX METACARPAL FX W/MANIPULATION EACH BONE,78000704G,CDM,450,RC,26605,HCPCS,Outpatient,,,695,521.25,,639.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,361.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,646.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,625.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,625.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,674.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,695,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,361.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,674.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,521.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,667.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,361.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,521.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,521.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,361.4,695,
CLOSED TX METACARPOPHALANGEAL DISLOCATION W/MANIP W/ANES,78000723G,CDM,450,RC,26705,HCPCS,Outpatient,,,496,372,,456.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,257.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,461.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,446.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,446.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,481.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,496,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,257.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,481.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,372,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,476.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,257.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,372,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,372,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,257.92,496,
CLOSED TX PHALANGEAL SHAFT FX PROX/MIDDLE W/MANIP,78000728G,CDM,450,RC,26725,HCPCS,Outpatient,,,629,471.75,,578.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,327.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,584.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,566.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,566.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,610.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,629,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,327.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,610.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,471.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,327.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,471.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,471.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,327.08,629,
CLOSED TX FINGER DISLOCATION W/MANIP W/O ANESTH,78002888G,CDM,450,RC,26770,HCPCS,Outpatient,,,759,569.25,,698.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,705.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,683.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,683.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,736.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,759,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,736.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,728.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.68,759,
CLOSED TX INTERPHALANGEAL JOINT DISLOC W/MANIP W/ANESTH,78000742G,CDM,450,RC,26775,HCPCS,Outpatient,,,632,474,,581.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,328.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,587.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,568.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,568.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,613.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,632,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,328.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,613.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,474,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,328.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,474,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,474,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,328.64,632,
INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA,78002199G,CDM,450,RC,27093,HCPCS,Outpatient,,,758,568.5,,697.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,704.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,682.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,682.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,735.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,758,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,735.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,727.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.16,758,
ED CLOSED TX POST HIP ARTHROPLASTY DISLC W/O ANES,78000803G,CDM,450,RC,27265,HCPCS,Outpatient,,,546,409.5,,502.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,507.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,546,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,283.92,546,
ED CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA,78000909G,CDM,450,RC,27560,HCPCS,Outpatient,,,636,477,,585.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,330.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,591.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,572.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,572.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,616.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,636,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,330.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,616.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,477,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,610.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,330.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,477,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,477,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,330.72,636,
CLOSED TX TIBIAL SHAFT FX W/MANIP W/WO SKEL TRACTION,78000965G,CDM,450,RC,27752,HCPCS,Outpatient,,,3009,2256.75,,2768.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1564.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2798.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2708.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2708.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2918.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3009,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1564.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2918.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2256.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2888.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1564.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2256.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2256.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1564.68,3009,
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANIP,78000996G,CDM,450,RC,27810,HCPCS,Outpatient,,,1120,840,,1030.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,582.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1041.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1008,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1008,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1086.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1120,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,582.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1086.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,840,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1075.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,582.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,840,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,840,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,582.4,1120,
CLOSED TX TRIMALLEOLAR ANKLE FX W/MANIPULATION,78001002G,CDM,450,RC,27818,HCPCS,Outpatient,,,1191,893.25,,1095.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,619.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1107.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1071.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1071.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1155.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1191,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,619.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1155.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,893.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1143.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,619.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,893.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,619.32,1191,
STRAPPING ELBOW/WRIST,78001166G,CDM,450,RC,29260,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,150.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.6,155,
APPLICATION LONG LEG CAST THIGH-TOE,78001174G,CDM,450,RC,29345,HCPCS,Outpatient,,,482,361.5,,443.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,250.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,448.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,433.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,433.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,467.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,482,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,250.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,467.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,361.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,462.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,250.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,361.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,361.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,250.64,482,
APPLICATION SHORT LEG CAST BELOW KNEE-TOE,78001176G,CDM,450,RC,29405,HCPCS,Outpatient,,,576,432,,529.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,535.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,518.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,518.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,558.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,576,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,558.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,552.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,299.52,576,
APPLICATION SHORT LEG CAST WALKING/AMBULATORY,78001178G,CDM,450,RC,29425,HCPCS,Outpatient,,,517,387.75,,475.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,480.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,517,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,496.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,268.84,517,
APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES,78001186G,CDM,450,RC,29505,HCPCS,Outpatient,,,426,319.5,,391.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,221.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,396.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,383.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,383.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,413.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,426,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,221.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,413.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,319.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,408.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,221.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,319.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,319.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,221.52,426,
APPLICATION SHORT LEG SPLINT CALF FOOT,78001188G,CDM,450,RC,29515,HCPCS,Outpatient,,,433,324.75,,398.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,225.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,402.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,389.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,389.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,420.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,433,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,225.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,420.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,324.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,415.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,225.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,324.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.16,433,
STRAPPING KNEE,78001190G,CDM,450,RC,29530,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
STRAPPING ANKLE  and /FOOT,78001192G,CDM,450,RC,29540,HCPCS,Outpatient,,,255,191.25,,234.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,237.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,255,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.6,255,
STRAPPING TOES,78001194G,CDM,450,RC,29550,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,94.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,168.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,162.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,175.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,181,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,94.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,175.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,135.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,173.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,94.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.12,181,
STRAPPING UNNA BOOT,78001196G,CDM,450,RC,29580,HCPCS,Outpatient,,,309,231.75,,284.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,287.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,278.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,278.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,299.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,309,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,299.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,296.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,160.68,309,
REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST,78001200G,CDM,450,RC,29700,HCPCS,Outpatient,,,517,387.75,,475.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,480.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,517,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,496.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,268.84,517,
WINDOWING CAST,78001202G,CDM,450,RC,29730,HCPCS,Outpatient,,,303,227.25,,278.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,272.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,272.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,293.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,303,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,293.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,290.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,157.56,303,
REMOVAL FOREIGN BODY INTRANASAL,78001249G,CDM,450,RC,30300,HCPCS,Outpatient,,,282,211.5,,259.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,146.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,253.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,253.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,273.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,282,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,146.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,273.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,211.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,270.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,146.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,211.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,211.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.64,282,
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE UNI,78001251G,CDM,450,RC,30901,HCPCS,Outpatient,,,224,168,,206.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,116.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,208.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,201.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,201.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,217.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,224,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,116.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,217.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,168,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,215.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,116.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,168,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,168,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,116.48,224,
CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX UNI,78001255G,CDM,450,RC,30903,HCPCS,Outpatient,,,459,344.25,,422.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,238.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,426.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,413.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,413.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,445.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,459,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,238.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,445.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,344.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,440.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,238.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,344.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,344.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.68,459,
CTRL NSL HEMRRG PST NASAL PACKS and /CAUTERY 1ST,78001259G,CDM,450,RC,30905,HCPCS,Outpatient,,,523,392.25,,481.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,271.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,486.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,470.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,470.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,507.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,523,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,271.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,507.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,392.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,502.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,271.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,392.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,392.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,271.96,523,
CTRL NSL HEMRRG PST NASAL PACKS and /CAUTERY SUBSQ,78001261G,CDM,450,RC,30906,HCPCS,Outpatient,,,241,180.75,,221.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,125.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,224.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,216.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,216.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,233.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,241,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,125.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,233.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,180.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,231.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,125.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,180.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.32,241,
INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,78001263G,CDM,450,RC,31500,HCPCS,Outpatient,,,878,658.5,,807.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,816.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,790.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,790.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,851.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,878,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,851.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.56,878,
TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL,78001266G,CDM,450,RC,31603,HCPCS,Outpatient,,,1230,922.5,,1131.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,639.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1143.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1107,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1107,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1193.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1230,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,639.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1193.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,922.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1180.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,639.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,922.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,922.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,639.6,1230,
TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE,78001268G,CDM,450,RC,31605,HCPCS,Outpatient,,,1416,1062,,1302.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,736.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1316.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1274.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1274.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1373.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1416,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,736.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1373.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1062,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1359.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,736.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1062,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1062,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,736.32,1416,
TUBE THORACOSTOMY INCLUDES WATER SEAL,78001276G,CDM,450,RC,32551,HCPCS,Outpatient,,,1469,1101.75,,1351.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,763.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1366.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1322.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1322.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1424.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1469,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,763.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1424.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1101.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1410.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,763.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1101.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1101.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,763.88,1469,
THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING,78001278G,CDM,450,RC,32554,HCPCS,Outpatient,,,1351,1013.25,,1242.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,702.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1256.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1215.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1215.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1310.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1351,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,702.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1310.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1013.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1296.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,702.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1013.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1013.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,702.52,1351,
THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING,78001280G,CDM,450,RC,32555,HCPCS,Outpatient,,,1741,1305.75,,1601.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,905.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1619.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1566.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1566.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1688.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1741,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,905.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1688.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1305.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1671.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,905.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1305.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1305.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,905.32,1741,
PERCUTANEOUS DRAINAGE PLEURA INSERT CATH W/O IMAGING,78001282G,CDM,450,RC,32556,HCPCS,Outpatient,,,1687,1265.25,,1552.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,877.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1568.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1518.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1518.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1636.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1687,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,877.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1636.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1265.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1619.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,877.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1265.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1265.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,877.24,1687,
REPAIR LIP FULL THICKNESS VERMILLION ONLY,78002854G,CDM,450,RC,40650,HCPCS,Outpatient,,,914,685.5,,840.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,475.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,850.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,822.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,822.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,886.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,914,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,475.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,886.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,685.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,877.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,475.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,685.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,685.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,475.28,914,
DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL,78001364G,CDM,450,RC,40800,HCPCS,Outpatient,,,495,371.25,,455.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,257.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,460.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,445.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,445.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,480.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,495,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,257.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,480.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,371.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,475.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,257.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,371.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,371.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,257.4,495,
RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG,78001374G,CDM,450,RC,41250,HCPCS,Outpatient,,,366,274.5,,336.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,190.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,340.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,329.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,329.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,355.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,366,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,190.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,355.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,274.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,351.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,190.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,274.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,274.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,190.32,366,
DRAINAGE OF GUM LESION,78001380G,CDM,450,RC,41800,HCPCS,Outpatient,,,400,300,,368,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,208,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,372,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,360,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,360,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,388,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,208,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,388,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,384,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,208,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,208,400,
INCISION  and  DRAINAGE ISCHIORECTAL AND OR PERIRECTAL ABSCE,78001457G,CDM,450,RC,46040,HCPCS,Outpatient,,,2985,2238.75,,2746.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1552.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2776.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2686.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2686.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2895.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2985,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1552.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2895.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2238.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2865.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1552.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2238.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2238.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1552.2,2985,
ABDOMINAL PARACENTESIS DX/THER W/IMAGING GUIDANCE,78001497G,CDM,450,RC,49083,HCPCS,Outpatient,,,1768,1326,,1626.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,919.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1644.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1591.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1591.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1714.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1768,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,919.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1714.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1326,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1697.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,919.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1326,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1326,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,919.36,1768,
VAGINAL DELIVERY ONLY,78001671,CDM,450,RC,59409,HCPCS,Outpatient,,,2411,1808.25,,2218.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1253.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2242.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2169.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2169.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2338.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2411,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1253.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2338.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1808.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2314.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1253.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1808.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1808.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1253.72,2411,
SPINAL PUNCTURE LUMBAR DIAGNOSTIC,78001703G,CDM,450,RC,62270,HCPCS,Outpatient,,,1047,785.25,,963.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,973.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,942.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,942.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1015.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1047,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1015.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1005.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,544.44,1047,
INJECTION ANES TRIGEMINAL NRV ANY DIV/BRANCH,78001720G,CDM,450,RC,64400,HCPCS,Outpatient,,,711,533.25,,654.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,369.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,661.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,639.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,689.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,711,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,369.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,689.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,533.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,682.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,369.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,533.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,533.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,369.72,711,
INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE,78001722G,CDM,450,RC,64405,HCPCS,Outpatient,,,1042,781.5,,958.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,541.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,969.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,937.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,937.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1010.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1042,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,541.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1010.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,781.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1000.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,541.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,781.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,781.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,541.84,1042,
INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE BILAT,78002806G,CDM,450,RC,64405,HCPCS,Outpatient,,,1042,781.5,,958.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,541.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,969.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,937.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,937.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1010.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1042,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,541.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1010.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,781.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1000.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,541.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,781.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,781.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,541.84,1042,
ED INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,78001738G,CDM,450,RC,64450,HCPCS,Outpatient,,,1381,1035.75,,1270.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,718.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1284.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1242.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1242.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1339.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1381,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,718.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1339.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1035.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1325.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,718.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1035.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1035.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,718.12,1381,
ED INJECTION ANES and /STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL,78001748G,CDM,450,RC,64483,HCPCS,Outpatient,,,2257,1692.75,,2076.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1173.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2099.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2031.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2031.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2189.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2257,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1173.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2189.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1692.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2166.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1173.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1692.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1692.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1173.64,2257,
ED INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL,78001756G,CDM,450,RC,64490,HCPCS,Outpatient,,,2923,2192.25,,2689.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2718.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2630.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2630.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2835.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2923,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2835.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2806.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1519.96,2923,
INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 2ND LVL,78001758G,CDM,450,RC,64491,HCPCS,Outpatient,,,2000,1500,,1840,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1040,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1860,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1800,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1940,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2000,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1040,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1940,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1500,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1920,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1040,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1500,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1500,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1040,2000,
REMOVAL FB EXTERNAL EYE CORNEAL W/SLIT LAMP,78001803G,CDM,450,RC,65222,HCPCS,Outpatient,,,611,458.25,,562.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,317.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,568.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,549.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,549.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,592.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,611,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,317.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,592.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,458.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,586.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,317.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,458.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,458.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,317.72,611,
ED CANTHOTOMY INCISION OF EYELID FOLD,78002868G,CDM,450,RC,67715,HCPCS,Outpatient,,,2674,2005.5,,2460.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1390.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2486.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2406.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2406.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2593.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2674,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1390.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2593.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2005.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2567.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1390.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2005.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2005.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1390.48,2674,
RMVL FB XTRNL AUDITORY CANAL W/O ANES,78001817G,CDM,450,RC,69200,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE UNI,78001819,CDM,450,RC,69209,HCPCS,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,149,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.48,149,
REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,78001820G,CDM,450,RC,69210,HCPCS,Outpatient,,,234,175.5,,215.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,217.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,210.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,210.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,234,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,175.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,175.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,175.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.68,234,
IMMUNIZATION ADMINISTRATION 1 VACCINE,78001826,CDM,771,RC,90471,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,293.79,
IMMUNIZATION ADMINISTRATION EACH ADD'L VACCINE,78001827,CDM,771,RC,90472,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.64,82,
CARDIOPULMONARY RESUSCITATION,68500001G,CDM,450,RC,92950,HCPCS,Outpatient,,,1466,1099.5,,1348.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,762.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1363.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1319.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1319.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1422.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1466,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,762.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1422.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1099.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1407.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,762.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1099.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1099.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,762.32,1466,
TEMPORARY TRANSCUTANEOUS PACING,68500003G,CDM,450,RC,92953,HCPCS,Outpatient,,,1052,789,,967.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,547.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,978.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,946.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,946.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1020.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1052,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,547.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1020.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,789,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1009.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,547.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,789,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,789,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,547.04,1052,
CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL,68500005G,CDM,450,RC,92960,HCPCS,Outpatient,,,1507,1130.25,,1386.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,783.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1401.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1356.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1356.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1461.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,783.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1461.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1130.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1446.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,783.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1130.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1130.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,783.64,1507,
CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX,68500007G,CDM,450,RC,92961,HCPCS,Outpatient,,,1166,874.5,,1072.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,606.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1084.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1049.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1049.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1131.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1166,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,606.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1131.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,874.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1119.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,606.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,874.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,874.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.32,1166,
THROMBOLYSIS CORONARY INTRAVENOUS INFUSION,68500009G,CDM,450,RC,92977,HCPCS,Outpatient,,,1482,1111.5,,1363.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,770.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1378.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1333.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1333.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1437.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1482,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,770.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1437.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1111.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1422.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,770.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1111.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1111.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,770.64,1482,
CONSCIOUS SEDATION SAME MD <5 YRS INIT 15 MIN,68500062,CDM,450,RC,99151,HCPCS,Outpatient,,,475,356.25,,437,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,247,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,441.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,427.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,427.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,460.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,475,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,247,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,460.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,356.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,247,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,356.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,356.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247,475,
CONSCIOUS SEDATION SAME MD 5+ YRS INIT 15 MIN,68500013,CDM,450,RC,99152,HCPCS,Outpatient,,,547,410.25,,503.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,284.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,508.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,492.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,492.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,530.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,547,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,284.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,530.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,410.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,525.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,284.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,410.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,410.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,284.44,547,
CONSCIOUS SEDATION SAME MD EA ADDL 15 MIN,68500015,CDM,450,RC,99153,HCPCS,Outpatient,,,157,117.75,,144.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,81.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,146.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,141.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,141.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,152.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,157,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,81.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,152.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,117.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,81.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,117.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.64,157,
CONSCIOUS SEDATION DIFF MD <5 YRS INIT 15 MIN,68500017,CDM,370,RC,99155,HCPCS,Outpatient,,,380,285,,349.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,197.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,353.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,342,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,342,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,368.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,380,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,197.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,368.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,285,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,364.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,197.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,285,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,285,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.6,380,
CONSCIOUS SEDATION DIFF MD 5+ YRS INIT 15 MIN,68500019,CDM,370,RC,99156,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,219.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,212.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,212.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,228.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,236,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,228.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,226.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.72,236,
CONSCIOUS SEDATION DIFF MD EA ADDL 15 MIN,68500021,CDM,370,RC,99157,HCPCS,Outpatient,,,179,134.25,,164.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,166.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,161.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,161.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,173.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,179,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,173.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,134.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.08,179,
ANOGENITAL CHILD/SUSPECT TRAUMA W IMAGING,68500023G,CDM,450,RC,99170,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
VISUAL ACUITY SCREENING BILAT,68500025G,CDM,450,RC,99173,HCPCS,Outpatient,,,24,18,,22.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,23.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12.48,24,
ER VISIT LEVEL 1 PROBLEM FOCUSED,68500030,CDM,450,RC,99281,HCPCS,Outpatient,,,259,194.25,,238.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,233.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,233.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,251.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,259,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,248.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.68,259,
ER VISIT LEVEL 2 EXPANDED PROBLEM FOCUSED,68500033,CDM,450,RC,99282,HCPCS,Outpatient,,,423,317.25,,389.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,219.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,380.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,380.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,410.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,423,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,219.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,410.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,317.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,406.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,219.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,317.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,219.96,423,
ER VISIT LEVEL 3 MOD SEVERITY,68500036,CDM,450,RC,99283,HCPCS,Outpatient,,,747,560.25,,687.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,694.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,672.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,672.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,724.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,747,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,724.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,717.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,388.44,747,
ER VISIT LEVEL 4 HIGH SEVERITY,68500039,CDM,450,RC,99284,HCPCS,Outpatient,,,1216,912,,1118.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,632.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1130.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1094.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1094.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1179.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1216,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,632.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1179.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1167.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,632.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,912,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.32,1216,
ER VISIT LEVEL 5 HIGH SEVERITY,68500042,CDM,450,RC,99285,HCPCS,Outpatient,,,1797,1347.75,,1653.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,934.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1671.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1617.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1617.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1743.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1797,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,934.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1743.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1347.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1725.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,934.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1347.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1347.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,934.44,1797,
CRITICAL CARE FIRST 30-74 MIN,68500046,CDM,450,RC,99291,HCPCS,Outpatient,,,2500,1875,,2300,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1300,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2325,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2250,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2250,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2425,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1300,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2425,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1875,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2400,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1300,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1875,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1875,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1300,2500,
CRITICAL CARE EA ADDL 30 MIN,68500049,CDM,450,RC,99292,HCPCS,Outpatient,,,800,600,,736,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,416,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,744,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,720,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,720,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,776,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,800,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,416,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,776,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,600,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,768,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,416,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,600,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,600,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,416,800,
AMBULANCE SERVICE OUT-OF-STATE PER MILE,69000001,CDM,540,RC,A0021,HCPCS,Outpatient,,,131,98.25,,120.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.12,131,
AMBULANCE IV DRUG THERAPY,69000002,CDM,540,RC,A0394,HCPCS,Outpatient,,,184,138,,169.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,171.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,165.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,165.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,178.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,184,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,178.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,176.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.68,184,
AMBULANCE SPECIALIZED SERVICE INTUBATION,69000003,CDM,540,RC,A0396,HCPCS,Outpatient,,,2293,1719.75,,2109.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1192.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2132.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2063.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2063.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2224.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2293,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1192.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2224.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1719.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2201.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1192.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1719.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1719.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1192.36,2293,
AMBULANCE EXTRA ATTENDANT,69000004,CDM,540,RC,A0424,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,219.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,212.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,212.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,228.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,236,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,228.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,226.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.72,236,
AMBULANCE GROUND MILEAGE PER MILE,69000005,CDM,540,RC,A0425,HCPCS,Outpatient,,,38,28.5,,34.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.76,38,
AMBULANCE ALS NON-EMERGENT TRANSPORT,69000009,CDM,540,RC,A0426,HCPCS,Outpatient,,,1567,1175.25,,1441.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,814.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1457.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1410.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1410.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1519.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1567,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,814.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1519.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1175.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1504.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,814.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1175.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1175.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,814.84,1567,
AMBULANCE ALS LEVEL 1 EMERGENT TRANSPORT,69000010,CDM,540,RC,A0427,HCPCS,Outpatient,,,1888,1416,,1736.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,981.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1755.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1699.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1699.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1831.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1888,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,981.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1831.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1416,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1812.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,981.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1416,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1416,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,981.76,1888,
AMBULANCE BLS NON-EMERGENT TRANSPORT,69000011,CDM,540,RC,A0428,HCPCS,Outpatient,,,1292,969,,1188.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,671.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1201.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1162.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1162.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1253.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1292,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,671.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1253.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,969,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1240.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,671.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,969,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,969,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,671.84,1292,
AMBULANCE BLS EMERGENT TRANSPORT,69000013,CDM,540,RC,A0429,HCPCS,Outpatient,,,1430,1072.5,,1315.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,743.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1329.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1287,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1287,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1387.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1430,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,743.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1387.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1072.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1372.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,743.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1072.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1072.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,743.6,1430,
PARAMEDIC INTERCEPT RURAL AREA,69000014,CDM,540,RC,A0432,HCPCS,Outpatient,,,2948,2211,,2712.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1532.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2741.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2653.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2653.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2859.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2948,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1532.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2859.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2211,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2830.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1532.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2211,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2211,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1532.96,2948,
AMBULANCE ALS LEVEL 2 EMERGENT TRANSPORT,69000016,CDM,540,RC,A0433,HCPCS,Outpatient,,,2050,1537.5,,1886,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1066,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1906.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1845,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1845,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1988.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2050,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1066,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1988.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1537.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1968,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1066,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1537.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1537.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1066,2050,
AMBULANCE SPECIALTY CARE TRANSPORT,69000017,CDM,540,RC,A0434,HCPCS,Outpatient,,,2210,1657.5,,2033.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1149.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2055.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1989,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1989,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2143.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2210,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1149.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2143.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1657.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2121.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1149.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1657.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1657.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1149.2,2210,
AMBULANCE NONCOVERED MILEAGE PER MILE,69000018,CDM,540,RC,A0888,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,35,
AMBULANCE RESPONSE  TREATMENT NO TRANSPORT,69000019,CDM,540,RC,A0998,HCPCS,Outpatient,,,328,246,,301.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,295.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,295.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,318.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,328,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,246,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,314.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,246,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,246,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.56,328,
TELEHEALTH ORIGINATING SITE FEE,68500061,CDM,450,RC,Q3014,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,
SPEC NEW PATIENT VISIT LEVEL 2,78001893,CDM,761,RC,G0463,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,178,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.56,178,
NEW PATIENT VISIT LEVEL 2,78001891,CDM,761,RC,99202,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,162,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.24,162,
NEW PATIENT VISIT LEVEL 3,78001895,CDM,761,RC,99203,HCPCS,Outpatient,,,219,164.25,,201.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,203.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,219,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.88,219,
NEW PATIENT VISIT LEVEL 4,78001899,CDM,761,RC,99204,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.04,327,
NEW PATIENT VISIT LEVEL 4,78001899,CDM,761,RC,99204,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.04,327,
NEW PATIENT VISIT LEVEL 5,78001903,CDM,761,RC,99205,HCPCS,Outpatient,,,432,324,,397.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,401.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,388.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,388.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,419.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,432,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,419.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,414.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.64,432,
ESTABLISHED PATIENT VISIT LEVEL 1,78001907,CDM,761,RC,99211,HCPCS,Outpatient,,,51,38.25,,46.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.52,51,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,761,RC,99212,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,761,RC,99212,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,761,RC,99212,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
ESTABLISHED PATIENT VISIT LEVEL 3,78001915,CDM,761,RC,99213,HCPCS,Outpatient,,,180,135,,165.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,180,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.6,180,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,761,RC,99214,HCPCS,Outpatient,,,249,186.75,,229.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,249,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,249,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,761,RC,99214,HCPCS,Outpatient,,,249,186.75,,229.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,249,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,249,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,761,RC,99214,HCPCS,Outpatient,,,249,186.75,,229.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,249,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,249,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,761,RC,99215,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.6,330,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,761,RC,99215,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.6,330,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,761,RC,99215,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.6,330,
INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS,78001976,CDM,761,RC,99383,HCPCS,Outpatient,,,264,198,,242.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,137.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,237.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,237.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,256.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,264,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,137.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,256.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,198,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,253.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,137.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,198,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,198,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,264,
PERIODIC PREVENTIVE MED EST PAT 40-64YRS,78001996,CDM,510,RC,99396,HCPCS,Outpatient,,,280,210,,257.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,145.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,260.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,252,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,252,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,271.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,280,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,145.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,271.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,210,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,268.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,145.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,145.6,280,
CULTURE GC SCREEN,70200883,CDM,300,RC,87081,HCPCS,Outpatient,,,140,105,,128.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,140,
GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS 2 HRS,70200319,CDM,300,RC,82951,HCPCS,Outpatient,,,141,105.75,,129.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,73.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,131.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,136.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,73.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,136.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,73.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.32,141,
GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS 3 HRS,70200320,CDM,300,RC,82951,HCPCS,Outpatient,,,175,131.25,,161,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,162.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,157.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,175,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,169.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,131.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,168,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,131.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,131.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91,175,
HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES,70200961,CDM,300,RC,87624,HCPCS,Outpatient,,,201,150.75,,184.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,104.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,180.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,194.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,104.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,150.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,104.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.52,201,
JAK2 EXONS 12-15,70201128,CDM,300,RC,81279,HCPCS,Outpatient,,,556,417,,511.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,289.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,517.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,500.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,500.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,539.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,556,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,289.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,539.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,417,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,533.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,289.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,417,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,417,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,289.12,556,
MANUAL DIFF,70200567,CDM,300,RC,85007,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
RBC W/DIFF WBC COUNT,70200568,CDM,300,RC,85007,HCPCS,Outpatient,,,32,24,,29.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,28.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,28.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,31.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.64,32,
25 HYDROXY INCLUDES FRACTIONS IF PERFORMED,70200210,CDM,300,RC,82306,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104,200,
HYDROXYINDOLACETIC ACID 5-HIAA,70200350,CDM,300,RC,83497,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.08,104,
ADRENOCORTICOTROPIC (ACTH) PLASMA ASSAY,70200162,CDM,300,RC,82024,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
BHCG LEVEL,70200558,CDM,300,RC,84702,HCPCS,Outpatient,,,46,34.5,,42.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.92,46,
ALPHA-FETOPROTEIN QUAD SCREENING,70200178,CDM,300,RC,82105,HCPCS,Outpatient,,,189,141.75,,173.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,175.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.28,189,
ESTRIOL ASSAY,70200281,CDM,300,RC,82677,HCPCS,Outpatient,,,73,54.75,,67.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,37.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,65.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,65.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,37.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,70.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,54.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,37.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.96,73,
INHIBIN A,70200719,CDM,300,RC,86336,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.56,103,
ALPHA-FETOPROTEIN SERUM TUMOR MARKER,70200179,CDM,300,RC,82105,HCPCS,Outpatient,,,189,141.75,,173.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,175.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.28,189,
ACETAMINOPHEN,70201093,CDM,300,RC,80143,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.2,135,
ACID FAST CULTURE AND STAIN,70200893,CDM,300,RC,87116,HCPCS,Outpatient,,,174,130.5,,160.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,161.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,168.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,174,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,168.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,167.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90.48,174,
ACID FAST STAIN,70200904,CDM,300,RC,87206,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
ACTIN (SMOOTH MUSCLE) ANTIBODY,70201120,CDM,300,RC,86015,HCPCS,Outpatient,,,60,45,,55.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.2,60,
ACUTE HEPATITIS PANEL,70200010,CDM,300,RC,80074,HCPCS,Outpatient,,,402,301.5,,369.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,209.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,373.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,361.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,361.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,389.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,402,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,209.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,389.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,301.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,385.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,209.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,301.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,301.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,209.04,402,
AEROBIC IDENTIFICATION SEND OUT,70200882,CDM,300,RC,87077,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,35,
SGPT TRANSFERASE ALANINE AMINO ALT,70200523,CDM,300,RC,84460,HCPCS,Outpatient,,,61,45.75,,56.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.72,61,
ALBUMIN SERUM PLASMA/WHOLE BLOOD,70200164,CDM,300,RC,82040,HCPCS,Outpatient,,,50,37.5,,46,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,46.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,48.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26,50,
ALBUMIN MICROALBUMIN QUANTIATIVE,70200168,CDM,300,RC,82043,HCPCS,Outpatient,,,110,82.5,,101.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,99,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,110,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,82.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.2,110,
ALCOHOL DRUG SCREEN QUANTITATIVE,70200076,CDM,300,RC,80320,HCPCS,Outpatient,,,132,99,,121.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,132,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.64,132,
ALDOLASE SERUM ASSAY,70200171,CDM,300,RC,82085,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,74.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.04,77,
ALDOSTERONE SERUM ASSAY,70200172,CDM,300,RC,82088,HCPCS,Outpatient,,,267,200.25,,245.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,240.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,267,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,256.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,138.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,200.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.84,267,
PHOSPHATASE BONE SPECIFIC ALKALINE ISOENZYMES,70200456,CDM,300,RC,84080,HCPCS,Outpatient,,,57,42.75,,52.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.64,57,
PHOSPHATASE ALKALINE ASSAY,70200454,CDM,300,RC,84075,HCPCS,Outpatient,,,55,41.25,,50.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.6,55,
PHOSPHATASE ALKALINE ISOENZYMES,70200455,CDM,300,RC,84080,HCPCS,Outpatient,,,57,42.75,,52.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.64,57,
ALLERGEN SPECIFIC IGE,70200620,CDM,300,RC,86003,HCPCS,Outpatient,,,24,18,,22.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,23.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12.48,24,
SHELLFISH ALLERGEN,70200665,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
ALPHA-1-ANTITRYPSIN TOTAL,70200174,CDM,300,RC,82103,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
PROTEIN URINE TOTAL,70200480,CDM,300,RC,84156,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,120,
PROTEIN URINE TOTAL,70200480,CDM,300,RC,84156,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,120,
AMMONIA ASSAY,70200185,CDM,300,RC,82140,HCPCS,Outpatient,,,123,92.25,,113.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,63.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,110.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,119.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,123,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,63.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,92.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,118.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,63.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,92.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.96,123,
HC AMNISURE RAPID TEST,70200460,CDM,300,RC,84112,HCPCS,Outpatient,,,297,222.75,,273.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,154.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,276.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,267.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,267.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,288.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,297,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,154.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,288.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,222.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,285.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,154.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,222.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.44,297,
AMYLASE ASSAY,70200187,CDM,300,RC,82150,HCPCS,Outpatient,,,165,123.75,,151.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,153.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,148.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,148.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,165,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,158.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.8,165,
ANDROSTENEDIONE,70200189,CDM,300,RC,82157,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.76,88,
ANTI CENTROMERE ANTIBODY,70200693,CDM,300,RC,86235,HCPCS,Outpatient,,,131,98.25,,120.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.12,131,
ANTI-MULLERIAN HORMONE (AMH),70201114,CDM,300,RC,82397,HCPCS,Outpatient,,,105,78.75,,96.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,94.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,94.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,105,
DNA ANTIBODY NATIVE/DOUBLE STRANDED,70200690,CDM,300,RC,86225,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.84,42,
CARDIOLIPIN ANTIBODY EACH IG CLASS,70200675,CDM,300,RC,86147,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.08,104,
CARDIOLIPIN ANTIBODY IGM,70200677,CDM,300,RC,86147,HCPCS,Outpatient,,,98,73.5,,90.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,91.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.96,98,
ANTIGLIADIN ABS IGG,70200361,CDM,300,RC,83516,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.28,114,
ANTIGLOMERULAR BM AB,70200357,CDM,300,RC,83516,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.28,114,
ANTINEUTROPHIL CYTOPLASMIC AB,70201122,CDM,300,RC,86037,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.6,30,
ANTINUCLEAR ANTIBODIES ANA,70200668,CDM,300,RC,86038,HCPCS,Outpatient,,,150,112.5,,138,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,150,
ISLET CELL ANTIBODY,70200723,CDM,300,RC,86341,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,70.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.52,76,
ANTIPHOSPHOLIPID SYNDROME,70201129,CDM,300,RC,85370,HCPCS,Outpatient,,,14,10.5,,12.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,7.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,13.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,7.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,10.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,7.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7.28,14,
SCLERODERMA 70 ANTIBODY,70200696,CDM,300,RC,86235,HCPCS,Outpatient,,,98,73.5,,90.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,91.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.96,98,
ASO TITER,70200671,CDM,300,RC,86060,HCPCS,Outpatient,,,180,135,,165.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,180,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.6,180,
CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY,70200590,CDM,300,RC,85300,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
APOLIPOPROTEIN A,70200191,CDM,300,RC,82172,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.28,114,
BLOOD GASES (ABG),70200309,CDM,300,RC,82803,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,178,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.56,178,
SGOT TRANSFERASE ASPARTATE AMINO AST,70200522,CDM,300,RC,84450,HCPCS,Outpatient,,,61,45.75,,56.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.72,61,
FLOW CYTOMETRY INTERPtRETATION 2-8 MARKERS,70201020,CDM,300,RC,88187,HCPCS,Outpatient,,,139,104.25,,127.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.28,139,
B TYPE NATRIURETIC PEPTIDE,70200428,CDM,300,RC,83880,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,150.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.6,155,
B PERTUSSIS B PARAPERTUSSIS PCR,70200969,CDM,300,RC,87798,HCPCS,Outpatient,,,375,281.25,,345,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,348.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,337.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,337.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,363.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,375,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,363.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,360,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,195,375,
CELL COUNT WBC BODY FLUIDS,70201069,CDM,300,RC,89051,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
BK VIRUS URINE QUANTITATIVE BY PCR,70201130,CDM,300,RC,87799,HCPCS,Outpatient,,,431,323.25,,396.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,400.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,387.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,387.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,418.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,431,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,418.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,413.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.12,431,
BK VIRUS PLASMA/SERUM QUANTITATIVE BY PCR,70200978,CDM,300,RC,87799,HCPCS,Outpatient,,,431,323.25,,396.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,400.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,387.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,387.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,418.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,431,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,418.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,413.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.12,431,
BASIC METABOLIC PANEL CALCIUM TOTAL,70200002,CDM,300,RC,80048,HCPCS,Outpatient,,,89,66.75,,81.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.28,89,
BHCG QUANTITATIVE,70200561,CDM,300,RC,84702,HCPCS,Outpatient,,,46,34.5,,42.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.92,46,
BETA 2 GLYCOPROTEIN I ANTIBODY,70200674,CDM,300,RC,86146,HCPCS,Outpatient,,,92,69,,84.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,47.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,82.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,82.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,89.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,47.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,89.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,69,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,47.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.84,92,
BETA 2 GLYCOPROTEIN I ANTIBODY,70200674,CDM,300,RC,86146,HCPCS,Outpatient,,,92,69,,84.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,47.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,82.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,82.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,89.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,47.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,89.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,69,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,47.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.84,92,
BETA-2 MICROGLOBULIN,70200196,CDM,300,RC,82232,HCPCS,Outpatient,,,203,152.25,,186.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,188.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,203,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.56,203,
ACETONE SERUM QUANTITATIVE,70200158,CDM,300,RC,82010,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
CHROMOTOGRA QUANTITATIVE,70200251,CDM,300,RC,82542,HCPCS,Outpatient,,,259,194.25,,238.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,233.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,233.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,251.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,259,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,248.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.68,259,
BILIRUBIN DIRECT,70200200,CDM,300,RC,82248,HCPCS,Outpatient,,,32,24,,29.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,28.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,28.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,31.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.64,32,
BILIRUBIN TOTAL,70200198,CDM,300,RC,82247,HCPCS,Outpatient,,,23,17.25,,21.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.96,23,
SENSITIVITY,70200900,CDM,300,RC,87186,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104,200,
BLOOD GASES (ABG),70200309,CDM,300,RC,82803,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,178,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.56,178,
ARTERIAL CORD GAS,70200310,CDM,300,RC,82803,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,178,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.56,178,
LACTATE ACID ASSAY,70200401,CDM,300,RC,83605,HCPCS,Outpatient,,,38,28.5,,34.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.76,38,
LACTATE ACID ASSAY,70200401,CDM,300,RC,83605,HCPCS,Outpatient,,,38,28.5,,34.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.76,38,
VENOUS BLOOD GAS,78001353,CDM,300,RC,82803,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,178,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.56,178,
UREA NITROGEN QUANTITATIVE ISTAT (BUN),70200532,CDM,300,RC,84520,HCPCS,Outpatient,,,34,25.5,,31.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,32.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.68,34,
BLOOD UREA NITROGEN,70200533,CDM,300,RC,84520,HCPCS,Outpatient,,,98,73.5,,90.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,91.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.96,98,
CELL COUNT RBC BODY FLUIDS,70201067,CDM,300,RC,89050,HCPCS,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.56,78,
BREATH ALCOHOL TEST,70200170,CDM,300,RC,82075,HCPCS,Outpatient,,,53,39.75,,48.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.56,53,
CLOSTRIDIUM DIFFICILE TOXIN B GENE SCREEN,70200940,CDM,300,RC,87493,HCPCS,Outpatient,,,207,155.25,,190.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,192.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,186.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,186.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,200.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,207,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,200.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,155.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,198.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,155.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.64,207,
C-PEPTIDE ASSAY,70200557,CDM,300,RC,84681,HCPCS,Outpatient,,,188,141,,172.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.76,188,
C-REACTIVE PROTEIN,70200672,CDM,300,RC,86140,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
C-REACTIVE PROTEIN HIGH SENSITIVITY,70200673,CDM,300,RC,86141,HCPCS,Outpatient,,,89,66.75,,81.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.28,89,
C-REACTIVE PROTEIN,70200672,CDM,300,RC,86140,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
CA 19 9 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE,70200706,CDM,300,RC,86301,HCPCS,Outpatient,,,129,96.75,,118.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,116.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,125.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,129,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.08,129,
CA 27-29 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE,70200704,CDM,300,RC,86300,HCPCS,Outpatient,,,215,161.25,,197.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,111.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,193.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,193.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,208.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,215,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,111.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,208.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,161.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,206.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,111.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,161.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,161.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.8,215,
CBC WITH MANUAL DIFF,70200573,CDM,300,RC,85025,HCPCS,Outpatient,,,61,45.75,,56.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.72,61,
CBC BLOOD COUNT COMPLETE AUTOMATED,70200575,CDM,300,RC,85027,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
CBC BLOOD COUNT COMPLETE AUTOMATED,70200575,CDM,300,RC,85027,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
CYCLIC CITRULLINATED PEPTIDE ANTIBODY,70200687,CDM,300,RC,86200,HCPCS,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.6,80,
T CELLS ABSOLUTE CD4  CD8 COUNT RATIO,70200734,CDM,300,RC,86360,HCPCS,Outpatient,,,198,148.5,,182.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,184.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,178.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,178.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,192.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,192.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,190.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.96,198,
CARCINOEMBRYONIC ANTIGEN CEA,70200222,CDM,300,RC,82378,HCPCS,Outpatient,,,154,115.5,,141.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,143.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.08,154,
CREATINE KINASE CK TOTAL,70200259,CDM,300,RC,82550,HCPCS,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.56,78,
CREATINE KINASE MB FRACTION ONLY,70200262,CDM,300,RC,82553,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.76,113,
COMPREHENSIVE METABOLIC PANEL,70200005,CDM,300,RC,80053,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,195.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,189,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,189,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,203.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,210,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,203.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.2,210,
CYTOMEGALOVIRUS QUANTIFICATION HYBRID CAPT,70200942,CDM,300,RC,87497,HCPCS,Outpatient,,,396,297,,364.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,368.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,356.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,356.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,384.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,396,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,384.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,380.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,205.92,396,
COLLECTION VENOUS BLOOD VENIPUNCTURE,78001297,CDM,300,RC,36415,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.6,30,
CELL COUNT CSF,70201070,CDM,300,RC,89051,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
VITAMIN D1 25 DIHYDROXY,70200276,CDM,300,RC,82652,HCPCS,Outpatient,,,301,225.75,,276.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,301,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.52,301,
CALCIUM IONIZED,70200215,CDM,300,RC,82330,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,166.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,166.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,179.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,185,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,179.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.2,185,
CALCIUM URINE QUANTITATIVE,70200216,CDM,300,RC,82340,HCPCS,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,149,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.48,149,
CALCULUS INFRARED SPECTROSCOPY,70201095,CDM,300,RC,82365,HCPCS,Outpatient,,,153,114.75,,140.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,142.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,148.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,153,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.56,153,
CALPROTECTIN FECAL ASSAY,70200448,CDM,300,RC,83993,HCPCS,Outpatient,,,269,201.75,,247.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,250.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,242.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,242.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,269,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,260.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,258.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.88,269,
CA 125 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE,70200707,CDM,300,RC,86304,HCPCS,Outpatient,,,129,96.75,,118.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,116.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,125.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,129,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.08,129,
CANDIDA ANTIBODY,70200768,CDM,300,RC,86628,HCPCS,Outpatient,,,71,53.25,,65.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.92,71,
CARBAMAZEPINE (TEGRETOL) DRUG ASSAY TOTAL,70200013,CDM,300,RC,80156,HCPCS,Outpatient,,,132,99,,121.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,132,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.64,132,
CARBOXYHEMOGLOBIN BLOOD QUANTITATIVE,70200221,CDM,300,RC,82375,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65,125,
CELIAC REFLEX PANEL,70200296,CDM,300,RC,82784,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
CERULOPLASMIN,70200227,CDM,300,RC,82390,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
CHLAMYDIA TRACHOMATIS CULTURE,70200916,CDM,300,RC,87491,HCPCS,Outpatient,,,189,141.75,,173.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,175.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.28,189,
CHLAMYDIA TRACHOMATIS DIRECT,70200936,CDM,300,RC,87491,HCPCS,Outpatient,,,189,141.75,,173.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,175.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.28,189,
CHLORIDE OTHER SOURCE,70200231,CDM,300,RC,82438,HCPCS,Outpatient,,,51,38.25,,46.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.52,51,
CHLORIDE URINE,70200230,CDM,300,RC,82436,HCPCS,Outpatient,,,99,74.25,,91.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,51.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,92.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,96.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,51.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,74.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,51.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.48,99,
CHOLESTEROL SERUM WHOLE BLOOD TOTAL,70200232,CDM,300,RC,82465,HCPCS,Outpatient,,,46,34.5,,42.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.92,46,
CHROMIUM SERUM ASSAY,70200236,CDM,300,RC,82495,HCPCS,Outpatient,,,61,45.75,,56.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.72,61,
CLOSTRIDIUM DIFFICILE,70200920,CDM,300,RC,87324,HCPCS,Outpatient,,,122,91.5,,112.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,118.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,122,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,118.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,117.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.44,122,
HC SPECIMAN HANDLING FEE,70201078,CDM,300,RC,99001,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.84,42,
COMPLEMENT ANTIGEN C3,70200681,CDM,300,RC,86160,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.16,233,
COMPLEMENT ANTIGEN C4 SERUM,70200682,CDM,300,RC,86160,HCPCS,Outpatient,,,183,137.25,,168.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,170.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,177.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,183,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,175.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.16,183,
COMPLEMENT TOTAL HEMOLYTIC,70200686,CDM,300,RC,86162,HCPCS,Outpatient,,,150,112.5,,138,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,150,
COPPER SERUM,70200244,CDM,300,RC,82525,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.76,113,
CORTISOL SERUM TOTAL,70200247,CDM,300,RC,82533,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
CORTISOL FREE SERUM,70200245,CDM,300,RC,82530,HCPCS,Outpatient,,,55,41.25,,50.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.6,55,
CORTISOL FREE URINE,70200246,CDM,300,RC,82530,HCPCS,Outpatient,,,55,41.25,,50.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.6,55,
CREATINE URINE 24-HOUR,70200249,CDM,300,RC,82540,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65,125,
CREATININE BLOOD,70200264,CDM,300,RC,82565,HCPCS,Outpatient,,,46,34.5,,42.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,9.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,46,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9.62,46,
CREATININE BLOOD,70200264,CDM,300,RC,82565,HCPCS,Outpatient,,,46,34.5,,42.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,9.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,46,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9.62,46,
CREATININE CLEARANCE,70200269,CDM,300,RC,82575,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.36,143,
CREATININE URINE,70200267,CDM,300,RC,82570,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.76,113,
CREATININE URINE 24 HOUR,70200266,CDM,300,RC,82570,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.76,113,
CREATININE RANDOM URINE,70200268,CDM,300,RC,82570,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.76,113,
CRYPTOSPORIDIUM AG EIA,70200921,CDM,300,RC,87328,HCPCS,Outpatient,,,93,69.75,,85.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,48.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,86.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,83.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,83.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,90.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,93,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,48.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,69.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,48.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.36,93,
CRYSTAL ID LIGHT MICROSCOPY ANALYSIS,70201072,CDM,300,RC,89060,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
CYSTIC FIBROSIS 32 MUTATIONS,70200132,CDM,310,RC,81220,HCPCS,Outpatient,,,1670,1252.5,,1536.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,868.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1553.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1503,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1503,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1619.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1670,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,868.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1619.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1252.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1603.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,868.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1252.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1252.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,868.4,1670,
CYTOMEGALOVIRUS CMV IGM ANTIBODY,70200776,CDM,300,RC,86645,HCPCS,Outpatient,,,167,125.25,,153.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,86.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,155.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,150.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,150.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,161.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,167,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,86.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,161.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,125.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,160.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,86.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.84,167,
D-DIMER QUANTITATIVE,70200602,CDM,300,RC,85379,HCPCS,Outpatient,,,218,163.5,,200.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,113.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,202.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,196.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,196.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,211.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,218,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,113.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,211.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,163.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,209.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,113.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,163.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,163.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.36,218,
PTERONYSSIN ALLERGEN,70200638,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
PTERONYSSIN ALLERGEN,70200638,CDM,300,RC,86003,HCPCS,Outpatient,,,19,14.25,,17.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,9.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,9.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,14.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,9.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,14.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9.88,19,
FARINAE ALLERGEN,70200637,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
DEHYDROEPIANDROSTERONE (DHEA) SERUM,70200274,CDM,300,RC,82626,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,70.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.52,76,
DEHYDROEPIANDROSTERONE SULFATE (DHEAS),70200275,CDM,300,RC,82627,HCPCS,Outpatient,,,222,166.5,,204.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,115.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,206.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,199.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,215.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,115.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,166.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,115.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,166.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.44,222,
DRUG SCREEN COLLECTION EMPLOYEE,70201136,CDM,300,RC,,,Outpatient,,,0.01,0.01,,0.01,92,,,percent of total billed charges,92% of total billed charges,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,93,,,percent of total billed charges,93% of total billed charges,0.01,90,,,percent of total billed charges,90% of total billed charges,0.01,90,,,percent of total billed charges,90% of total billed charges,0.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,97,,,percent of total billed charges,97% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,96,,,percent of total billed charges,96% of total billed charges,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,0.01,
AMINOLEVULINIC ACID,70200183,CDM,300,RC,82135,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,
DIGOXIN DRUG SCREEN QUANTITATIVE TOTAL,70200016,CDM,300,RC,80162,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.76,88,
DRUG SCREEN COLLECTION ONLY NON- DOT,70201145,CDM,300,RC,,,Outpatient,,,57,42.75,,52.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.64,57,
Drug Screen - Collection Non-DOT,70201145,CDM,300,RC,,,Outpatient,,,57,42.75,,52.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.64,57,
URINE DRUG SCREEN,70200068,CDM,300,RC,80307,HCPCS,Outpatient,,,131,98.25,,120.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.12,131,
DOT Drug Screen Collection,70200050,CDM,300,RC,,,Outpatient,,,57,42.75,,52.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.64,57,
E COLI SHIGA-LIKE TOXIN BY EIA,70200931,CDM,300,RC,87427,HCPCS,Outpatient,,,46,34.5,,42.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.92,46,
CAT DANDER ALLERGEN,70200626,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
DOG DANDER ALLERGEN,70200627,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
MOUSE URINE ALLERGEN,70201137,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
EPSTEIN-BARR EB VIRUS VIRAL CAPSID (VCA) IGG,70200783,CDM,300,RC,86665,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,99.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,178.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,186.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,99.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,144,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,99.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,192,
EPSTEIN-BARR EB VIRUS VIRAL CAPSID (VCA) IGM,70200782,CDM,300,RC,86665,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,99.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,178.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,186.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,99.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,144,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,99.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,192,
EPSTEIN-BARR EB VIRUS NUCLEAR AG IG,70200781,CDM,300,RC,86664,HCPCS,Outpatient,,,183,137.25,,168.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,170.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,177.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,183,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,175.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.16,183,
SEDIMENTATION RATE ERYTHROCYTE,70200612,CDM,300,RC,85651,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,
ENDOMYSIAL ANTIBODY IgA,70201126,CDM,300,RC,86231,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.6,30,
ENTEROVIRUS TRANSCRIPTION,70200943,CDM,300,RC,87498,HCPCS,Outpatient,,,303,227.25,,278.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,272.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,272.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,293.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,303,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,293.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,290.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,157.56,303,
NASAL SMEAR FOR EOSINOPHILS,70201090,CDM,300,RC,89190,HCPCS,Outpatient,,,22,16.5,,20.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,19.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,16.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,11.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.44,22,
EPSTEIN-BARR VIRUS BY PCR,70200974,CDM,300,RC,87798,HCPCS,Outpatient,,,375,281.25,,345,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,348.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,337.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,337.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,363.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,375,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,363.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,360,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,195,375,
ERYTHROPOIETIN ASSAY,70200278,CDM,300,RC,82668,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65,125,
ESTRADIOL SERUM ASSAY,70200279,CDM,300,RC,82670,HCPCS,Outpatient,,,317,237.75,,291.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,164.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,294.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,285.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,285.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,307.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,317,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,164.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,307.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,237.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,304.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,164.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,237.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.84,317,
ESTRADIOL SERUM ASSAY,70200279,CDM,300,RC,82670,HCPCS,Outpatient,,,317,237.75,,291.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,164.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,294.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,285.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,285.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,307.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,317,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,164.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,307.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,237.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,304.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,164.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,237.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.84,317,
ESTRONE ASSAY,70200283,CDM,300,RC,82679,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,
ESTRONE ASSAY,70200283,CDM,300,RC,82679,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,
GLUTEN FOOD ALLERGEN,70200634,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH),70200327,CDM,300,RC,83001,HCPCS,Outpatient,,,172,129,,158.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,89.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,159.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,154.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,154.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,166.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,172,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,89.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,166.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,165.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,89.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.44,172,
F2 CPNNTHNUWBIN COAGULATION FACTOR II,70200137,CDM,300,RC,81240,HCPCS,Outpatient,,,296,222,,272.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,275.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,266.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,266.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,287.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,287.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,284.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.92,296,
FACTOR V LEIDEN PCR,70200138,CDM,310,RC,81241,HCPCS,Outpatient,,,242,181.5,,222.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,217.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,217.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,234.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,242,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,232.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.84,242,
FACTOR VIII ACTIVITY,70200581,CDM,300,RC,85240,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.16,233,
FACTOR X STUART-PROWER,70200586,CDM,300,RC,85260,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,70.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.52,76,
FATTY ACIDS NONESTERIFIED,70200288,CDM,300,RC,82725,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,193.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,187.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,187.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,201.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,208,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,199.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.16,208,
FAT STOOL QUALITATIVE,70200285,CDM,300,RC,82705,HCPCS,Outpatient,,,136,102,,125.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,70.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,122.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,131.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,136,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,70.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,131.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,102,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,70.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.72,136,
FAT STOOL QUANTITATIVE,70200287,CDM,300,RC,82710,HCPCS,Outpatient,,,160,120,,147.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,144,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,160,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,155.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.2,160,
HEMOSURE IFOB,70200205,CDM,300,RC,82274,HCPCS,Outpatient,,,57,42.75,,52.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.64,57,
HEMOSURE IFOB,70200205,CDM,300,RC,82274,HCPCS,Outpatient,,,57,42.75,,52.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.64,57,
LEUKOCYTE FECAL ASSESSMENT,70201071,CDM,300,RC,89055,HCPCS,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.56,78,
FERRITIN (BLOOD PROTEIN) LEVEL,70200289,CDM,300,RC,82728,HCPCS,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.84,142,
FERRITIN ASSAY,70200289,CDM,300,RC,82728,HCPCS,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.84,142,
FETAL FIBRONECTIN,70200290,CDM,300,RC,82731,HCPCS,Outpatient,,,1071,803.25,,985.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,556.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,996.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,963.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,963.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1038.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1071,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,556.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1038.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,803.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1028.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,556.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,803.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,803.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,556.92,1071,
FIBRINOGEN ACTIVITY,70200603,CDM,300,RC,85384,HCPCS,Outpatient,,,153,114.75,,140.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,142.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,148.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,153,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.56,153,
FOLIC ACID SERUM,70200291,CDM,300,RC,82746,HCPCS,Outpatient,,,130,97.5,,119.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,124.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.6,130,
FREE K+L LT CHAINS QN S,70201117,CDM,300,RC,83521,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,
FREE THYROXINE (T-4) SERUM ASSAY,70200517,CDM,300,RC,84439,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,151,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,146.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.52,151,
TESTOSTERONE FREE ASSAY,70200510,CDM,300,RC,84402,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104,200,
BERMUDA GRASS ALLERGEN IGE,70200621,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
TIMOTHY GRASS ALLERGEN,70200635,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
GI PANEL,70200945,CDM,300,RC,87507,HCPCS,Outpatient,,,874,655.5,,804.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,812.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,786.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,786.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,847.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,874,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,847.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,839.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,454.48,874,
PROTEIN SERUM ELECTROPHORETIC FRACT  QUANT,70200487,CDM,300,RC,84165,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.72,111,
GLUTAMYLTRASE GAMMA (GGTP),70200325,CDM,300,RC,82977,HCPCS,Outpatient,,,49,36.75,,45.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,44.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.48,49,
GENERAL HEALTH PANEL,70201144,CDM,300,RC,80050,HCPCS,Outpatient,,,335,251.25,,308.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,174.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,311.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,301.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,301.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,324.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,335,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,174.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,251.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,321.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,174.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,251.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.2,335,
GENTAMICIN DRUG SCREEN QUANTITATIVE,70200019,CDM,300,RC,80170,HCPCS,Outpatient,,,170,127.5,,156.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,88.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,153,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,153,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,164.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,170,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,88.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,164.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,127.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,163.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,88.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,127.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.4,170,
GENTAMICIN DRUG SCREEN QUANTITATIVE,70200019,CDM,300,RC,80170,HCPCS,Outpatient,,,170,127.5,,156.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,88.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,153,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,153,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,164.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,170,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,88.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,164.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,127.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,163.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,88.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,127.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.4,170,
GIARDIA ANTIGEN STOOL,70200922,CDM,300,RC,87329,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.76,88,
GLUCAGON,70200313,CDM,300,RC,82943,HCPCS,Outpatient,,,130,97.5,,119.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,124.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.6,130,
GLUCOSE QUANTITATIVE BLOOD ISTAT,70200315,CDM,300,RC,82947,HCPCS,Outpatient,,,34,25.5,,31.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,32.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.68,34,
GLUCOSE BODY FLUID OTHER THAN BLOOD,70200314,CDM,300,RC,82945,HCPCS,Outpatient,,,55,41.25,,50.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.6,55,
GLUCOSE QUANTITATIVE BLOOD EXCEPT REAGENT STRIP,70200316,CDM,300,RC,82947,HCPCS,Outpatient,,,26,19.5,,23.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13.52,26,
GLUCOSE POST GLUCOSE DOSE,70200318,CDM,300,RC,82950,HCPCS,Outpatient,,,59,44.25,,54.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,53.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,53.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.68,59,
GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS 3 HRS,70200320,CDM,300,RC,82951,HCPCS,Outpatient,,,169,126.75,,155.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,87.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,152.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,152.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,163.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,169,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,87.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,163.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,126.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,162.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,87.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.88,169,
H-PYLORI,70200788,CDM,300,RC,86677,HCPCS,Outpatient,,,180,135,,165.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,180,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.6,180,
HELICOBACTOR ANGIGEN HELAST STOOL,70200925,CDM,300,RC,87338,HCPCS,Outpatient,,,203,152.25,,186.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,188.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,203,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.56,203,
HEPATITIS B SURFACTANT AGENT,70200926,CDM,300,RC,87340,HCPCS,Outpatient,,,98,73.5,,90.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,91.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.96,98,
BHCG LEVEL,70200558,CDM,300,RC,84702,HCPCS,Outpatient,,,46,34.5,,42.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.92,46,
HCV GENOTYPING,70200993,CDM,300,RC,87902,HCPCS,Outpatient,,,773,579.75,,711.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,401.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,718.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,695.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,695.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,749.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,773,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,401.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,749.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,579.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,742.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,401.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,579.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,579.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,401.96,773,
HEPATITIS C QUANTITATIVE ASSAY,70200949,CDM,300,RC,87522,HCPCS,Outpatient,,,387,290.25,,356.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,359.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,348.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,348.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,375.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,387,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,375.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,371.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.24,387,
HEPATITIS C QUANTITATIVE ASSAY,70200949,CDM,300,RC,87522,HCPCS,Outpatient,,,387,290.25,,356.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,359.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,348.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,348.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,375.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,387,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,375.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,371.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.24,387,
HEPATITIS C QUANTITATIVE ASSAY,70200949,CDM,300,RC,87522,HCPCS,Outpatient,,,387,290.25,,356.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,359.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,348.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,348.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,375.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,387,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,375.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,371.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.24,387,
LIPOPROTEIN CHOLESTEROL (HDL),70200414,CDM,300,RC,83718,HCPCS,Outpatient,,,53,39.75,,48.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.56,53,
HIV-1 AND HIV-2 ANTIBODY SINGLE RESULT,70200804,CDM,300,RC,86703,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.76,113,
HIV-1 RNA QUANTITATIVE BY PCR,70200953,CDM,300,RC,87536,HCPCS,Outpatient,,,724,543,,666.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,376.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,673.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,651.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,651.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,702.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,724,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,376.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,702.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,543,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,695.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,376.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,543,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,543,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,376.48,724,
HIV-1 AND HIV-2 ANTIBODY SINGLE RESULT,70200804,CDM,300,RC,86703,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.76,113,
HIV-2 ANTIBODY,70200803,CDM,300,RC,86702,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,78.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,78.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,84.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.24,87,
HLA B 27 DISEASE ASSOCIATION,70201125,CDM,300,RC,81374,HCPCS,Outpatient,,,281,210.75,,258.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,252.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,252.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,272.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,281,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.12,281,
HSV 1 GLYCOPROTEIN ANTIBODY IGG,70200796,CDM,300,RC,86695,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.64,82,
HSV 1 GLYCOPROTEIN ANTIBODY IGG,70200796,CDM,300,RC,86695,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.64,82,
HERPES SIMPLEX VIRUS BY PCR,70200950,CDM,300,RC,87529,HCPCS,Outpatient,,,203,152.25,,186.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,188.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,203,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.56,203,
HERPES SIMPLEX TYPE 2 ANTIBODY,70200798,CDM,300,RC,86696,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.08,104,
HERPES SIMPLEX TYPE 2,70200799,CDM,300,RC,86696,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.08,104,
HERPES SIMPLEX VIRUS CULTURE,70200914,CDM,300,RC,87255,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
HERPES SIMPLEX VIRUS BY PCR,70200950,CDM,300,RC,87529,HCPCS,Outpatient,,,203,152.25,,186.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,188.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,203,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.56,203,
HERPESE 1  2 IGG IGM,70200793,CDM,300,RC,86694,HCPCS,Outpatient,,,119,89.25,,109.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,107.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,107.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,115.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,119,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,89.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,114.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,61.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,89.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.88,119,
HERPES SIMPLEX TYPE 2 ANTIBODY,70200798,CDM,300,RC,86696,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.08,104,
ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED,70200839,CDM,300,RC,86790,HCPCS,Outpatient,,,74,55.5,,68.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.48,74,
HAPTOGLOBIN QUANTITATIVE,70200331,CDM,300,RC,83010,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,70.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.52,76,
Health Fair A1C,70200341,CDM,300,RC,83036,HCPCS,Outpatient,,,10.83,8.12,,9.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,9.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.83,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5.63,10.83,
Health Fair CBC ,70200575,CDM,300,RC,85027,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
Health Fair CMP,70200005,CDM,300,RC,80053,HCPCS,Outpatient,,,10.84,8.13,,9.97,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,9.76,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9.76,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.84,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,8.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.41,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5.64,10.84,
Health Fair Estradiol,70200279,CDM,300,RC,82670,HCPCS,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.8,40,
Health Fair FSH,70200327,CDM,300,RC,83001,HCPCS,Outpatient,,,172,129,,158.24,92,,,percent of total billed charges,92% of total billed charges,89.44,52,,,percent of total billed charges,52% of total billed charges,159.96,93,,,percent of total billed charges,93% of total billed charges,154.8,90,,,percent of total billed charges,90% of total billed charges,154.8,90,,,percent of total billed charges,90% of total billed charges,166.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,89.44,52,,,percent of total billed charges,52% of total billed charges,166.84,97,,,percent of total billed charges,97% of total billed charges,129,75,,,percent of total billed charges,75% of total billed charges,165.12,96,,,percent of total billed charges,96% of total billed charges,89.44,52,,,percent of total billed charges,52% of total billed charges,129,75,,,percent of total billed charges,75% of total billed charges,129,75,,,percent of total billed charges,75% of total billed charges,89.44,166.84,
Health Fair Lipid Panel,70200007,CDM,300,RC,80061,HCPCS,Outpatient,,,10.83,8.12,,9.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,9.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.83,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5.63,10.83,
Health Fair PSA,70200474,CDM,300,RC,84153,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
Health Fair T3 ,70200527,CDM,300,RC,84481,HCPCS,Outpatient,,,159,119.25,,146.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,159,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.68,159,
Health Fair T4  ,70200517,CDM,300,RC,84439,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
Health Fair TPO,70200736,CDM,300,RC,86376,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.72,111,
Health Fair TSH,70200519,CDM,300,RC,84443,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
Health Fair Testosterone ,70200512,CDM,300,RC,84403,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
Health Fair Vitamin B12,70200272,CDM,300,RC,82607,HCPCS,Outpatient,,,281,210.75,,258.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,252.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,252.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,272.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,281,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.12,281,
Health Fair Vitamin D,70200276,CDM,300,RC,82652,HCPCS,Outpatient,,,27.5,20.63,,25.3,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,14.3,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,26.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,14.3,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,20.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,14.3,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14.3,27.5,
HELPER T-LYMPH-CD4,70201134,CDM,300,RC,86361,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,99.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,178.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,186.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,99.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,144,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,99.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,192,
HEMOGLOBIN HGB,70200572,CDM,300,RC,85018,HCPCS,Outpatient,,,64,48,,58.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.28,64,
BLOOD OCCULT FECES,70200202,CDM,300,RC,82270,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
HEMATOCRIT,70200570,CDM,300,RC,85014,HCPCS,Outpatient,,,26,19.5,,23.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13.52,26,
GLYCOHEMOGLOBIN,70200341,CDM,300,RC,83036,HCPCS,Outpatient,,,47,35.25,,43.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.44,47,
HEPATITIS IGM ANTIBODY,70200811,CDM,300,RC,86709,HCPCS,Outpatient,,,105,78.75,,96.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,94.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,94.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,105,
HEPATITIS A (HAAB) AB IGG,70200809,CDM,300,RC,86708,HCPCS,Outpatient,,,132,99,,121.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,132,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.64,132,
HEPATITIS B CORE ANTIBODY HBCAB TOTAL,70200805,CDM,300,RC,86704,HCPCS,Outpatient,,,55,41.25,,50.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.6,55,
HEPATITIS BE ANTIBODY,70200808,CDM,300,RC,86707,HCPCS,Outpatient,,,59,44.25,,54.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,53.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,53.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.68,59,
HEPATITIS BE ANTIGEN,70200927,CDM,300,RC,87350,HCPCS,Outpatient,,,59,44.25,,54.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,53.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,53.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.68,59,
HEPATIC FUNCTION PANEL,70200011,CDM,300,RC,80076,HCPCS,Outpatient,,,92,69,,84.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,47.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,82.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,82.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,89.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,47.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,89.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,69,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,47.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.84,92,
HEPARIN ANTI-XA LOW ASSAY,70200606,CDM,300,RC,85520,HCPCS,Outpatient,,,150,112.5,,138,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,150,
HEPATITIS B SURF AB QUANT,70201113,CDM,300,RC,86317,HCPCS,Outpatient,,,37,27.75,,34.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.24,37,
HEPATITIS B SURFACTANT AGENT,70200926,CDM,300,RC,87340,HCPCS,Outpatient,,,98,73.5,,90.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,91.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.96,98,
HEPATITIS C ANTIBODY,70200847,CDM,300,RC,86803,HCPCS,Outpatient,,,97,72.75,,89.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,50.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,94.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,50.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,72.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,50.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.44,97,
GENE MUTATIONS,70200140,CDM,300,RC,81256,HCPCS,Outpatient,,,349,261.75,,321.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,349,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,335.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.48,349,
HEMOGLOBIN HGB,70200572,CDM,300,RC,85018,HCPCS,Outpatient,,,64,48,,58.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.28,64,
HEMOGLOBIN FRACTION/QUANT,70200337,CDM,300,RC,83020,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,151,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,146.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.52,151,
SICKLE CELL SCREEN,70200614,CDM,300,RC,85660,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.76,88,
HISTAMINE WHOLE BLOOD,70200345,CDM,300,RC,83088,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
HISTOPLASMA ANTIBODY,70200800,CDM,300,RC,86698,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.36,143,
HOMOCYSTEINE,70200346,CDM,300,RC,83090,HCPCS,Outpatient,,,295,221.25,,271.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,153.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,274.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,265.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,265.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,286.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,295,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,153.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,286.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,221.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,283.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,153.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,221.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,221.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.4,295,
GERMAN COCKROACH ALLERGEN,70200636,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
IMMUNOFIXJ ELECTROPHORESIS SERUM,70200717,CDM,300,RC,86334,HCPCS,Outpatient,,,209,156.75,,192.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,108.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,188.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,188.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,202.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,209,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,108.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,202.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,156.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,200.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,108.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,156.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.68,209,
INSULIN GROWTH FACTOR ASSAY,70200508,CDM,300,RC,84305,HCPCS,Outpatient,,,150,112.5,,138,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,150,
THYROTROPIN,70200378,CDM,300,RC,83520,HCPCS,Outpatient,,,237,177.75,,218.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,220.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,229.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,237,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.24,237,
IMMUNOGLOBULIN SUBCLASSES,70200306,CDM,300,RC,82787,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
IMMUNOFIXJ ELECTROPHORESIS SERUM,70200717,CDM,300,RC,86334,HCPCS,Outpatient,,,209,156.75,,192.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,108.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,188.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,188.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,202.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,209,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,108.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,202.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,156.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,200.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,108.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,156.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.68,209,
IMMUNOGLOBULIN A,70200301,CDM,300,RC,82784,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
IMMUNOGLOBULIN IGE,70200305,CDM,300,RC,82785,HCPCS,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.6,80,
IMMUNOGLOBULIN IGE,70200305,CDM,300,RC,82785,HCPCS,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.6,80,
IMMUNOGLOBULIN G,70200302,CDM,300,RC,82784,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
IMMUNOGLOBULIN M,70201142,CDM,300,RC,82784,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
GAMMAGLOBULIN IGA IGG,70200295,CDM,300,RC,82784,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.28,114,
INFLUENZA AB WITH DIRECT OPTICAL OBSERVATION,70200981,CDM,300,RC,87804,HCPCS,Outpatient,,,71,53.25,,65.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.92,71,
INFLUENZA 1ST 2 TYPES ID NOW,70200944,CDM,300,RC,87502,HCPCS,Outpatient,,,294,220.5,,270.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,152.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,273.42,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,264.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,264.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,285.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,294,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,152.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,285.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,220.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,282.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,152.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,220.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,220.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.88,294,
INHIBIN A,70200719,CDM,300,RC,86336,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.56,103,
INSULIN ANTIBODIES,70200721,CDM,300,RC,86337,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,162,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.24,162,
INSULIN TOTAL,70200394,CDM,300,RC,83525,HCPCS,Outpatient,,,188,141,,172.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.76,188,
IRON ASSAY,70200396,CDM,300,RC,83540,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.08,104,
IRON ASSAY,70200396,CDM,300,RC,83540,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.08,104,
JAK2 GENE ANALYSIS VAL617 MUTATION QUALITATIVE,70200143,CDM,300,RC,81270,HCPCS,Outpatient,,,463,347.25,,425.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,240.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,430.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,416.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,416.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,449.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,463,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,240.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,449.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,347.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,444.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,240.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,347.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,347.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240.76,463,
POTASSIUM HYDROXIDE KOH YEAST PREPS,70201091,CDM,300,RC,,,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,70.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.52,76,
KETONE BODY(S) QUALITATIVE,70201092,CDM,300,RC,82009,HCPCS,Outpatient,,,81,60.75,,74.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,78.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.12,81,
KETONE BODY(S) QUALITATIVE,70201092,CDM,300,RC,82009,HCPCS,Outpatient,,,81,60.75,,74.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,78.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.12,81,
L. PNEUMOPHILA SEROGP 1 UR AG,70201119,CDM,300,RC,87449,HCPCS,Outpatient,,,129,96.75,,118.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,116.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,125.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,129,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.08,129,
LACTATE DEHYDROGENASE LDH BODY FLUID,70200404,CDM,300,RC,83615,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,74.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.04,77,
LACOSAMIDE,70201127,CDM,300,RC,80235,HCPCS,Outpatient,,,188,141,,172.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.76,188,
LACTATE DEHYDROGENASE,70200402,CDM,300,RC,83615,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,74.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.04,77,
LACTATE ACID ASSAY,70200401,CDM,300,RC,83605,HCPCS,Outpatient,,,38,28.5,,34.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.76,38,
LAMOTRIGINE DRUG SCREEN QUANTITATIVE,70200022,CDM,300,RC,80175,HCPCS,Outpatient,,,147,110.25,,135.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,76.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,136.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,132.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,132.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,142.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,147,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,76.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,142.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,110.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,76.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,110.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.44,147,
LEAD BLOOD ASSAY,70200408,CDM,300,RC,83655,HCPCS,Outpatient,,,81,60.75,,74.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,78.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.12,81,
LEVETIRACETAM DRUG SCREEN QUANTITATIVE,70200024,CDM,300,RC,80177,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.2,135,
LIPASE LEVEL,70200412,CDM,300,RC,83690,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
LIPID PANEL,70200007,CDM,300,RC,80061,HCPCS,Outpatient,,,109,81.75,,100.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.68,109,
LIPOPROTEIN ASSAY,70200413,CDM,300,RC,83695,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.76,88,
LITHIUM DRUG SCREEN QUANTITATIVE,70200025,CDM,300,RC,80178,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.64,82,
PHOSPHATASE ALKALINE ASSAY,70200454,CDM,300,RC,84075,HCPCS,Outpatient,,,55,41.25,,50.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.6,55,
LUTEINIZING HORMONE,70200328,CDM,300,RC,83002,HCPCS,Outpatient,,,172,129,,158.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,89.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,159.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,154.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,154.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,166.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,172,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,89.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,166.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,165.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,89.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.44,172,
LYME DISEASE PANEL,70200766,CDM,300,RC,86618,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
ELECTROLYTE PANEL,70200004,CDM,300,RC,80051,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,37.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,64.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,69.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,37.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,37.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.44,72,
PENICILLIAN CHRYSOGEN ALLERGEN,70201138,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
CLADOSPORIUM HERBARUM ALLERGEN,70201139,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
ASPERGILLUS FUMIGATUS ALLERGEN,70201140,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
ALTERNARIA ALTERNATA ALLERGEN,70201141,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
MAGNESIUM,70200417,CDM,300,RC,83735,HCPCS,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.56,78,
MAGNESIUM URINE 24-HOUR,70200416,CDM,300,RC,83735,HCPCS,Outpatient,,,129,96.75,,118.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,116.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,125.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,129,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.08,129,
MITOCHONDRIAL (M2) ANTIBODY,70201121,CDM,300,RC,86381,HCPCS,Outpatient,,,64,48,,58.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.28,64,
HETEROPHILE ANTIBODIES SCREEN,70200709,CDM,300,RC,86308,HCPCS,Outpatient,,,140,105,,128.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,140,
HETEROPHILE ANTIBODIES SCREEN,70200709,CDM,300,RC,86308,HCPCS,Outpatient,,,140,105,,128.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,140,
MUMPS IGG,70200817,CDM,300,RC,86735,HCPCS,Outpatient,,,89,66.75,,81.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.28,89,
MYCOPLASMA ANTIBODY,70200818,CDM,300,RC,86738,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.56,103,
MYOGLOBIN LEVEL,70200426,CDM,300,RC,83874,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.08,104,
PROBRAIN NATRIURETIC,70200429,CDM,300,RC,83880,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,150.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.6,155,
BILIRUBIN NEONATAL TOTAL,70200197,CDM,300,RC,82247,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
DRUG SCREEN SINGLE,70200065,CDM,300,RC,80307,HCPCS,Outpatient,,,248,186,,228.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,230.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,240.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,248,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.96,248,
NOROVIRUS (NORWALK) BY PCR,70200975,CDM,300,RC,87798,HCPCS,Outpatient,,,375,281.25,,345,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,348.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,337.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,337.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,363.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,375,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,363.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,360,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,195,375,
BLOOD OCCULT FECES,70200202,CDM,300,RC,82270,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
OLIGOCLONAL BANDS,70200435,CDM,300,RC,83916,HCPCS,Outpatient,,,145,108.75,,133.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75.4,145,
OSMOLALITY SERUM ASSAY,70200442,CDM,300,RC,83930,HCPCS,Outpatient,,,89,66.75,,81.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.28,89,
OSMOLALITY URINE ASSAY,70200443,CDM,300,RC,83935,HCPCS,Outpatient,,,89,66.75,,81.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.28,89,
OVA  PARASITE DIRECT SMEARS,70200896,CDM,300,RC,87177,HCPCS,Outpatient,,,222,166.5,,204.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,115.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,206.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,199.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,215.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,115.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,166.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,115.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,166.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.44,222,
OVA  PARASITE STAIN,70201116,CDM,300,RC,87209,HCPCS,Outpatient,,,45,33.75,,41.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,40.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,43.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,33.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.4,45,
PROSTATE SPECIFIC ANTIGEN (PSA) TOTAL DX,70200475,CDM,300,RC,84153,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
PROSTATE HEALTH INDEX,70200474,CDM,300,RC,84153,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
PROSTATE SPECIFIC ANTIGEN (PSA) FREE,70200477,CDM,300,RC,84154,HCPCS,Outpatient,,,179,134.25,,164.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,166.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,161.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,161.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,173.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,179,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,173.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,134.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.08,179,
PROSTATE SPECIFIC ANTIGEN (PSA) ULTRA SENSITIVE,70200476,CDM,300,RC,84153,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
PARATHORMONE ASSAY,70200446,CDM,300,RC,83970,HCPCS,Outpatient,,,277,207.75,,254.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,257.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,277,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.04,277,
PTHrP (PTH-RELATED PEPTIDE),70201133,CDM,300,RC,82397,HCPCS,Outpatient,,,136,102,,125.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,70.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,122.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,131.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,136,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,70.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,131.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,102,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,70.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.72,136,
21-HYDROXYLASE ANTIBODY,70200370,CDM,300,RC,83519,HCPCS,Outpatient,,,140,105,,128.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,140,
PANCREATIC ELASTASE FECAL,70201123,CDM,300,RC,82653,HCPCS,Outpatient,,,100,75,,92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52,100,
SPECIAL STAIN FOR MICRO ORGANISM,70200905,CDM,300,RC,87207,HCPCS,Outpatient,,,318,238.5,,292.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,295.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,286.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,286.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,308.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,318,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,308.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,305.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,165.36,318,
THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD,70200615,CDM,300,RC,85730,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.28,114,
THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD,70200615,CDM,300,RC,85730,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.28,114,
HC BLOOD SMEAR INTRPRETATION,70201089,CDM,305,RC,85060,HCPCS,Outpatient,,,61,45.75,,56.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.72,61,
PHENYTOIN (DILANTIN) DRUG SCREEN QUANT TOTAL,70200028,CDM,300,RC,80185,HCPCS,Outpatient,,,144,108,,132.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,144,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,144,
PHOSPHORUS ASSAY INORGANIC,70201085,CDM,300,RC,84100,HCPCS,Outpatient,,,17,12.75,,15.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,8.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,16.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,8.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,12.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,8.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,12.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.84,17,
PHOSPHORUS URINE,70200458,CDM,300,RC,84105,HCPCS,Outpatient,,,133,99.75,,122.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,127.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.16,133,
POLIO ANTIBODY TYPE,70200778,CDM,300,RC,86658,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,
POTASSIUM SERUM PLASMA/WHOLE BLOOD,70200463,CDM,300,RC,84132,HCPCS,Outpatient,,,39,29.25,,35.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,35.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,35.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,29.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.28,39,
POTASSIUM URINE,70200465,CDM,300,RC,84133,HCPCS,Outpatient,,,99,74.25,,91.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,51.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,92.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,96.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,51.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,74.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,51.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.48,99,
PREALBUMIN,70200466,CDM,300,RC,84134,HCPCS,Outpatient,,,74,55.5,,68.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.48,74,
BHCG QUALATATIVE,70200562,CDM,300,RC,84703,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,120,
URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS,70200125,CDM,300,RC,81025,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
PROCALCITONIN (PCT),70200469,CDM,300,RC,84145,HCPCS,Outpatient,,,223,167.25,,205.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,200.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,200.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,216.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,223,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.96,223,
PROGESTERONE SERUM,70200468,CDM,300,RC,84144,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
PROINSULIN ASSAY,70200492,CDM,300,RC,84206,HCPCS,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.6,80,
PROLACTIN,70200470,CDM,300,RC,84146,HCPCS,Outpatient,,,183,137.25,,168.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,170.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,177.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,183,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,175.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.16,183,
PROSTATE SPECIFIC ANTIGEN (PSA) TOTAL,70200473,CDM,300,RC,84153,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
PROSTATE SPECIFIC ANTIGEN (PSA) TOTAL,70200473,CDM,300,RC,84153,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
PROTEIN TOTAL BODY FLUID,70200483,CDM,300,RC,84157,HCPCS,Outpatient,,,144,108,,132.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,144,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,144,
PROTEIN C ANTIGEN,70200592,CDM,300,RC,85302,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
PROTEIN C FUNCTIONAL ACTIVITY,70200594,CDM,300,RC,85303,HCPCS,Outpatient,,,52,39,,47.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,27.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,46.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,46.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,27.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,27.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.04,52,
MYELIN BASIC PROTEIN CEREBROSPINAL FLUID,70200425,CDM,300,RC,83873,HCPCS,Outpatient,,,109,81.75,,100.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.68,109,
PROTEIN S FUNCTIONAL FREE,70200597,CDM,300,RC,85306,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.32,66,
PROTEIN SERUM TOTAL,70200478,CDM,300,RC,84155,HCPCS,Outpatient,,,37,27.75,,34.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.24,37,
PROTEIN URINE TOTAL,70200480,CDM,300,RC,84156,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,120,
PROTEIN TOTAL BODY FLUID,70200483,CDM,300,RC,84157,HCPCS,Outpatient,,,144,108,,132.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,144,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,144,
PROTEIN SERUM TOTAL,70200478,CDM,300,RC,84155,HCPCS,Outpatient,,,37,27.75,,34.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.24,37,
PROTEIN URINE ELECTROP QUANTITATIVE,70200490,CDM,300,RC,84166,HCPCS,Outpatient,,,159,119.25,,146.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,159,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.68,159,
PROTEIN URINE ELECTROP QUANTITATIVE,70200490,CDM,300,RC,84166,HCPCS,Outpatient,,,159,119.25,,146.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,159,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.68,159,
PROTHROMBIN TIME (FINGER STICK),70200608,CDM,300,RC,85610,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
PROTHROMBIN TIME WITH INR,70201111,CDM,300,RC,85610,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
QuantiFERON Employee Health,70201143,CDM,300,RC,86480,HCPCS,Outpatient,,,186,139.5,,171.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,96.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,186,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,96.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,180.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,139.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,178.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,96.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.72,186,
QUANTIFERON GOLD 4 TUBE,70200746,CDM,300,RC,86480,HCPCS,Outpatient,,,186,139.5,,171.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,96.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,186,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,96.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,180.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,139.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,178.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,96.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.72,186,
HIV-1 RNA QUANTITATIVE BY PCR,70200953,CDM,300,RC,87536,HCPCS,Outpatient,,,724,543,,666.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,376.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,673.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,651.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,651.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,702.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,724,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,376.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,702.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,543,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,695.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,376.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,543,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,543,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,376.48,724,
RNA (RIBONUCLEIC PROTEIN) IGG,70200694,CDM,300,RC,86235,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.64,82,
VDRL SPINAL FLUID QUALITATIVE,70200750,CDM,300,RC,86592,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,37.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,64.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,69.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,37.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,37.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.44,72,
RESPIRATORY SYNCYTIAL VIRUS (RSV),70200965,CDM,300,RC,87634,HCPCS,Outpatient,,,253,189.75,,232.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,131.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,235.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,227.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,227.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,245.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,253,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,131.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,189.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,242.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,131.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,189.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,189.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,131.56,253,
RESPIRATORY SYNCYTIAL VIRUS (RSV),70200965,CDM,300,RC,87634,HCPCS,Outpatient,,,253,189.75,,232.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,131.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,235.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,227.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,227.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,245.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,253,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,131.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,189.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,242.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,131.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,189.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,189.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,131.56,253,
RENAL FUNCTION PANEL,70200009,CDM,300,RC,80069,HCPCS,Outpatient,,,160,120,,147.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,144,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,160,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,155.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.2,160,
RENIN ACTIVITY ASSAY,70200498,CDM,300,RC,84244,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.32,66,
RESPIRATRY PROBE  REV TRNSCR 12-25 TARGET,70200964,CDM,300,RC,87637,HCPCS,Outpatient,,,452,339,,415.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,235.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,420.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,406.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,406.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,438.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,452,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,235.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,339,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,433.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,235.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,339,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,235.04,452,
BLOOD COUNT RETICULOCYTE  AUTOMATED,70201094,CDM,300,RC,85045,HCPCS,Outpatient,,,133,99.75,,122.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,127.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.16,133,
TRIIODOTHYRONINE T3 REVERSE,70200528,CDM,300,RC,84482,HCPCS,Outpatient,,,93,69.75,,85.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,48.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,86.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,83.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,83.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,90.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,93,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,48.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,69.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,48.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.36,93,
RHEUMATOID FACTOR B QUANTITATIVE,70200743,CDM,300,RC,86431,HCPCS,Outpatient,,,54,40.5,,49.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,28.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,48.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,48.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,28.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,28.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.08,54,
ROCKY MOUNTAIN SPOTTED FEVER RICKETTSIA ANTIBDY,70200822,CDM,300,RC,86757,HCPCS,Outpatient,,,71,53.25,,65.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.92,71,
RUBELLA ANTIBODY,70200824,CDM,300,RC,86762,HCPCS,Outpatient,,,100,75,,92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52,100,
RUBEOLA IGM ANTIBODY,70200827,CDM,300,RC,86765,HCPCS,Outpatient,,,55,41.25,,50.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,28.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.6,55,
ANTI-SARS-COV-2 ANTIBODY,70200828,CDM,300,RC,86769,HCPCS,Outpatient,,,109,81.75,,100.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.68,109,
SARS COV-2 COVID-19 AMPLIFIED PROBE,70200966,CDM,300,RC,87635,HCPCS,Outpatient,,,130,97.5,,119.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,124.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.6,130,
SARS COV-2 COVID-19 AMPLIFIED PROBE,70200966,CDM,300,RC,87635,HCPCS,Outpatient,,,130,97.5,,119.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,124.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.6,130,
STAT LABORATORY REQUEST,70201083,CDM,300,RC,,,Outpatient,,,306,229.5,,281.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,159.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,284.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,275.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,275.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,296.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,306,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,159.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,296.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,229.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,293.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,159.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,229.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,159.12,306,
SALICYLATE DRUG ASSAY,70201084,CDM,300,RC,80179,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.2,135,
CORTISOL SALIVA TOTAL,70200248,CDM,300,RC,82533,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
SEMEN ANALYSIS POST VASECTOMY,70201075,CDM,300,RC,89321,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,77.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,83.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.72,86,
SEX HORMONE BINDING GLOBULN (SHBG) ASSAY FEMALE,70200502,CDM,300,RC,84270,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.28,114,
SJOGRENS ANTIBODY IGG,70200697,CDM,300,RC,86235,HCPCS,Outpatient,,,98,73.5,,90.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,91.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,50.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.96,98,
SODIUM SERUM PLASMA OR WHOLE BLOOD,70200504,CDM,300,RC,84295,HCPCS,Outpatient,,,37,27.75,,34.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.24,37,
SODIUM URINE ASSAY,70200506,CDM,300,RC,84300,HCPCS,Outpatient,,,100,75,,92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52,100,
SODIUM URINE ASSAY,70200506,CDM,300,RC,84300,HCPCS,Outpatient,,,100,75,,92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52,100,
SPINAL MUSCULAR ATROPHY,70200149,CDM,300,RC,81329,HCPCS,Outpatient,,,621,465.75,,571.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,322.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,577.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,558.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,558.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,602.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,621,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,322.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,602.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,465.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,596.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,322.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,465.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,465.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,322.92,621,
STREP SCREEN GROUP A,70200985,CDM,300,RC,87880,HCPCS,Outpatient,,,71,53.25,,65.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.92,71,
STREPTOCOCCUS PNEUMONIA ANTIGEN URINE,70200990,CDM,300,RC,87899,HCPCS,Outpatient,,,179,134.25,,164.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,166.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,161.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,161.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,173.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,179,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,173.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,134.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.08,179,
FTA ANTIBODIES,70200833,CDM,300,RC,86780,HCPCS,Outpatient,,,183,137.25,,168.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,170.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,177.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,183,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,175.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,95.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.16,183,
BOX ELDER MAPLE TREE ALLERGEN,70200640,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
ALDER TREE ALLERGEN,70200639,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
CEDAR TREE ALLERGEN,70200643,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
OAK TREE ALLERGEN,70200644,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
ELM TREE ALLERGEN,70200642,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
OLIVE TREE ALLERGEN,70200645,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
COTTONWOOD TREE ALLERGEN,70200641,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
WHITE MULBERRY TREE ALLERGEN,70200646,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
TRIIODOTHYRONINE T3 FREE,70200527,CDM,300,RC,84481,HCPCS,Outpatient,,,159,119.25,,146.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,159,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.68,159,
T3 UPTAKE,70201124,CDM,300,RC,84479,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.12,106,
TPMT GENETIC TEST,70201135,CDM,300,RC,81335,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,465,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,450,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,450,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,485,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,485,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,480,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,260,500,
THYROID STIMULATING HORMONE (TSH) ASSAY,70200519,CDM,300,RC,84443,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
TACROLIMUS (PROFRAF) DRUG SCREEN QUANTITATIVE,70200032,CDM,300,RC,80197,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.04,327,
TESTOSTERONE FREE  TOTAL ASSAY,70200511,CDM,300,RC,84403,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
TESTOSTERONE TOTAL ASSAY,70200512,CDM,300,RC,84403,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
TESTOSTERONE FREE ASSAY,70200510,CDM,300,RC,84402,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104,200,
THYROGLOBULIN ANTIBODY,70200845,CDM,300,RC,86800,HCPCS,Outpatient,,,53,39.75,,48.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.56,53,
HC PHLEBOTOMY THERAPEUTIC,70201080,CDM,300,RC,99195,HCPCS,Outpatient,,,284,213,,261.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,147.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,264.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,255.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,255.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,275.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,284,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,147.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,275.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,213,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,147.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,213,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.68,284,
THYROID PEROXIDASE ANTIBODY TPO,70200738,CDM,300,RC,86376,HCPCS,Outpatient,,,154,115.5,,141.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,143.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.08,154,
THYROGLOBULIN ANTIBODY,70200845,CDM,300,RC,86800,HCPCS,Outpatient,,,53,39.75,,48.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.56,53,
MICROSOMAL ANTIBODIES EACH,70200736,CDM,300,RC,86376,HCPCS,Outpatient,,,154,115.5,,141.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,143.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.08,154,
THYROID STIMULATING HORMONE (TSH) ASSAY,70200519,CDM,300,RC,84443,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
TSH RECEPTOR ANTIBODY,70200392,CDM,300,RC,83520,HCPCS,Outpatient,,,300,225,,276,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,300,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156,300,
THYROXINE TOTAL (T4) ASSAY,70200515,CDM,300,RC,84436,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,70.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.52,76,
TOPIRAMATE (TOPAMAX) DRUG SCREEN QUANTITATIVE,70200035,CDM,300,RC,80201,HCPCS,Outpatient,,,154,115.5,,141.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,143.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.08,154,
IRON BINDING CAPACITY,70200398,CDM,300,RC,83550,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.08,104,
IRON BINDING CAPACITY,70200398,CDM,300,RC,83550,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.08,104,
TOXOPLASMA IGM ANTIBODY,70200832,CDM,300,RC,86778,HCPCS,Outpatient,,,81,60.75,,74.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,78.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.12,81,
TRANSFERRIN ASSAY,70200524,CDM,300,RC,84466,HCPCS,Outpatient,,,170,127.5,,156.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,88.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,153,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,153,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,164.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,170,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,88.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,164.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,127.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,163.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,88.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,127.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.4,170,
TREPONEMA PALLIDUM ANTIBODY,70200834,CDM,300,RC,86780,HCPCS,Outpatient,,,84,63,,77.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,43.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,75.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,75.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,43.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,43.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.68,84,
TRICHOMONAS VAGINALIS,70200967,CDM,300,RC,87661,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.72,111,
TRIGLYCERIDES BLOOD ASSAY,70200525,CDM,300,RC,84478,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,35,
TRIIODOTHYRONINE T3 TOTAL,70200526,CDM,300,RC,84480,HCPCS,Outpatient,,,207,155.25,,190.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,192.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,186.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,186.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,200.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,207,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,200.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,155.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,198.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,155.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.64,207,
CARDIAC TROPONIN QUANTITATIVE,70200529,CDM,300,RC,84484,HCPCS,Outpatient,,,131,98.25,,120.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.12,131,
CARDIAC TROPONIN QUANTITATIVE,70200529,CDM,300,RC,84484,HCPCS,Outpatient,,,131,98.25,,120.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.12,131,
TRYPTASE LEVEL QUANTITATIVE,70200391,CDM,300,RC,83520,HCPCS,Outpatient,,,300,225,,276,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,300,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156,300,
URINALYSIS MICROSCOPIC ONLY,70200124,CDM,300,RC,81015,HCPCS,Outpatient,,,24,18,,22.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,23.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12.48,24,
UA Microalb/Creat Ratio POCT,70200266,CDM,300,RC,82570,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.76,113,
UA Microalbumin POCT,70200169,CDM,300,RC,82044,HCPCS,Outpatient,,,26,19.5,,23.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13.52,26,
URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY,70200118,CDM,300,RC,81001,HCPCS,Outpatient,,,74,55.5,,68.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.48,74,
UREA NITROGEN QUANTITATIVE,70200531,CDM,300,RC,84520,HCPCS,Outpatient,,,34,25.5,,31.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,32.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.68,34,
BLOOD URIC ACID ASSAY,70200536,CDM,300,RC,84550,HCPCS,Outpatient,,,61,45.75,,56.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.72,61,
VASOACTIVE INTESTINAL PEPTIDE,70200542,CDM,300,RC,84586,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.12,106,
VALPROIC DIPROPYLACETIC ACID (DEPAKOTE) TOTAL,70200017,CDM,300,RC,80164,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.12,106,
VANCOMYCIN DRUG SCREEN QUANTITATIVE,70200036,CDM,300,RC,80202,HCPCS,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.76,138,
VANCOMYCIN DRUG SCREEN QUANTITATIVE,70200036,CDM,300,RC,80202,HCPCS,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.76,138,
VARICELLA-ZOSTER ZOSTER IGG ANTIBODY,70200835,CDM,300,RC,86787,HCPCS,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,87.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,156.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,151.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,151.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,168,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,87.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,162.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,126,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,161.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,87.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.36,168,
COLLECTION VENOUS BLOOD VENIPUNCTURE,78001297,CDM,300,RC,36415,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.6,30,
VITAMIN A ASSAY,70200545,CDM,300,RC,84590,HCPCS,Outpatient,,,61,45.75,,56.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.72,61,
THIAMINE-VITAMIN B-1 ASSAY,70200513,CDM,300,RC,84425,HCPCS,Outpatient,,,144,108,,132.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,144,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,144,
CYANOCOBALAMIN VITAMIN B-12,70200272,CDM,300,RC,82607,HCPCS,Outpatient,,,281,210.75,,258.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,252.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,252.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,272.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,281,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.12,281,
VITAMIN B3 (NIACIN) ASSAY,70200546,CDM,300,RC,84591,HCPCS,Outpatient,,,127,95.25,,116.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,66.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,118.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,114.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,123.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,127,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,66.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,95.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,66.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.04,127,
VITAMIN D HYDROXY,70200276,CDM,300,RC,82306,HCPCS,Outpatient,,,301,225.75,,276.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,301,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.52,301,
25 HYDROXY VITAMIN D2  D3 BY TANDEM,70200209,CDM,300,RC,82306,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104,200,
TOCOPHEROL ALPHA (VITAMIN E),70200521,CDM,300,RC,84446,HCPCS,Outpatient,,,61,45.75,,56.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.72,61,
RAGWEED ALLERGEN,70200648,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
MUGWORT ALLERGEN,70200649,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
RUSSIAN THISTLE ALLERGEN IGE,70200651,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
PIGWEED ALLERGEN,70200650,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
SHEEP SORRE ALLERGEN,70200652,CDM,300,RC,86003,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
WEST NILE VIRUS IGM ANTIBODY,70200837,CDM,300,RC,86788,HCPCS,Outpatient,,,96,72,,88.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,49.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,89.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,86.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,86.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,96,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,49.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,49.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.92,96,
WEST NILE VIRUS IGG ANTIBODY,70200838,CDM,300,RC,86789,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.56,103,
WET PREP,70200908,CDM,300,RC,87210,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,78.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,78.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,84.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.24,87,
ZINC SERUM,70200556,CDM,300,RC,84630,HCPCS,Outpatient,,,147,110.25,,135.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,76.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,136.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,132.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,132.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,142.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,147,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,76.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,142.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,110.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,76.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,110.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.44,147,
PH BODY FLUID NOT ELSEWHERE SPECIFIED,70200447,CDM,300,RC,83986,HCPCS,Outpatient,,,62,46.5,,57.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,55.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,55.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,62,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,46.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,46.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.24,62,
t-TRANSGLUTAMINASE (tTG) IgA,70201118,CDM,300,RC,86364,HCPCS,Outpatient,,,29,21.75,,26.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,28.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.08,29,
t-TRANSGLUTAMINASE (tTG) IgG,70201132,CDM,300,RC,86364,HCPCS,Outpatient,,,29,21.75,,26.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,28.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.08,29,
FACTOR VIII VW FACTOR RISTOCETIN COFACTOR,70200583,CDM,300,RC,85245,HCPCS,Outpatient,,,314,235.5,,288.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,163.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,282.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,282.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,304.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,314,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,163.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,235.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,301.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,163.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,235.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,235.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,163.28,314,
FACTOR VIII VW FACTOR ANTIGEN,70200584,CDM,300,RC,85246,HCPCS,Outpatient,,,74,55.5,,68.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.48,74,
CASE MANAGEMENT - FOLLOW-UP EVALUATION,60400016,CDM,999,RC,,,Outpatient,,,23,17.25,,21.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.96,23,
CASE MANAGEMENT - INITIAL EVALUATION,60400015,CDM,999,RC,,,Outpatient,,,23,17.25,,21.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.96,23,
CASE MANAGEMENT - QUARTERLY EVALUATION EACH 15 MINUTES,60400017,CDM,999,RC,,,Outpatient,,,23,17.25,,21.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.96,23,
CASE MANAGEMENT - RE-EVALUATION RENEWAL EACH 15 MINUTES,60400018,CDM,999,RC,,,Outpatient,,,23,17.25,,21.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.96,23,
HOMEMAKER SERVICE - HOUSEKEEPING EACH 15 MINUTES,60400024,CDM,999,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
HOMEMAKER SERVICE - LAUNDRY LINEN CHANGE EACH 15 MINUTES,60400026,CDM,999,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
HOMEMAKER SERVICE - MEAL PREPARATION EACH 15 MINUTES,60400025,CDM,999,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
HOMEMAKER SERVICE - OTHER EACH 15 MINUTES,60400028,CDM,999,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
HOMEMAKER SERVICE - SHOPPING EACH 15 MINUTES,60400027,CDM,999,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
NURSING SERVICE - ASSESSMENT EACH 15 MINUTES,60400033,CDM,999,RC,,,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
NURSING SERVICE - DELEGATION EACH 15 MINUTES,60400031,CDM,999,RC,,,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
NURSING SERVICE - MEDICATION MANAGEMENT EACH 15 MINUTES,60400030,CDM,999,RC,,,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
NURSING SERVICE - RE-ASSESSMENT EACH 15 MINUTES,60400032,CDM,999,RC,,,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
PERSONAL CARE SERVICE - BATHING SHOWERING EACH 15 MINUTES,60400021,CDM,999,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
PERSONAL CARE SERVICE - DRESSING EACH 15 MINUTES,60400019,CDM,999,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
PERSONAL CARE SERVICE - OTHER EACH 15 MINUTES,60400023,CDM,999,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
PERSONAL CARE SERVICE - SKIN CARE EACH 15 MINUTES,60400020,CDM,999,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
PERSONAL CARE SERVICE - TRANSFERRING EACH 15 MINUTES,60400022,CDM,999,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
PERSONAL EMERGENCY RESPONSE SYSTEM (PERS) - SYSTEM INSTALL AND TEST,60400034,CDM,999,RC,,,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,78.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,78.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,84.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.24,87,
PERSONAL EMERGENCY RESPONSE SYSTEM (PERS) - MONTHLY CHECK,60400035,CDM,999,RC,,,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
RESPITE SERVICE - IN HOME EACH 15 MINUTES,60400029,CDM,999,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
PERSONAL EMERGENCY RESPONSE SYSTEM (PERS) - MONTHLY CHECK,60400035,CDM,999,RC,,,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
INJECTION INTRALESIONAL UP TO & INCLUD 7 LESION (TC/PC),78000156G,CDM,361,RC,11900,HCPCS,Outpatient,,,165,123.75,,151.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,153.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,148.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,148.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,165,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,158.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.8,165,
INJECTION INTRALESIONAL UP TO  INCLUD 7 LESION,78000156,CDM,361,RC,11900,HCPCS,Outpatient,,,165,123.75,,151.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,153.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,148.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,148.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,165,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,158.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.8,165,
INJECTION THERAPEUTIC CARPAL TUNNEL,78000346,CDM,361,RC,20526,HCPCS,Outpatient,,,301,225.75,,276.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,301,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.52,301,
INJECTION THERAPEUTIC CARPAL TUNNEL (TC/PC),78000346G,CDM,361,RC,20526,HCPCS,Outpatient,,,301,225.75,,276.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,301,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.52,301,
INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS (TC/PC),78000348G,CDM,361,RC,20550,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,195.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,189,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,189,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,203.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,210,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,203.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.2,210,
INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,78000348,CDM,361,RC,20550,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,195.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,189,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,189,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,203.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,210,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,203.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.2,210,
INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES (TC/PC),78000352G,CDM,361,RC,20552,HCPCS,Outpatient,,,458,343.5,,421.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,238.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,425.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,412.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,412.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,444.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,458,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,238.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,444.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,343.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,439.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,238.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,343.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,343.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.16,458,
INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,78000352,CDM,361,RC,20552,HCPCS,Outpatient,,,531,398.25,,488.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,276.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,493.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,477.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,477.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,515.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,531,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,276.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,515.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,398.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,509.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,276.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,398.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,398.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.12,531,
INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,78000354,CDM,361,RC,20553,HCPCS,Outpatient,,,603,452.25,,554.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,313.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,560.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,542.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,542.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,584.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,603,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,313.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,584.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,452.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,578.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,313.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,452.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,452.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.56,603,
INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES (TC/PC),78000354G,CDM,361,RC,20553,HCPCS,Outpatient,,,411,308.25,,378.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,382.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,369.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,398.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,411,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,398.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.72,411,
ARTHROCENTESIS ASPIR/INJ SMALL JT/BURSA W/O US BILAT,78000358,CDM,361,RC,20600,HCPCS,Outpatient,,,644,483,,592.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,598.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,579.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,579.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,624.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,644,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,624.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,618.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,334.88,644,
ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US BILAT (TC/PC,78000358G,CDM,361,RC,20600,HCPCS,Outpatient,,,518,388.5,,476.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,481.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,466.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,466.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,502.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,518,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,502.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,497.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.36,518,
ARTHROCENTESIS ASPIR/INJ SMALL JT/BURSA W/O US,78000356,CDM,361,RC,20600,HCPCS,Outpatient,,,644,483,,592.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,598.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,579.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,579.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,624.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,644,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,624.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,618.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,334.88,644,
ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US (TC/PC),78000356G,CDM,361,RC,20600,HCPCS,Outpatient,,,345,258.75,,317.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,179.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,310.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,310.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,334.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,345,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,179.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,334.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,258.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,179.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,258.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,179.4,345,
ARTHROCENTESIS ASPIR/INJ SML JT/BURSAW/US REC RPRT BIL,78002269,CDM,361,RC,20604,HCPCS,Outpatient,,,871,653.25,,801.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,452.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,810.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,783.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,783.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,844.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,871,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,452.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,844.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,653.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,836.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,452.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,653.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,653.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,452.92,871,
ARTHROCENTESIS ASPIR/INJ SML JT/BURSAW/US REC RPRT,78000360,CDM,361,RC,20604,HCPCS,Outpatient,,,871,653.25,,801.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,452.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,810.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,783.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,783.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,844.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,871,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,452.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,844.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,653.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,836.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,452.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,653.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,653.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,452.92,871,
ARTHROCENTESIS ASPIR&/INJ SML JT/BURSAW/US REC RPRT (TC/PC),78000360G,CDM,361,RC,20604,HCPCS,Outpatient,,,358,268.5,,329.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,186.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,322.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,322.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,347.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,358,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,186.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,347.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,268.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,343.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,186.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,268.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.16,358,
ARTHROCENTESIS ASPIR&/INJ SML JT/BUR/US REC RPRT BIL (TC/PC),78002269G,CDM,361,RC,20604,HCPCS,Outpatient,,,537,402.75,,494.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,279.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,499.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,520.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,537,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,279.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,520.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,402.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,515.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,279.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,402.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,402.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,279.24,537,
ARTHROCENTESIS ASPIR/INJ INTERM JT/BURS W/O US BILAT,78000364,CDM,361,RC,20605,HCPCS,Outpatient,,,692,519,,636.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,643.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,692,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.84,692,
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US BILAT (TC/PC,78000364G,CDM,361,RC,20605,HCPCS,Outpatient,,,584,438,,537.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,303.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,543.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,525.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,525.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,566.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,584,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,303.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,566.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,438,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,560.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,303.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,438,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,303.68,584,
ARTHROCENTESIS ASPIR/INJ INTERM JT/BURS W/O US,78000362,CDM,361,RC,20605,HCPCS,Outpatient,,,692,519,,636.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,643.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,692,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.84,692,
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US (TC/PC),78000362G,CDM,361,RC,20605,HCPCS,Outpatient,,,390,292.5,,358.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,202.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,362.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,351,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,351,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,378.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,390,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,202.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,378.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,292.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,374.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,202.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,202.8,390,
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US (TC/PC),78000366G,CDM,361,RC,20606,HCPCS,Outpatient,,,467,350.25,,429.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,242.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,434.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,420.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,420.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,452.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,467,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,242.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,452.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,350.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,448.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,242.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,350.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,350.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,242.84,467,
ARTHROCENTESIS ASPIR/INJ INTERM JT/BURS W/US BIL,78002271,CDM,361,RC,20606,HCPCS,Outpatient,,,990,742.5,,910.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,514.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,920.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,891,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,891,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,960.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,990,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,514.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,960.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,742.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,950.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,514.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,742.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,742.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,514.8,990,
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US BIL (TC/PC),78002271G,CDM,361,RC,20606,HCPCS,Outpatient,,,701,525.75,,644.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,364.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,651.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,630.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,630.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,679.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,701,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,364.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,679.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,525.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,672.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,364.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,525.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,525.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,364.52,701,
ARTHROCENTESIS ASPIR/INJ INTERM JT/BURS W/US,78000366,CDM,361,RC,20606,HCPCS,Outpatient,,,990,742.5,,910.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,514.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,920.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,891,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,891,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,960.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,990,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,514.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,960.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,742.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,950.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,514.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,742.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,742.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,514.8,990,
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US BIL (TC/PC),78000370G,CDM,361,RC,20610,HCPCS,Outpatient,,,828,621,,761.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,430.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,770.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,745.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,745.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,803.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,828,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,430.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,803.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,621,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,794.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,430.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,621,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,621,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,430.56,828,
ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA W/O US BILAT,78000370,CDM,361,RC,20610,HCPCS,Outpatient,,,854,640.5,,785.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,794.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,768.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,768.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,828.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,854,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,828.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,444.08,854,
ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA W/O US,78000368,CDM,361,RC,20610,HCPCS,Outpatient,,,854,640.5,,785.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,794.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,768.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,768.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,828.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,854,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,828.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,444.08,854,
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US (TC/PC),78000368G,CDM,361,RC,20610,HCPCS,Outpatient,,,552,414,,507.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,513.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,496.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,496.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,535.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,552,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,535.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,529.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,287.04,552,
ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA W/US BIL,78002273,CDM,361,RC,20611,HCPCS,Outpatient,,,1135,851.25,,1044.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,590.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1055.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1021.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1021.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1100.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1135,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,590.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1100.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,851.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1089.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,590.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,851.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,851.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,590.2,1135,
ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA W/US,78000372,CDM,361,RC,20611,HCPCS,Outpatient,,,1135,851.25,,1044.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,590.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1055.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1021.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1021.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1100.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1135,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,590.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1100.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,851.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1089.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,590.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,851.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,851.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,590.2,1135,
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US (TC/PC),78000372G,CDM,361,RC,20611,HCPCS,Outpatient,,,585,438.75,,538.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,304.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,544.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,526.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,526.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,567.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,585,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,304.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,567.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,438.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,561.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,304.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,438.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,304.2,585,
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US BIL (TC/PC),78002273G,CDM,361,RC,20611,HCPCS,Outpatient,,,877,657.75,,806.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,456.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,815.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,789.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,789.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,850.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,877,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,456.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,850.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,657.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,841.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,456.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,657.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,657.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.04,877,
INJECTION SI JOINT ARTHRGRPHY/ANES/STEROID W/IMA,78000764,CDM,361,RC,27096,HCPCS,Outpatient,,,2719,2039.25,,2501.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2528.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2447.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2447.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2637.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2719,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2610.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1413.88,2719,
INJECTION SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA (TC/PC),78000764G,CDM,361,RC,27096,HCPCS,Outpatient,,,369,276.75,,339.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,191.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,343.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,332.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,332.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,357.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,369,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,191.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,357.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,276.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,191.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,276.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,191.88,369,
INJECTION SI JOINT ARTHRY&/ANES/STEROID W/IMA BIL (TC/PC),78000766G,CDM,361,RC,27096,HCPCS,Outpatient,,,553,414.75,,508.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,287.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,514.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,497.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,497.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,536.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,553,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,287.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,536.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,414.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,530.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,287.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,414.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,414.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,287.56,553,
INJECTION SI JOINT ARTHRY/ANES/STEROID W/IMA BIL,78000766,CDM,361,RC,27096,HCPCS,Outpatient,,,2719,2039.25,,2501.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2528.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2447.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2447.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2637.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2719,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2610.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1413.88,2719,
TRANSFUSION BLOOD/BLOOD COMPONENTS,78001304,CDM,361,RC,36430,HCPCS,Outpatient,,,622,466.5,,572.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,323.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,578.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,559.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,559.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,603.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,622,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,323.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,603.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,466.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,597.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,323.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,466.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,466.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,323.44,622,
46700 Dressing PICC/ CVC,46700,CDM,272,RC,46700,HCPCS,Outpatient,,,121,90.75,,111.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,116.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.92,121,
INJECTION DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN,78001709,CDM,361,RC,62320,HCPCS,Outpatient,,,1101,825.75,,1012.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,572.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1023.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,990.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,990.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1067.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,572.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1067.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,825.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1056.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,572.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,825.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,825.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,572.52,1101,
INJECTION DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN (TC/PC),78001709G,CDM,361,RC,62320,HCPCS,Outpatient,,,1101,825.75,,1012.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,572.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1023.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,990.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,990.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1067.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,572.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1067.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,825.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1056.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,572.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,825.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,825.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,572.52,1101,
INJECTION DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN,78001711,CDM,361,RC,62321,HCPCS,Outpatient,,,2951,2213.25,,2714.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1534.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2744.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2655.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2655.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2862.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2951,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1534.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2862.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2213.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2832.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1534.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2213.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2213.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1534.52,2951,
INJECTION DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN (TC/PC),78001711G,CDM,361,RC,62321,HCPCS,Outpatient,,,1574,1180.5,,1448.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,818.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1463.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1416.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1416.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1526.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1574,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,818.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1526.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1180.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1511.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,818.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1180.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1180.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,818.48,1574,
62322 NJX Interlaminar Lumbar or Sacral - Tech,78001713,CDM,361,RC,62322,HCPCS,Outpatient,,,2066,1549.5,,1900.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1074.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1921.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1859.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1859.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2004.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2066,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1074.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2004.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1549.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1983.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1074.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1549.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1549.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1074.32,2066,
INJECTION DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN,78001715,CDM,361,RC,62323,HCPCS,Outpatient,,,1675,1256.25,,1541,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,871,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1557.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1507.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1507.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1624.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1675,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,871,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1624.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1256.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1608,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,871,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1256.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1256.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,871,1675,
INJECTION DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN (TC/PC),78001715G,CDM,361,RC,62323,HCPCS,Outpatient,,,1675,1256.25,,1541,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,871,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1557.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1507.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1507.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1624.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1675,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,871,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1624.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1256.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1608,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,871,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1256.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1256.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,871,1675,
62324 NJX Interlaminar Cervical Thoracic - Tech,78002160,CDM,361,RC,62324,HCPCS,Outpatient,,,1704,1278,,1567.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,886.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1584.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1533.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1533.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1652.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1704,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,886.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1652.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1278,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1635.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,886.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1278,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1278,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,886.08,1704,
INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE,78001722,CDM,361,RC,64405,HCPCS,Outpatient,,,1102,826.5,,1013.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,573.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1024.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,991.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,991.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1068.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1102,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,573.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1068.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,826.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1057.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,573.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,826.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,826.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,573.04,1102,
INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE (TC/PC),78001722G,CDM,361,RC,64405,HCPCS,Outpatient,,,656,492,,603.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,341.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,610.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,590.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,590.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,636.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,656,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,341.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,636.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,492,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,629.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,341.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,492,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,492,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,341.12,656,
INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE (TC/PC),78001726G,CDM,361,RC,64418,HCPCS,Outpatient,,,775,581.25,,713,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,403,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,720.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,697.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,697.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,751.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,775,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,403,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,751.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,744,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,403,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,581.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,403,775,
INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE,78001726,CDM,361,RC,64418,HCPCS,Outpatient,,,775,581.25,,713,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,403,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,720.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,697.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,697.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,751.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,775,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,403,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,751.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,744,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,403,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,581.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,403,775,
INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE,78001728,CDM,361,RC,64420,HCPCS,Outpatient,,,1309,981.75,,1204.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,680.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1217.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1178.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1178.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1269.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1309,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,680.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1269.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,981.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1256.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,680.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,981.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,981.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,680.68,1309,
INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE (TC/PC),78001728G,CDM,361,RC,64420,HCPCS,Outpatient,,,1027,770.25,,944.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,534.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,955.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,924.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,924.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,996.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1027,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,534.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,996.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,770.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,985.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,534.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,770.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,770.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,534.04,1027,
MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES (TC/PC),78001730G,CDM,361,RC,64421,HCPCS,Outpatient,,,1363,1022.25,,1253.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,708.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1267.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1226.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1226.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1322.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1363,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,708.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1322.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1022.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1308.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,708.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1022.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1022.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,708.76,1363,
MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES,78001730,CDM,361,RC,64421,HCPCS,Outpatient,,,1793,1344.75,,1649.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,932.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1667.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1613.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1613.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1739.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1793,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,932.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1739.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1344.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1721.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,932.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1344.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1344.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,932.36,1793,
INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRV (TC/PC),78001732G,CDM,361,RC,64425,HCPCS,Outpatient,,,845,633.75,,777.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,439.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,785.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,760.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,760.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,819.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,845,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,439.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,819.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,633.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,811.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,439.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,633.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,633.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,439.4,845,
INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRV,78001732,CDM,361,RC,64425,HCPCS,Outpatient,,,1047,785.25,,963.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,973.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,942.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,942.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1015.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1047,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1015.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1005.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,544.44,1047,
INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE,78001736,CDM,361,RC,64445,HCPCS,Outpatient,,,1219,914.25,,1121.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,633.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1133.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1097.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1097.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1182.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1219,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,633.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1182.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,914.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1170.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,633.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,914.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,914.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,633.88,1219,
INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE (TC/PC),78001736G,CDM,361,RC,64445,HCPCS,Outpatient,,,1299,974.25,,1195.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,675.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1208.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1169.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1169.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1260.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1299,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,675.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1260.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,974.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1247.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,675.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,974.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,974.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,675.48,1299,
INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,78001738,CDM,361,RC,64450,HCPCS,Outpatient,,,1381,1035.75,,1270.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,718.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1284.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1242.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1242.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1339.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1381,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,718.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1339.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1035.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1325.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,718.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1035.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1035.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,718.12,1381,
INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH (TC/PC),78001738G,CDM,361,RC,64450,HCPCS,Outpatient,,,853,639.75,,784.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,793.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,767.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,767.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,827.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,853,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,827.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,818.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,443.56,853,
INJECTION AA/STRD NERVES NRVTG SI JOINT W/IMG,78001740,CDM,361,RC,64451,HCPCS,Outpatient,,,1536,1152,,1413.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,798.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1428.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1382.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1382.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1489.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1536,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,798.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1489.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1152,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1474.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,798.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1152,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1152,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,798.72,1536,
INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG (TC/PC),78001740G,CDM,361,RC,64451,HCPCS,Outpatient,,,1536,1152,,1413.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,798.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1428.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1382.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1382.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1489.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1536,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,798.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1489.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1152,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1474.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,798.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1152,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1152,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,798.72,1536,
INJECTION AA/STRD GENICULAR NRV BRANCHES W/IMG,78001742,CDM,361,RC,64454,HCPCS,Outpatient,,,1505,1128.75,,1384.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,782.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1399.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1354.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1354.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1459.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,782.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1459.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1128.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1444.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,782.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1128.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1128.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,782.6,1505,
INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG (TC/PC),78001742G,CDM,361,RC,64454,HCPCS,Outpatient,,,1505,1128.75,,1384.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,782.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1399.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1354.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1354.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1459.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,782.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1459.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1128.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1444.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,782.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1128.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1128.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,782.6,1505,
PVB THORACIC SINGLE INJECTION SITE W/IMG GUIDE,78001744,CDM,361,RC,64461,HCPCS,Outpatient,,,1193,894.75,,1097.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,620.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1109.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1073.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1073.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1157.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1193,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,620.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1157.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,894.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1145.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,620.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,894.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,894.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,620.36,1193,
PVB THORACIC SINGLE INJECTION SITE W/IMG GUIDE (TC/PC),78001744G,CDM,361,RC,64461,HCPCS,Outpatient,,,1193,894.75,,1097.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,620.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1109.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1073.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1073.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1157.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1193,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,620.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1157.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,894.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1145.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,620.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,894.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,894.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,620.36,1193,
PVB THORACIC SECOND  ADDL INJ SITE W/IMG GUIDANCE,78001746,CDM,361,RC,64462,HCPCS,Outpatient,,,637,477.75,,586.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,331.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,592.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,573.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,573.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,617.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,637,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,331.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,617.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,477.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,611.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,331.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,477.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,477.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.24,637,
PVB THORACIC SECOND & ADDL INJ SITE W/IMG GUIDANCE (TC/PC),78001746G,CDM,361,RC,64462,HCPCS,Outpatient,,,637,477.75,,586.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,331.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,592.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,573.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,573.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,617.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,637,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,331.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,617.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,477.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,611.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,331.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,477.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,477.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.24,637,
INJECTION ANES/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL,78001748,CDM,361,RC,64483,HCPCS,Outpatient,,,2257,1692.75,,2076.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1173.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2099.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2031.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2031.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2189.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2257,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1173.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2189.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1692.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2166.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1173.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1692.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1692.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1173.64,2257,
INJECTION ANES/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL (TC/PC),78001748G,CDM,361,RC,64483,HCPCS,Outpatient,,,1761,1320.75,,1620.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,915.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1637.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1584.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1584.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1708.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1761,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,915.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1708.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1320.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1690.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,915.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1320.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1320.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,915.72,1761,
INJECTION ANES/STRD W/IMG TFRML EDRL LMBR/SAC EA LV,78001750,CDM,361,RC,64484,HCPCS,Outpatient,,,1061,795.75,,976.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,551.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,986.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,954.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,954.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1029.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1061,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,551.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1029.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,795.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1018.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,551.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,795.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,795.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,551.72,1061,
INJECTION ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV (TC/PC),78001750G,CDM,361,RC,64484,HCPCS,Outpatient,,,908,681,,835.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,472.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,844.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,817.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,817.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,880.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,908,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,472.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,880.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,681,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,871.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,472.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,681,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,681,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,472.16,908,
TRANSVERSUS ABDIMINIS PLANE BLOCK W/GUIDANCE (TC/PC),78001752G,CDM,361,RC,64486,HCPCS,Outpatient,,,1021,765.75,,939.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,530.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,949.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,918.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,918.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,990.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1021,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,530.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,990.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,765.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,980.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,530.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,765.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,765.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,530.92,1021,
TRANSVERSUS ABDIMINIS PLANE BLOCK W/GUIDANCE,78001752,CDM,361,RC,64486,HCPCS,Outpatient,,,1021,765.75,,939.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,530.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,949.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,918.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,918.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,990.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1021,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,530.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,990.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,765.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,980.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,530.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,765.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,765.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,530.92,1021,
TAP BLOCK BILATERAL BY INJECTION(S),78001754,CDM,361,RC,64488,HCPCS,Outpatient,,,1575,1181.25,,1449,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,819,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1464.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1417.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1417.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1527.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1575,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,819,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1527.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1181.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1512,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,819,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1181.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1181.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819,1575,
TAP BLOCK BILATERAL BY INJECTION(S) (TC/PC),78001754G,CDM,361,RC,64488,HCPCS,Outpatient,,,1575,1181.25,,1449,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,819,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1464.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1417.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1417.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1527.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1575,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,819,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1527.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1181.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1512,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,819,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1181.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1181.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819,1575,
INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 1 LVL  (TC/PC),78001756G,CDM,361,RC,64490,HCPCS,Outpatient,,,1558,1168.5,,1433.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,810.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1448.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1402.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1402.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1511.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1558,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,810.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1511.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1168.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1495.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,810.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1168.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1168.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,810.16,1558,
INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL,78001756,CDM,361,RC,64490,HCPCS,Outpatient,,,2923,2192.25,,2689.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2718.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2630.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2630.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2835.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2923,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2835.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2806.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1519.96,2923,
INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 2ND LVL,78001758,CDM,361,RC,64491,HCPCS,Outpatient,,,3215,2411.25,,2957.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1671.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2989.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2893.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2893.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3118.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3215,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1671.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3118.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2411.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3086.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1671.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2411.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2411.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1671.8,3215,
INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 2ND LVL (TC/PC),78001758G,CDM,361,RC,64491,HCPCS,Outpatient,,,853,639.75,,784.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,793.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,767.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,767.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,827.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,853,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,827.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,818.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,443.56,853,
INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL,78001760,CDM,361,RC,64492,HCPCS,Outpatient,,,3507,2630.25,,3226.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1823.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3261.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3156.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3156.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3401.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1823.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3401.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2630.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3366.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1823.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2630.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2630.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1823.64,3507,
INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL,78001762,CDM,361,RC,64493,HCPCS,Outpatient,,,1584,1188,,1457.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1473.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1425.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1425.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1536.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1584,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1536.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1520.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,823.68,1584,
INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 1 LVL  (TC/PC),78001762G,CDM,361,RC,64493,HCPCS,Outpatient,,,1584,1188,,1457.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1473.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1425.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1425.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1536.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1584,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1536.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1520.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,823.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1188,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,823.68,1584,
INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LVL,78001764,CDM,361,RC,64494,HCPCS,Outpatient,,,2059,1544.25,,1894.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1914.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2059,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1976.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1070.68,2059,
INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LVL (TC/PC),78001764G,CDM,361,RC,64494,HCPCS,Outpatient,,,2059,1544.25,,1894.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1914.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2059,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1976.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1070.68,2059,
INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL (TC/PC,78001766G,CDM,361,RC,64495,HCPCS,Outpatient,,,2059,1544.25,,1894.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1914.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2059,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1976.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1070.68,2059,
INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL,78001766,CDM,361,RC,64495,HCPCS,Outpatient,,,2059,1544.25,,1894.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1914.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1853.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2059,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1997.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1976.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1070.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1544.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1070.68,2059,
INJECTION ANES AGENT SPHENOPALATINE GANGLION,78001768,CDM,361,RC,64505,HCPCS,Outpatient,,,687,515.25,,632.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,357.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,638.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,618.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,618.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,666.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,687,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,357.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,666.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,515.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,659.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,357.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,515.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,515.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357.24,687,
INJECTION ANES AGENT SPHENOPALATINE GANGLION (TC/PC),78001768G,CDM,361,RC,64505,HCPCS,Outpatient,,,687,515.25,,632.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,357.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,638.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,618.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,618.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,666.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,687,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,357.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,666.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,515.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,659.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,357.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,515.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,515.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357.24,687,
64510 NJX Stellate Ganglion Block - Tech,78002802,CDM,361,RC,64510,HCPCS,Outpatient,,,1681,1260.75,,1546.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,874.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1563.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1512.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1512.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1630.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1681,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,874.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1630.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1260.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1613.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,874.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1260.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1260.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,874.12,1681,
64520 NJX Lumbar Thoracic Paravertebral Block - Tech,78001770,CDM,361,RC,64520,HCPCS,Outpatient,,,1777,1332.75,,1634.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,924.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1652.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1599.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1599.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1723.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1777,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,924.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1723.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1332.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1705.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,924.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1332.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1332.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,924.04,1777,
DESTRUCTION NEUROLYTIC AGENT INTERCOSTAL NERVE,78001772,CDM,361,RC,64620,HCPCS,Outpatient,,,1886,1414.5,,1735.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,980.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1753.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1697.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1697.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1829.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1886,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,980.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1829.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1414.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1810.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,980.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1414.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1414.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,980.72,1886,
DESTRUCTION NEUROLYTIC AGENT INTERCOSTAL NERVE (TC/PC),78001772G,CDM,361,RC,64620,HCPCS,Outpatient,,,1886,1414.5,,1735.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,980.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1753.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1697.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1697.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1829.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1886,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,980.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1829.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1414.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1810.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,980.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1414.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1414.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,980.72,1886,
DESTRUCTION NEUROLYTIC AGENT GENICULAR NRVE W/IMG,78001774,CDM,361,RC,64624,HCPCS,Outpatient,,,3046,2284.5,,2802.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1583.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2832.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2741.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2741.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2954.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3046,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1583.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2954.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2284.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2924.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1583.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2284.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2284.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1583.92,3046,
DESTRUCTION NEUROLYTIC AGENT GENICULAR NRVE W/IMG (TC/PC),78001774G,CDM,361,RC,64624,HCPCS,Outpatient,,,3046,2284.5,,2802.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1583.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2832.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2741.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2741.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2954.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3046,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1583.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2954.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2284.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2924.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1583.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2284.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2284.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1583.92,3046,
DESTRUCTION NEURO AGENT PARVERTEB FCT SGL CRVCL/THOR (TC/PC),78001776G,CDM,361,RC,64633,HCPCS,Outpatient,,,2374,1780.5,,2184.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1234.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2207.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2136.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2136.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2302.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2374,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1234.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2302.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1780.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2279.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1234.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1780.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1780.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1234.48,2374,
DESTRUCTION NEUROLYTIC AGENT PARVERTEB FCT SNGL CRVCL/THOR,78001776,CDM,361,RC,64633,HCPCS,Outpatient,,,2374,1780.5,,2184.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1234.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2207.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2136.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2136.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2302.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2374,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1234.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2302.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1780.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2279.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1234.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1780.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1780.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1234.48,2374,
DESTRUCTION NEURO AGNT PARVERTEB FCT ADDL CRVCL/THOR (TC/PC),78001778G,CDM,361,RC,64634,HCPCS,Outpatient,,,1107,830.25,,1018.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,575.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1029.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,996.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,996.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1073.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1107,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,575.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1073.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,830.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1062.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,575.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,830.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,830.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,575.64,1107,
DESTRUCTION NEUROLYTIC AGENT PARVERTEB FCT ADDL CRVCL/THOR,78001778,CDM,361,RC,64634,HCPCS,Outpatient,,,1107,830.25,,1018.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,575.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1029.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,996.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,996.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1073.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1107,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,575.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1073.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,830.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1062.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,575.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,830.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,830.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,575.64,1107,
DESTRUCTION NEUROLYTIC AGENT PARVERTEB FCT SNGL LMBR/SACRL,78001780,CDM,361,RC,64635,HCPCS,Outpatient,,,2614,1960.5,,2404.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1359.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2431.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2352.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2352.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2535.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2614,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1359.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2535.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1960.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2509.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1359.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1960.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1960.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1359.28,2614,
DESTRUCTION NEURO AGNT PARVERTEB FCT SNGL LMBR/SACRL (TC/PC),78001780G,CDM,361,RC,64635,HCPCS,Outpatient,,,2614,1960.5,,2404.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1359.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2431.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2352.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2352.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2535.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2614,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1359.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2535.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1960.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2509.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1359.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1960.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1960.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1359.28,2614,
DESTRUCTION NEUROLYTIC AGENT PARVERTEB FCT ADDL LUMBAR/SACRA,78001784,CDM,361,RC,64636,HCPCS,Outpatient,,,1332,999,,1225.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,692.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1238.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1198.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1198.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1292.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1332,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,692.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1292.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,999,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1278.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,692.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,999,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,999,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,692.64,1332,
DESTRUCTION NEURO AGENT PARVERTEB FCT ADDL LMBR/SCRL (TC/PC),78001784G,CDM,361,RC,64636,HCPCS,Outpatient,,,1332,999,,1225.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,692.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1238.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1198.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1198.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1292.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1332,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,692.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1292.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,999,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1278.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,692.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,999,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,999,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,692.64,1332,
DESTRUCTION NEUROLYTIC AGENT OTHER PERIPHERAL NERVE,78001786,CDM,361,RC,64640,HCPCS,Outpatient,,,1353,1014.75,,1244.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,703.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1258.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1217.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1217.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1312.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1353,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,703.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1312.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1014.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1298.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,703.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1014.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1014.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,703.56,1353,
DESTRUCTION NEUROLYTIC AGENT OTHER PERIPHERAL NERVE (TC/PC),78001786G,CDM,361,RC,64640,HCPCS,Outpatient,,,1353,1014.75,,1244.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,703.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1258.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1217.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1217.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1312.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1353,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,703.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1312.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1014.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1298.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,703.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1014.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1014.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,703.56,1353,
UNLISTED PROCEDURE NERVOUS SYSTEM,78001795,CDM,361,RC,64999,HCPCS,Outpatient,,,1247,935.25,,1147.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,648.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1159.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1122.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1122.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1209.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,648.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1209.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,935.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1197.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,648.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,935.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,935.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,648.44,1247,
UNLISTED PROCEDURE NERVOUS SYSTEM (TC/PC),78001795G,CDM,361,RC,64999,HCPCS,Outpatient,,,1247,935.25,,1147.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,648.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1159.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1122.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1122.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1209.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,648.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1209.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,935.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1197.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,648.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,935.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,935.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,648.44,1247,
OXYGEN PER HOUR,74000029,CDM,270,RC,,,Outpatient,,,14.83,11.12,,13.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,7.71,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,13.35,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,13.35,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,14.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.83,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,7.71,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,14.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,11.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,7.71,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7.71,14.83,
US GUIDANCE NEEDLE PLACEMENT IMG SI,72600031,CDM,402,RC,76942,HCPCS,Outpatient,,,720,540,,662.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,374.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,669.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,648,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,648,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,698.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,720,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,374.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,698.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,540,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,691.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,374.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,540,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,540,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,374.4,720,
XR FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,71800466,CDM,320,RC,77002,HCPCS,Outpatient,,,678,508.5,,623.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,630.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,610.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,610.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,678,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,657.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,650.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,352.56,678,
XR FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,71800468,CDM,320,RC,77003,HCPCS,Outpatient,,,348,261,,320.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,180.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,323.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,313.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,313.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,337.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,348,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,180.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,261,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,334.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,180.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.96,348,
DRUG SCREEN SINGLE,70200065,CDM,300,RC,80307,HCPCS,Outpatient,,,248,186,,228.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,230.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,240.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,248,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.96,248,
INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,66100019,CDM,260,RC,96360,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,437.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,423,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,423,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,455.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,470,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,455.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,451.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.4,470,
INFUSION HYDRATION EACH ADDITIONAL HOUR,66100020,CDM,260,RC,96361,HCPCS,Outpatient,,,140,105,,128.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,140,
INFUSION EACH ADDITIONAL HOUR,66100022,CDM,260,RC,96366,HCPCS,Outpatient,,,139,104.25,,127.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.28,139,
INFUSION ADDL SEQUENTIAL NEW DRUG FIRST HOUR,66100023,CDM,260,RC,96367,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
INFUSION IV CONCURRENT,66100024,CDM,260,RC,96368,HCPCS,Outpatient,,,401,300.75,,368.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,208.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,372.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,360.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,360.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,388.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,401,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,208.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,388.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,300.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,384.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,208.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,300.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,300.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,208.52,401,
INJECTION SUBQ OR IM,66100025,CDM,260,RC,96372,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
INJECTION INTRA-ARTERIAL,66100026,CDM,260,RC,96373,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,315,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,163.8,315,
INJECTION IV PUSH SINGLE OR INITIAL DRUG,66100027,CDM,260,RC,96374,HCPCS,Outpatient,,,312,234,,287.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,312,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,299.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,162.24,312,
INJECTION IV PUSH EACH NEW DRUG,66100028,CDM,260,RC,96375,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
INJECTION EACH ADD'L SEQ IV PUSH SAME DRUG,66100029,CDM,260,RC,96376,HCPCS,Outpatient,,,132,99,,121.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,132,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.64,132,
CHEMOTHERAPY SUBQ/IM ADMN NON-HORMONAL ANTI-NEO,66100030,CDM,331,RC,96401,HCPCS,Outpatient,,,1083,812.25,,996.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,563.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1007.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,974.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,974.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1050.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1083,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,563.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1050.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,812.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1039.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,563.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,812.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,812.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,563.16,1083,
CHEMOTHERAPY SUBQ/IM ADMIN HORMONAL ANTI-NEO,66100031,CDM,331,RC,96402,HCPCS,Outpatient,,,420,315,,386.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,390.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,378,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,378,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,407.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,420,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,407.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,403.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,218.4,420,
CHEMOTHERAPY IV PUSH SINGLE OR INITIAL SUBSTANCE,66100037,CDM,331,RC,96409,HCPCS,Outpatient,,,388,291,,356.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,360.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,388,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,372.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.76,388,
CHEMOTHERAPY IV PUSH EACH ADD'L SUBSTANCE,66100032,CDM,335,RC,96411,HCPCS,Outpatient,,,334,250.5,,307.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,173.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,310.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,300.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,300.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,323.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,334,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,173.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,323.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,250.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,320.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,173.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,250.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,173.68,334,
CHEMOTHERAPY IV INFUSION UP TO 1HR INITIAL SUBS,66100033,CDM,335,RC,96413,HCPCS,Outpatient,,,544,408,,500.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,282.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,505.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,489.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,489.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,527.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,544,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,282.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,527.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,408,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,522.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,282.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,408,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,408,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,282.88,544,
CHEMOTHERAPY IV INFUSION EACH ADD'L HR,66100034,CDM,335,RC,96415,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,101.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,181.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,175.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,175.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,189.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,101.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,189.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,146.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,187.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,101.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,146.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.4,195,
CHEMOTHERAPY IV ADMIN W/PUMP PROLONGED,66100038,CDM,335,RC,96416,HCPCS,Outpatient,,,704,528,,647.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,366.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,654.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,633.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,633.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,682.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,704,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,366.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,682.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,528,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,675.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,366.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,528,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,528,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,366.08,704,
CHEMOTHERAPY EACH ADD'L SEQUENTIAL INFUS <=1 HR,66100035,CDM,335,RC,96417,HCPCS,Outpatient,,,230,172.5,,211.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,119.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,213.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,207,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,207,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,223.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,230,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,119.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,223.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,172.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,220.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,119.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.6,230,
CHEMOTHERAPY ADMIN INTRA-ARTERIAL UP TO 1 HOUR,66100039,CDM,335,RC,96422,HCPCS,Outpatient,,,727,545.25,,668.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,378.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,676.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,654.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,654.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,705.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,727,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,378.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,705.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,545.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,378.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,545.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,545.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,378.04,727,
CHEMOTHERAPY ADMIN INTRA-ARTERIAL EA ADD'L HR,66100040,CDM,335,RC,96423,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.64,82,
IRRIGATION IMPLNTD VENOUS ACCESS DRUG DLVRY SYS,66100036,CDM,361,RC,96523,HCPCS,Outpatient,,,156,117,,143.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,81.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,145.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,140.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,140.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,151.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,156,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,81.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,117,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,81.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,117,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.12,156,
CONSCIOUS SEDATION SAME MD 5+ YRS INIT 15 MIN,68500013,CDM,370,RC,99152,HCPCS,Outpatient,,,805,603.75,,740.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,418.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,748.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,724.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,724.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,780.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,805,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,418.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,780.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,603.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,772.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,418.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,603.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,418.6,805,
CONSCIOUS SEDATION SAME MD EA ADDL 15 MIN,68500015,CDM,370,RC,99153,HCPCS,Outpatient,,,202,151.5,,185.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,187.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,195.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,202,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,195.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,193.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.04,202,
INFUSION FIRST DRUG INITIAL HOUR,66100021,CDM,260,RC,96365,HCPCS,Outpatient,,,468,351,,430.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,243.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,435.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,421.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,421.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,453.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,468,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,243.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,453.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,351,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,449.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,243.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,351,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,351,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,243.36,468,
CAR SEAT CHALLENGE 60 MINUTES,65000006,CDM,920,RC,94780,HCPCS,Outpatient,,,226,169.5,,207.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,219.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,226,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,219.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,117.52,226,
CAR SEAT CHALLENGE ADDL 30MIN,65000007,CDM,920,RC,94781,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,78.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,78.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,84.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.24,87,
LABOR  DELIVERY PROCEDURE LEVEL 1,60500002,CDM,720,RC,,,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.2,135,
SCREENING TEST PURE TONE AIR ONLY,65000005,CDM,470,RC,92551,HCPCS,Outpatient,,,357,267.75,,328.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,357,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.64,357,
ANAEROBIC CULTURE,70200881,CDM,300,RC,87075,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.12,106,
BLOOD CULTURE,70200876,CDM,300,RC,87040,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.36,143,
Blood Culture x 2Blood Culture x 2,7.02E+15,CDM,300,RC,8704087040,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.36,143,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
FUNGUS CULTURE NOT SKIN OR BLOOD,70200888,CDM,300,RC,87102,HCPCS,Outpatient,,,184,138,,169.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,171.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,165.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,165.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,178.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,184,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,178.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,176.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.68,184,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
GRAM STAIN,70200902,CDM,300,RC,87205,HCPCS,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.56,78,
STREP A CULTURE,70200886,CDM,300,RC,87081,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,74.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.04,77,
DETECTION TEST FOR STREPTOCOCCUS GROUP B (BACTERIA),70200980,CDM,300,RC,87802,HCPCS,Outpatient,,,159,119.25,,146.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,159,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.68,159,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
Micro Sensitivty,70200898,CDM,300,RC,87186,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104,200,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
STOOL CULTURE AEROBIC BACTERIAL,70200877,CDM,300,RC,87045,HCPCS,Outpatient,,,180,135,,165.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,180,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.6,180,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
URINE CULTURE BACTERIAL QUANTTATIVE,70200887,CDM,300,RC,87086,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,118,
BACTERIAL CULTURE,70200878,CDM,300,RC,87070,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
HAND OR FINGER PROCEDURE,78000749,CDM,361,RC,26989,HCPCS,Outpatient,,,442,331.5,,406.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,411.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,397.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,442,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,428.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,424.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,229.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,229.84,442,
VENIPUNCTURE <3 YRS PHY/QHP SKILL FEMRL/JGLR VN,78001293,CDM,361,RC,36400,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.6,30,
VENIPNCTURE 3 YEARS/> REQUIRING SKILL OF MD OR QHP,78001295,CDM,361,RC,36410,HCPCS,Outpatient,,,322,241.5,,296.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,299.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,289.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,289.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,312.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,322,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,312.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,309.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,167.44,322,
I&D PERIANAL ABSCESS SUPERFICIAL,78001459G,CDM,361,RC,46050,HCPCS,Outpatient,,,1412,1059,,1299.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,734.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1313.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1270.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1270.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1369.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1412,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,734.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1369.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1059,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1355.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,734.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1059,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1059,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,734.24,1412,
INJECTION ANES LUMBAR/THORACIC PARAVERTBRL SYMPATHETIC,78001770,CDM,361,RC,64520,HCPCS,Outpatient,,,1777,1332.75,,1634.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,924.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1652.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1599.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1599.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1723.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1777,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,924.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1723.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1332.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1705.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,924.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1332.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1332.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,924.04,1777,
IMMUNIZATION ADMINISTRATION EACH ADD'L VACCINE,78001827,CDM,771,RC,90472,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.64,82,
FIRST HOUR OBSERVATION CHARGE,60200014,CDM,762,RC,,,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,94.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,168.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,162.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,175.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,181,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,94.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,175.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,135.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,173.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,94.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.12,181,
IMMUNIZATION ADMINISTRATION ONE VACCINE,78001826,CDM,771,RC,90471,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,293.79,
PUNCH BIOPSY SKIN SINGLE LESION,78000054,CDM,361,RC,11104,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,288,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.76,288,
PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000056,CDM,361,RC,11105,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING,78001280,CDM,361,RC,32555,HCPCS,Outpatient,,,1741,1305.75,,1601.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,905.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1619.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1566.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1566.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1688.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1741,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,905.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1688.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1305.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1671.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,905.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1305.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1305.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,905.32,1741,
INSERT/REPLACE TEMP LEAD SINGLE CHAMBER PACEMKER,78002229,CDM,361,RC,33210,HCPCS,Outpatient,,,8879,6659.25,,8168.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4617.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8257.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,7991.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7991.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8612.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8879,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4617.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8612.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,6659.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8523.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4617.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6659.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6659.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4617.08,8879,
VENIPNCTURE 3 YEARS/> REQUIRING SKILL OF MD OR QHP,78001295,CDM,361,RC,36410,HCPCS,Outpatient,,,322,241.5,,296.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,299.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,289.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,289.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,312.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,322,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,312.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,309.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,167.44,322,
INSERT TUNNELED CVAD W/SUBQ PUMP,78002233,CDM,361,RC,36563,HCPCS,Outpatient,,,3785,2838.75,,3482.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1968.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3520.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3406.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3406.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3671.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3785,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1968.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3671.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2838.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3633.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1968.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2838.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2838.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1968.2,3785,
INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION AGE 5 YR/>,78001319,CDM,361,RC,36569,HCPCS,Outpatient,,,2405,1803.75,,2212.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1250.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2236.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2164.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2164.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2332.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2405,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1250.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2332.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1803.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2308.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1250.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1803.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1803.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1250.6,2405,
INSERT CENTRAL VENOUS CATHETER FOR INFUSION W/PORT AGE 5 YR/,78001321,CDM,361,RC,36571,HCPCS,Outpatient,,,3730,2797.5,,3431.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1939.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3468.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3357,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3357,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3618.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3730,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1939.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3618.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2797.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3580.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1939.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2797.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2797.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1939.6,3730,
REPAIR TUNNELED CV CATHETER,78002239,CDM,361,RC,36575,HCPCS,Outpatient,,,1185,888.75,,1090.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,616.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1102.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1066.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1066.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1149.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1185,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,616.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1149.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,888.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1137.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,616.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,888.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,888.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,616.2,1185,
REPLACE TUNNELED CV CATHETER,78002241,CDM,361,RC,36578,HCPCS,Outpatient,,,3629,2721.75,,3338.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1887.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3374.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3266.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3266.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3520.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3629,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1887.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3520.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2721.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3483.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1887.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2721.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2721.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1887.08,3629,
REPLACE NON-TUNNELED CV CATHETER,78002243,CDM,361,RC,36580,HCPCS,Outpatient,,,1751,1313.25,,1610.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,910.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1628.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1575.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1575.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1698.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1751,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,910.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1698.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1313.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1680.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,910.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1313.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1313.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,910.52,1751,
REPLACE TUNNELED CV CATHETER,78002245,CDM,361,RC,36581,HCPCS,Outpatient,,,4735,3551.25,,4356.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2462.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4403.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4261.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4261.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4592.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4735,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2462.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4592.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4545.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2462.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2462.2,4735,
REPLACE PICC W/O PORT/PUMP THROUGH ACCESS SITE,78002251,CDM,361,RC,36584,HCPCS,Outpatient,,,3004,2253,,2763.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1562.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2793.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2703.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2703.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2913.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3004,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1562.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2913.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2253,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2883.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1562.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2253,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2253,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1562.08,3004,
REPLACE PICC VAD CATH W/PORT THROUGH ACCESS SITE,78002253,CDM,361,RC,36585,HCPCS,Outpatient,,,7269,5451.75,,6687.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3779.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6760.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6542.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6542.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7050.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7269,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3779.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7050.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5451.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6978.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3779.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5451.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5451.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3779.88,7269,
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE,78001334,CDM,300,RC,36591,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.36,143,
COLLECT BLOOD FROM CATHETER VENOUS NOS,78001336,CDM,361,RC,36592,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.36,143,
DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CTH,78001338,CDM,361,RC,36593,HCPCS,Outpatient,,,469,351.75,,431.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,243.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,436.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,422.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,422.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,454.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,469,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,243.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,454.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,351.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,450.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,243.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,351.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,351.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,243.88,469,
INSERT ARTERIAL CATHETER FOR BLOOD SAMPLING OR INFUSION,78002266,CDM,361,RC,36625,HCPCS,Outpatient,,,582,436.5,,535.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,302.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,541.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,523.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,523.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,564.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,582,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,302.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,564.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,436.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,558.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,302.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,436.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,436.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.64,582,
NASO/ORO-GASTRIC TUBE PLMT REQ PHYS  and  FLUOR GUIDE,78001419,CDM,361,RC,43752,HCPCS,Outpatient,,,386,289.5,,355.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,200.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,358.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,347.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,347.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,374.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,386,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,200.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,374.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,289.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,370.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,200.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,289.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,289.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,200.72,386,
ABDOMINAL PARACENTESIS DX/THER W/IMAGING GUIDANCE,78001497,CDM,361,RC,49083,HCPCS,Outpatient,,,1768,1326,,1626.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,919.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1644.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1591.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1591.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1714.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1768,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,919.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1714.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1326,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1697.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,919.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1326,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1326,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,919.36,1768,
INSERT NON-NDWELLG BLADDER CATHETER,78001532,CDM,761,RC,51701,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,166.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,166.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,179.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,185,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,179.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.2,185,
INSERT  and  PLACE FLOW DIRECTED CATHETER,78002231,CDM,361,RC,93503,HCPCS,Outpatient,,,3788,2841,,3484.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1969.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3522.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3409.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3409.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3674.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3788,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1969.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3674.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2841,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3636.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1969.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2841,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2841,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1969.76,3788,
DERMATOLOGICAL SERVICE OR PROCEDURE PHOTOTHERAPY,78002862,CDM,940,RC,96999,HCPCS,Outpatient,,,361,270.75,,332.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,335.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,324.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,324.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,350.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,361,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,350.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,346.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,187.72,361,
NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQCM,78001867,CDM,361,RC,97605,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.6,330,
NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM,78001869,CDM,361,RC,97606,HCPCS,Outpatient,,,587,440.25,,540.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,305.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,545.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,528.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,528.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,569.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,587,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,305.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,569.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,440.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,563.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,305.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,440.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,440.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,305.24,587,
NEGATIVE PRESSURE WOUND THERAPY NON DME </= 50 SQ CM,78001871,CDM,361,RC,97607,HCPCS,Outpatient,,,563,422.25,,517.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,292.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,523.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,506.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,506.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,546.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,563,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,292.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,546.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,422.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,540.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,292.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,422.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,422.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,292.76,563,
NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM,78001873,CDM,361,RC,97608,HCPCS,Outpatient,,,546,409.5,,502.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,507.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,546,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,283.92,546,
NEW PATIENT VISIT LEVEL 3,78001895G,CDM,761,RC,99203,HCPCS,Outpatient,,,219,164.25,,201.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,203.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,219,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.88,219,
CRITICAL CARE FIRST 30-74 MIN,68500046,CDM,361,RC,99291,HCPCS,Outpatient,,,2399,1799.25,,2207.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1247.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2231.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2159.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2159.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2327.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2399,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1247.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2327.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1799.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2303.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1247.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1799.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1799.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1247.48,2399,
CRITICAL CARE EA ADDL 30 MIN,68500049,CDM,361,RC,99292,HCPCS,Outpatient,,,526,394.5,,483.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,273.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,489.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,473.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,473.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,510.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,526,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,273.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,510.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,394.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,504.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,273.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,394.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273.52,526,
PSYCH DIAG EVAL W/MED SRVCS,78002426,CDM,450,RC,90792,HCPCS,Outpatient,,,153,114.75,,140.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,142.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,148.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,153,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.56,153,
PUNCH BIOPSY SKIN SINGLE LESION,78000054,CDM,361,RC,11104,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,288,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.76,288,
TELEHEALTH ORIGINATING SITE FEE,68500061,CDM,761,RC,Q3014,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,
TELEHEALTH ORIGINATING SITE FEE (ED),68500061,CDM,780,RC,Q3014,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,
TELEHEALTH ORIGINATING SITE FEE (FLOOR),68500061,CDM,780,RC,Q3014,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,
DIABETES SELF-MANAGE TRAIN INDIVIDUAL EA 30MIN,75000001,CDM,942,RC,G0108,HCPCS,Outpatient,,,117,87.75,,107.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,105.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.84,117,
DIABETES SELF-MANAGEMENT TRAINING GROUP EA 30MIN,75000002,CDM,942,RC,G0109,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,
CHEMOTHERAPY SUBQ/IM ADMN NON-HORMONAL ANTI-NEO,66100030,CDM,331,RC,96401,HCPCS,Outpatient,,,239,179.25,,219.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,124.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,222.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,215.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,215.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,231.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,239,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,124.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,179.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,229.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,124.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,179.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,179.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,124.28,239,
CHEMOTHERAPY SUBQ/IM ADMIN HORMONAL ANTI-NEO,66100031,CDM,331,RC,96402,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,120,
CHEMOTHERAPY IV PUSH EACH ADD'L SUBSTANCE,66100032,CDM,335,RC,96411,HCPCS,Outpatient,,,243,182.25,,223.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,126.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,218.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,218.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,235.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,243,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,126.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,235.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,182.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,233.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,126.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.36,243,
FINE NEEDLE ASPIRATION BX W/US GDN EA ADD'L,78002853,CDM,402,RC,10006,HCPCS,Outpatient,,,665,498.75,,611.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,345.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,618.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,598.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,598.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,645.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,665,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,345.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,645.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,498.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,638.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,345.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,498.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,498.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,345.8,665,
TENDON SHEATH INCISION,78000659,CDM,361,RC,26055,HCPCS,Outpatient,,,2297,1722.75,,2113.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1194.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2136.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2067.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2067.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2228.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2297,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1194.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2228.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2205.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1194.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1194.44,2297,
INSERT NON-NDWELLG BLADDER CATHETER,78001532,CDM,761,RC,51701,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
INSERT TEMP INDWELLING BLADDER CATHETER SIMPLE,78001534,CDM,761,RC,51702,HCPCS,Outpatient,,,217,162.75,,199.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,112.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,195.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,195.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,210.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,217,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,112.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,162.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,208.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,112.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,162.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,162.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.84,217,
INSERT OR REINSERT TEMP INDWELLING BLADDER CATHETER COMPLICA,78001536,CDM,761,RC,51703,HCPCS,Outpatient,,,299,224.25,,275.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,278.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,269.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,269.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,290.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,299,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,287.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.48,299,
GLUCOSE BLOOD GLUCOSCAN/METER FINGER STICK,70200322,CDM,300,RC,82962,HCPCS,Outpatient,,,68,51,,62.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,65.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.36,68,
BLOOD OCCULT FECES,70200202,CDM,300,RC,82270,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
PROTHROMBIN TIME (FINGER STICK),70200608,CDM,300,RC,85610,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
PT PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20MIN,74300017,CDM,424,RC,97164,HCPCS,Outpatient,,,171,128.25,,157.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,88.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,159.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,153.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,153.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,165.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,171,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,88.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,128.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,88.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.92,171,
PT GAIT TRAINING EACH 15 MIN,74300011,CDM,420,RC,97116,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.12,106,
PT GAIT TRAINING EACH 15 MIN,74300011,CDM,420,RC,97116,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.12,106,
PT MYOFACIAL RELEASE EACH 15 MINUTES,74300012,CDM,420,RC,97140,HCPCS,Outpatient,,,137,102.75,,126.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,71.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,123.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,123.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,132.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,137,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,71.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,102.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,131.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,71.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.24,137,
PT MYOFACIAL RELEASE EACH 15 MINUTES,74300012,CDM,420,RC,97140,HCPCS,Outpatient,,,137,102.75,,126.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,71.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,123.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,123.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,132.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,137,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,71.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,102.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,131.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,71.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.24,137,
PT NEUROMUSCULAR RE-EDUCATION EACH 15 MIN,74300010,CDM,420,RC,97112,HCPCS,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.76,138,
PT NEUROMUSCULAR RE-EDUCATION EACH 15 MIN,74300010,CDM,420,RC,97112,HCPCS,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.76,138,
REMOVAL DEVITALIZD TISS N-SLCTV DBRDMT W/O ANES,78001866,CDM,420,RC,97602,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
PT ORTHOTIC MGMTTRAINJ UXTR LXTR/TRNK EA 15,74300022,CDM,420,RC,97760,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.72,111,
CANALITH REPOSITIONING PROCEDURE,78001859,CDM,420,RC,95992,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,120,
PT PHYSICAL THERAPY EVAL HIGH COMPLEX 45 MINS,74300016,CDM,424,RC,97163,HCPCS,Outpatient,,,347,260.25,,319.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,180.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,322.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,312.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,312.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,336.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,347,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,180.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,336.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,260.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,333.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,180.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,260.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,260.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.44,347,
PT PHYSICAL THERAPY EVAL LOW COMPLEX 20 MINS,74300014,CDM,424,RC,97161,HCPCS,Outpatient,,,238,178.5,,218.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,123.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,221.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,214.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,214.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,230.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,238,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,123.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,230.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,178.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,228.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,123.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,178.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,178.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.76,238,
PT PHYSICAL THERAPY EVAL MOD COMPLEX 30 MINS,74300015,CDM,424,RC,97162,HCPCS,Outpatient,,,284,213,,261.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,147.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,264.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,255.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,255.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,275.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,284,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,147.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,275.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,213,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,147.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,213,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.68,284,
APPLY MLT LYR COMPRS LEG BELW KNEE W/ANKLE FOOT,78001198,CDM,420,RC,29581,HCPCS,Outpatient,,,303,227.25,,278.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,272.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,272.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,293.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,303,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,293.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,290.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,157.56,303,
REMOVAL DEVITALIZD TISS N-SLCTV DBRDMT W/O ANES,78001866,CDM,420,RC,97602,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
ORTHOTIC/PROSTH MANAGE AND/OR TRAIN SUBSQ VISIT,74300026,CDM,420,RC,97763,HCPCS,Outpatient,,,110,82.5,,101.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,99,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,110,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,82.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.2,110,
PROSTHETIC MANAGEMENT TRAIN INITIAL ENCOUNTER,74300025,CDM,420,RC,97761,HCPCS,Outpatient,,,102,76.5,,93.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,53.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,91.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,91.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,98.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,102,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,53.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,76.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,53.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.04,102,
DEBRIDEMENT OPEN WOUND 20 SQ CM/<,78001862,CDM,420,RC,97597,HCPCS,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,363,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.76,363,
SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES,74400008,CDM,420,RC,97535,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.72,111,
PT WHEELCHAIR TRAN/ASSESS EACH 15 MINUTES,74300028,CDM,420,RC,97542,HCPCS,Outpatient,,,129,96.75,,118.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,116.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,125.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,129,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.08,129,
DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM,78001864,CDM,420,RC,97598,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182,350,
DEBRIDEMENT OPEN WOUND 20 SQ CM/<,78001862,CDM,420,RC,97597,HCPCS,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,363,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.76,363,
PT THERAPEUTIC ACTVITY EACH 15 MIN,74300018,CDM,420,RC,97530,HCPCS,Outpatient,,,122,91.5,,112.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,118.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,122,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,118.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,117.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.44,122,
PT THERAPEUTIC ACTVITY EACH 15 MIN,74300018,CDM,420,RC,97530,HCPCS,Outpatient,,,122,91.5,,112.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,118.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,122,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,118.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,117.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.44,122,
PT THERAPEUTIC EXCERCISES 1/> AREAS EACH 15 MIN,74300009,CDM,420,RC,97110,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
PT THERAPEUTIC EXCERCISES 1/> AREAS EACH 15 MIN,74300009,CDM,420,RC,97110,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
STRAPPING UNNA BOOT,78001196,CDM,420,RC,29580,HCPCS,Outpatient,,,309,231.75,,284.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,287.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,278.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,278.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,299.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,309,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,299.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,296.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,160.68,309,
DIPHTH/TET/ACELL PERT DTAP VACC <7 YR IM DOSE,78002139,CDM,636,RC,90700,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,103.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.16,108,
DIPHTH/TET/ACELL PERTUSSIS TDAP VACC >7 YR IM,78002133,CDM,636,RC,90715,HCPCS,Outpatient,,,239.9,179.93,,220.71,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,124.75,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,223.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,215.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,215.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,232.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,239.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,124.75,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,232.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,179.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,230.3,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,124.75,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,179.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,179.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,239.9,
AMB ZOSTER VACCINE SHINGRIX IM,78002341,CDM,636,RC,90750,HCPCS,Outpatient,,,440.17,330.13,,404.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,228.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,396.15,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,396.15,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,426.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,440.17,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,228.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,426.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,330.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,422.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,228.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,330.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,330.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,228.89,440.17,
AMB CYANOCOBALAM B-12 1000MCG/ML INJECTION,78002292,CDM,636,RC,J3420,HCPCS,Outpatient,,,43.7,32.78,,40.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,22.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,39.33,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,39.33,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,42.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.7,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,22.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,32.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.95,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,22.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.72,43.7,
AMB DEXAMETHASONE 10MG/ML INJECTION,78002761,CDM,636,RC,J1100,HCPCS,Outpatient,,,41.1,30.83,,37.81,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36.99,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.99,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,39.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.1,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30.83,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.46,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.83,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.83,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.37,41.1,
AMB TRIAMCINOLONE ACET,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,20.03,15.02,,18.43,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18.03,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18.03,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.03,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15.02,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.23,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,10.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15.02,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.02,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.42,20.03,
AMB CYANOCOBALAM B-12 1000MCG/ML INJECTION,78002292,CDM,636,RC,J3420,HCPCS,Outpatient,,,87.4,65.55,,80.41,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.45,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,78.66,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,78.66,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,84.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.45,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,65.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.9,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.45,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.45,87.4,
METHYLPREDNISOLONE ACETATE 20MG,78002154,CDM,636,RC,J1020,HCPCS,Outpatient,,,31.7,23.78,,29.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,16.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,28.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,28.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,30.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.7,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,16.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,23.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.43,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,16.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,23.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.48,31.7,
AMB TRIAMCINOLOONE ACET,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,40.06,30.05,,36.86,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.83,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36.05,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.05,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.06,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.83,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30.05,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.46,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.83,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.05,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.05,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.83,40.06,
AMB DEXAMETHASONE 4MG/ML INJECTION,78002294,CDM,636,RC,J1100,HCPCS,Outpatient,,,11.84,8.88,,10.89,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,6.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,10.66,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10.66,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,11.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.84,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,6.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,8.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.37,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,6.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6.16,11.84,
AMB DEPO-MEDROL 40MG/ML INJECTION,78002319,CDM,636,RC,J1030,HCPCS,Outpatient,,,63.4,47.55,,58.33,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.97,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,57.06,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.06,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.97,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.86,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.97,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.97,63.4,
AMB TRIAMCINOLONE ACET (KENALOG) 40MG,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,80.12,60.09,,73.71,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72.11,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.11,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.12,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.66,80.12,
AMB TRIAMCINOLONE ACET,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,120.18,90.14,,110.57,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.49,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108.16,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.16,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.18,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.49,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90.14,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.49,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90.14,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90.14,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.49,120.18,
AMB DEXAMETHASONE 4MG/ML INJECTION,78002294,CDM,636,RC,J1100,HCPCS,Outpatient,,,23.68,17.76,,21.79,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,12.31,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,21.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.68,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,12.31,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.76,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.73,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,12.31,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.76,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.76,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12.31,23.68,
AMB DEPO-MEDROL 80MG/ML INJECTION,78002320,CDM,636,RC,J1040,HCPCS,Outpatient,,,110.05,82.54,,101.25,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.23,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,99.05,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.05,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,110.05,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.23,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,82.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.65,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.23,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.23,110.05,
AMB TRIAMCINOLONE ACET (KENALOG) 40MG,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,160.24,120.18,,147.42,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,83.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,144.22,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.22,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,160.24,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,83.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,155.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,120.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.83,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,83.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.32,160.24,
IMMUNIZATION FIRST VACCINE/TOXOID THRU 18 YR,78001824,CDM,771,RC,90460,HCPCS,Outpatient,,,21.71,16.28,,19.97,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.29,21.71,
IMMUNIZATION EA ADD'L VACCINE/TOXOID THRU 18 YR,78001825,CDM,771,RC,90461,HCPCS,Outpatient,,,21.71,16.28,,19.97,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.29,21.71,
IMMUNIZATION ADMIN BY INTRANASAL OR ORAL,78001828,CDM,771,RC,90473,HCPCS,Outpatient,,,83,62.25,,76.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,74.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,74.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,
IMMUNIZATION ADMINISTRATION ORAL/NASAL EACH ADDITIONAL,78002352,CDM,771,RC,90474,HCPCS,Outpatient,,,60,45,,55.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.2,60,
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE,78001334,CDM,361,RC,36591,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.36,143,
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE,78001334,CDM,361,RC,36591,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.36,143,
BOOSTRIX,78002133,CDM,636,RC,90715,HCPCS,Outpatient,,,257.9,193.43,,237.27,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,134.11,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,232.11,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,232.11,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,250.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,257.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,134.11,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,250.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,193.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.58,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,134.11,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,193.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,193.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,257.9,
IMMUNIZATION ADMINISTRATION EACH ADD'L VACCINE,78001827,CDM,771,RC,90472,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.64,82,
IMMUNIZATION ADMINISTRATION ONE VACCINE,78001826,CDM,771,RC,90471,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,293.79,
TRAUMA ACTIVATION FULL,68500052,CDM,684,RC,G0390,HCPCS,Outpatient,,,5557,4167.75,,5112.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2889.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5168.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5001.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5001.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5390.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5557,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2889.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5390.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4167.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5334.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2889.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4167.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4167.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2889.64,5557,
ADMINISTRATION INFLUENZA VACCINE,78001822,CDM,771,RC,G0008,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,118,
ADMINISTRATION OF PNEUMOCOCCAL VACCINE,78001823,CDM,771,RC,G0009,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,118,
G0010: Medicare Hep B,78001826,CDM,771,RC,G0010,HCPCS,Outpatient,,,107,80.25,,98.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,103.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,80.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.64,107,
VAPOTHERM PER SESSION/DAY,74000017,CDM,410,RC,,,Outpatient,,,601,450.75,,552.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,312.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,558.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,540.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,540.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,582.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,601,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,312.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,582.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,450.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,576.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,312.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,450.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,450.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,312.52,601,
INJECTION SUBQ OR IM,66100025,CDM,260,RC,96372,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
INJECTION SUBQ OR IM,66100025,CDM,260,RC,96372,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
INSERT ARTERIAL CATHETER FOR BLOOD SAMPLE OR INFUSION ACCESS,78001342,CDM,361,RC,36620,HCPCS,Outpatient,,,737,552.75,,678.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,383.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,685.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,663.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,663.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,714.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,737,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,383.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,714.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,552.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,707.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,383.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,552.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,552.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,383.24,737,
COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE,78001334,CDM,300,RC,36591,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.36,143,
INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,78001263,CDM,361,RC,31500,HCPCS,Outpatient,,,878,658.5,,807.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,816.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,790.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,790.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,851.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,878,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,851.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.56,878,
AMB LEVONORGESTREL-RELEASING (KYLEENA) 19.5MG IUD,78002314,CDM,636,RC,J7296,HCPCS,Outpatient,,,3777.27,2832.95,,3475.09,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3512.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3777.27,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3626.18,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1964.18,3777.27,
AMB LEVONORGESTREL-RELEASING INTRAUTERINE (MIRENA) 52MG IUD,78002316,CDM,636,RC,J7298,HCPCS,Outpatient,,,3777.27,2832.95,,3475.09,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3512.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3777.27,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3626.18,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1964.18,3777.27,
TRAUMA ACTIVATION MODIFIED,68500064,CDM,684,RC,G0390,HCPCS,Outpatient,,,3910,2932.5,,3597.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2033.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3636.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3519,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3519,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3792.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3910,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2033.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3792.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2932.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3753.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2033.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2932.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2932.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2033.2,3910,
VFC DIPHTH/TET/ACELL PERT DTAP VACC <7 YR IM,78002134,CDM,636,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
INSERT TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>,78001317,CDM,361,RC,36561,HCPCS,Outpatient,,,6299,4724.25,,5795.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3275.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5858.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5669.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5669.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6110.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6299,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3275.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6110.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4724.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6047.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3275.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4724.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4724.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3275.48,6299,
REMOVAL DEVITALIZD TISS N-SLCTV DBRDMT W/O ANES,78001866,CDM,420,RC,97602,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
DEBRIDEMENT OPEN WOUND 20 SQ CM/<,78001862,CDM,420,RC,97597,HCPCS,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,363,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.76,363,
ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE,78001495,CDM,361,RC,49082,HCPCS,Outpatient,,,1368,1026,,1258.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,711.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1272.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1231.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1231.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1326.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1368,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,711.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1326.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1026,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1313.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,711.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1026,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1026,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,711.36,1368,
INSERTION PICC W/RS and I 5 YR/>,78001323,CDM,361,RC,36573,HCPCS,Outpatient,,,2738,2053.5,,2518.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1423.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2546.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2464.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2464.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2655.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2738,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1423.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2655.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2053.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2628.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1423.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2053.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2053.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1423.76,2738,
INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,78001263,CDM,361,RC,31500,HCPCS,Outpatient,,,878,658.5,,807.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,816.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,790.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,790.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,851.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,878,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,851.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.56,878,
AMB LEVONORGESTRE (SKYLA) 13.5MG IMPLANT,78002315,CDM,636,RC,J7301,HCPCS,Outpatient,,,3145.2,2358.9,,2893.58,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1635.5,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2925.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2830.68,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2830.68,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3050.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3145.2,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1635.5,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3050.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2358.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3019.39,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1635.5,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2358.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2358.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1635.5,3145.2,
SPINAL PUNCTURE LUMBAR DIAGNOSTIC,78001703,CDM,361,RC,62270,HCPCS,Outpatient,,,1047,785.25,,963.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,973.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,942.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,942.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1015.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1047,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1015.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1005.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,544.44,1047,
THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING,78001278,CDM,361,RC,32554,HCPCS,Outpatient,,,1351,1013.25,,1242.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,702.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1256.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1215.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1215.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1310.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1351,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,702.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1310.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1013.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1296.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,702.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1013.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1013.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,702.52,1351,
INSERT CENTRAL VENOUS CATHETER  IMPLANTED DEVICE FOR INFUSI,78001317,CDM,361,RC,36561,HCPCS,Outpatient,,,6299,4724.25,,5795.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3275.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5858.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5669.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5669.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6110.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6299,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3275.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6110.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4724.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6047.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3275.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4724.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4724.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3275.48,6299,
AMB HYLAN G-F,78002297,CDM,636,RC,J7325,HCPCS,Outpatient,,,1752,1314,,1611.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1629.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1576.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1576.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1699.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1752,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1699.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1681.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,911.04,1752,
AMB HYALURONATE SODIUM 48MG/6ML INJ,78002856,CDM,636,RC,J7325,HCPCS,Outpatient,,,4930.62,3697.97,,4536.17,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2563.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4585.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4437.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4437.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4782.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4930.62,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2563.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4782.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3697.97,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4733.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2563.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3697.97,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3697.97,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2563.92,4930.62,
ROOM/BED: Observation,60200006,CDM,762,RC,G0378,HCPCS,Outpatient,,,130,97.5,,119.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,124.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.6,130,
"49281-0400-10 - tetanus/diphtheria/pertussis, acel (Tdap) 5 units-2 units-15.5 mcg/0.5 mL IM Susp 0 mL [MEMO]",,,250,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
"50632-0010-01 - rabies vaccine, purified chick embyro cell 2.5 intl units IM Inj [MEMO]",40580066,CDM,250,RC,90675,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,293.79,
58160-0842-52 - tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2.5 units-18.5 mcg/0.5 mL Sus [MEMO],40580065,CDM,250,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
"58160-0964-12 - rabies vaccine, purified chick embyro cell 2.5 intl units IM Inj [MEMO]",40580066,CDM,250,RC,90675,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,293.79,
PT PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20MIN,74300017,CDM,424,RC,97164,HCPCS,Outpatient,,,171,128.25,,157.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,88.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,159.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,153.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,153.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,165.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,171,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,88.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,128.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,88.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.92,171,
PULMONARY STRESS TESTING 6-MINUTE WALK,74000004,CDM,410,RC,94618,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
US TRANSVAGINAL ADD-ON,72600020,CDM,402,RC,76817,HCPCS,Outpatient,,,809,606.75,,744.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,420.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,752.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,728.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,728.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,784.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,809,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,420.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,784.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,776.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,420.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,606.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,420.68,809,
US TRANSVAGINAL NON-OB,72600024,CDM,402,RC,76830,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,664.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,643.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,643.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,693.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,166.49,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,715,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,693.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,686.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.49,715,
XR DXA BONE DENSITY STUDY 1/> SITES AXIAL SKLTN,71800495,CDM,320,RC,77080,HCPCS,Outpatient,,,517,387.75,,475.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,480.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,517,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,496.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,268.84,517,
MEMO NM AMINOPHYLLINE 250MG/10ML,73000032,CDM,255,RC,J0280,HCPCS,Outpatient,,,45.15,33.86,,41.54,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,40.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,43.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,33.86,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.34,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.86,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.86,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.48,45.15,
CT ABDOMEN  and  PELVIS W/O CONTRST 1/> BODY RE,72300054,CDM,352,RC,74178,HCPCS,Outpatient,,,4790,3592.5,,4406.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2490.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4454.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4311,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4311,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4646.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,488.88,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4790,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2490.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4646.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3592.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4598.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2490.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3592.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3592.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,488.88,4790,
CT ABDOMEN  and  PELVIS W/CONTRAST MATERIAL,72300053,CDM,352,RC,74177,HCPCS,Outpatient,,,4525,3393.75,,4163,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2353,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4208.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4072.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4072.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4389.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4525,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2353,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4389.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4344,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2353,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2353,4525,
CT ABDOMEN  and  PELVIS W/O CONTRAST MATERIAL,72300052,CDM,352,RC,74176,HCPCS,Outpatient,,,4259,3194.25,,3918.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2214.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3960.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3833.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3833.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4131.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,243.33,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4259,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2214.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4131.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4088.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2214.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,243.33,4259,
CT ABDOMEN W/O  and  W/CONTRAST MATERIAL,72300050,CDM,352,RC,74170,HCPCS,Outpatient,,,2840,2130,,2612.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1476.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2641.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2556,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2556,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2754.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5548.84,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2840,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1476.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2130,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2726.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1476.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2130,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2130,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1476.8,5548.84,
CT ABDOMEN W/CONTRAST MATERIAL,72300049,CDM,352,RC,74160,HCPCS,Outpatient,,,2459,1844.25,,2262.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1278.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2286.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2213.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2213.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2385.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,426.02,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2459,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1278.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2385.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1844.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2360.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1278.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1844.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1844.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,426.02,2459,
CT ABDOMEN W/O CONTRAST MATERIAL,72300048,CDM,352,RC,74150,HCPCS,Outpatient,,,2087,1565.25,,1920.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1085.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1940.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1878.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1878.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2024.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,333.4,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2087,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1085.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2024.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1565.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2003.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1085.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1565.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1565.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,333.4,2087,
CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,72300051,CDM,352,RC,74175,HCPCS,Outpatient,,,2421,1815.75,,2227.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1258.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2251.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2178.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2178.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2348.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2421,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1258.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2348.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1815.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2324.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1258.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1815.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1815.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1258.92,2421,
CTA ABDL AORTA and BI ILIOFEM W/CONTRAST and POSTP,72300055,CDM,350,RC,75635,HCPCS,Outpatient,,,3614,2710.5,,3324.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1879.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3361.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3252.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3252.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3505.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3614,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1879.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3505.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2710.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3469.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1879.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2710.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2710.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1879.28,3614,
CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,72300013,CDM,351,RC,70496,HCPCS,Outpatient,,,1572,1179,,1446.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,817.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1461.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1414.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1414.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1524.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1572,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,817.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1524.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1179,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1509.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,817.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1179,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1179,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,817.44,1572,
CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,72300019,CDM,352,RC,71275,HCPCS,Outpatient,,,2887,2165.25,,2656.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1501.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2684.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2598.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2598.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2800.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2887,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1501.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2800.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2165.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2771.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1501.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2165.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2165.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1501.24,2887,
CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,72300019,CDM,352,RC,71275,HCPCS,Outpatient,,,2887,2165.25,,2656.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1501.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2684.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2598.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2598.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2800.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2887,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1501.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2800.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2165.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2771.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1501.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2165.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2165.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1501.24,2887,
CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,72300019,CDM,352,RC,71275,HCPCS,Outpatient,,,2887,2165.25,,2656.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1501.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2684.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2598.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2598.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2800.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2887,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1501.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2800.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2165.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2771.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1501.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2165.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2165.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1501.24,2887,
CT ANGIOGRAPHY LOWER EXTREMITY BILATERAL,72300047,CDM,352,RC,73706,HCPCS,Outpatient,,,7129.35,5347.01,,6559,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3707.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6630.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6416.42,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6416.42,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6915.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7129.35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3707.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6915.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5347.01,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6844.18,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3707.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5347.01,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5347.01,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3707.26,7129.35,
CT ANGIOGRAPHY LOWER EXTREMITY LT,72300046,CDM,352,RC,73706,HCPCS,Outpatient,,,5281,3960.75,,4858.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2746.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4911.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4752.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4752.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5122.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5281,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2746.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5122.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3960.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5069.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2746.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3960.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3960.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2746.12,5281,
CT ANGIOGRAPHY LOWER EXTREMITY RT,72300046,CDM,352,RC,73706,HCPCS,Outpatient,,,5281,3960.75,,4858.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2746.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4911.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4752.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4752.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5122.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5281,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2746.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5122.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3960.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5069.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2746.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3960.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3960.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2746.12,5281,
CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,72300014,CDM,351,RC,70498,HCPCS,Outpatient,,,2660,1995,,2447.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1383.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2473.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2394,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2394,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2580.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2660,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1383.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2580.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1995,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2553.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1383.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1995,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1995,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1383.2,2660,
CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,72300051,CDM,352,RC,74175,HCPCS,Outpatient,,,2431,1823.25,,2236.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1264.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2260.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2187.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2187.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2358.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2431,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1264.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2358.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1823.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2333.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1264.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1823.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1823.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1264.12,2431,
CT ANGIOGRAPHY UPPER EXTREMITY BIL,72300038,CDM,352,RC,73206,HCPCS,Outpatient,,,3658.5,2743.88,,3365.82,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1902.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3402.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3292.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3292.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3548.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3658.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1902.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3548.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2743.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3512.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1902.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2743.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2743.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1902.42,3658.5,
CT ANGIOGRAPHY UPPER EXTREMITY LT,72300038,CDM,352,RC,73206,HCPCS,Outpatient,,,2710,2032.5,,2493.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1409.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2520.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2439,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2439,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2628.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2710,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1409.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2628.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2032.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2601.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1409.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2032.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2032.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1409.2,2710,
CT ANGIOGRAPHY UPPER EXTREMITY RT,72300038,CDM,352,RC,73206,HCPCS,Outpatient,,,2710,2032.5,,2493.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1409.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2520.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2439,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2439,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2628.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2710,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1409.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2628.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2032.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2601.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1409.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2032.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2032.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1409.2,2710,
CT LOWER EXTREMITY W/O  and  W/CONTRAST MATRL BIL,72300045,CDM,352,RC,73702,HCPCS,Outpatient,,,6092.55,4569.41,,5605.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5666.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6092.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5848.85,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3168.13,6092.55,
CT LOWER EXTREMITY W/O  and  W/CONTRAST LT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT LOWER EXTREMITY W/O  and  W/CONTRAST RT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT LOWER EXTREMITY W/CONTRAST MATERIAL BIL,72300043,CDM,352,RC,73701,HCPCS,Outpatient,,,4359.15,3269.36,,4010.42,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4054.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4359.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4184.78,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2266.76,4359.15,
CT LOWER EXTREMITY W/CONTRAST MATERIAL LT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT LOWER EXTREMITY W/CONTRAST MATERIAL RT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT LOWER EXTREMITY W/O CONTRAST MATERIAL BIL,72300041,CDM,352,RC,73700,HCPCS,Outpatient,,,2963.25,2222.44,,2726.19,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2755.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2963.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2844.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2963.25,
CT LOWER EXTREMITY W/O CONTRAST MATERIAL LT,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CT LOWER EXTREMITY W/O CONTRAST MATERIAL RT,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,78001274,CDM,350,RC,32408,HCPCS,Outpatient,,,2672,2004,,2458.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1389.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2484.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2404.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2404.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2591.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2672,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1389.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2591.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2004,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2565.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1389.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2004,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2004,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1389.44,2672,
CT BIOPSY RETROPERITONEAL ABDOMEN,78002203,CDM,350,RC,49180,HCPCS,Outpatient,,,2264,1698,,2082.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1177.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2105.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2037.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2196.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2264,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1177.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2196.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1698,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2173.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1177.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1698,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1698,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1177.28,2264,
CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE,42000060,CDM,350,RC,77078,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,664.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,643.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,643.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,693.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,715,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,693.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,686.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,371.8,715,
CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE,72300061,CDM,350,RC,77078,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,664.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,643.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,643.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,693.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,715,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,693.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,686.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,371.8,715,
CT HEAD/BRAIN W/O  and  W/CONTRAST MATERIAL,72300003,CDM,350,RC,70470,HCPCS,Outpatient,,,2712,2034,,2495.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1410.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2522.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2440.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2440.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2630.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,437.72,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2712,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1410.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2630.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2034,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2603.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1410.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2034,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2034,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,437.72,2712,
CT HEAD/BRAIN W/CONTRAST MATERIAL,72300002,CDM,350,RC,70460,HCPCS,Outpatient,,,1861,1395.75,,1712.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,967.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1730.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1674.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1674.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1805.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,353.87,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1861,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,967.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1805.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1395.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1786.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,967.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1395.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1395.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,353.87,1861,
CT HEAD/BRAIN W/O CONTRAST MATERIAL,72300001,CDM,350,RC,70450,HCPCS,Outpatient,,,1752,1314,,1611.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1629.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1576.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1576.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1699.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,293.44,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1752,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1699.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1681.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,293.44,1752,
CT THORAX W/O  and  W/CONTRAST MATERIAL,72300017,CDM,352,RC,71270,HCPCS,Outpatient,,,2234,1675.5,,2055.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1161.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2077.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2010.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2010.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2166.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2234,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1161.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2166.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1675.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2144.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1161.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1675.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1675.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1161.68,2234,
CT THORAX W/CONTRAST MATERIAL,72300016,CDM,352,RC,71260,HCPCS,Outpatient,,,1968,1476,,1810.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1023.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1830.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1771.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1771.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1908.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1968,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1023.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1908.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1476,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1889.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1023.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1476,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1476,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1023.36,1968,
CT THORAX W/O CONTRAST MATERIAL,72300015,CDM,352,RC,71250,HCPCS,Outpatient,,,1623,1217.25,,1493.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1509.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1460.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1460.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1574.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,357.77,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1623,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1574.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1558.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357.77,1623,
CT THORAX W/O  and  W/CONTRAST MATERIAL,72300017,CDM,352,RC,71270,HCPCS,Outpatient,,,2234,1675.5,,2055.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1161.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2077.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2010.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2010.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2166.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2234,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1161.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2166.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1675.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2144.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1161.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1675.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1675.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1161.68,2234,
CT THORAX W/CONTRAST MATERIAL,72300016,CDM,352,RC,71260,HCPCS,Outpatient,,,1968,1476,,1810.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1023.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1830.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1771.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1771.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1908.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1968,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1023.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1908.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1476,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1889.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1023.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1476,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1476,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1023.36,1968,
CT THORAX W/O CONTRAST MATERIAL,72300015,CDM,352,RC,71250,HCPCS,Outpatient,,,1623,1217.25,,1493.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1509.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1460.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1460.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1574.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,357.77,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1623,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1574.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1558.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357.77,1623,
CT UPPER EXTREMITY W/O  and  W/CONTRAST BIL,72300037,CDM,352,RC,73202,HCPCS,Outpatient,,,2836.5,2127.38,,2609.58,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2552.85,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2552.85,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2751.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2836.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2751.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2723.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1474.98,2836.5,
CT UPPER EXTREMITY W/O  and  W/CONTRAST LT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT UPPER EXTREMITY W/O  and  W/CONTRAST RT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT UPPER EXTREMITY W/CONTRAST MATERIAL BIL,72300035,CDM,352,RC,73201,HCPCS,Outpatient,,,2505.6,1879.2,,2305.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2330.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2505.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2405.38,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302.91,2505.6,
CT UPPER EXTREMITY W/CONTRAST MATERIAL LT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT UPPER EXTREMITY W/CONTRAST MATERIAL RT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT CLAVICLE UPPER EXTREMITY W/O CONTRAST BIL,72300033,CDM,352,RC,73200,HCPCS,Outpatient,,,2505.6,1879.2,,2305.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2330.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2505.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2405.38,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302.91,2505.6,
CT CLAVICLE UPPER EXTREMITY W/O CONTRAST LT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT CLAVICLE UPPER EXTREMITY W/O CONTRAST RT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS and I,72300056,CDM,320,RC,75989,HCPCS,Outpatient,,,1949,1461.75,,1793.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1013.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1812.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1754.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1754.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1949,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1013.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1890.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1461.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1871.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1013.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1461.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1461.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1013.48,1949,
CT ELBOW UPPER EXTREMITY W/O  and  W/CONT BIL,72300037,CDM,352,RC,73202,HCPCS,Outpatient,,,2836.5,2127.38,,2609.58,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2552.85,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2552.85,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2751.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2836.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2751.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2723.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1474.98,2836.5,
CT ELBOW UPPER EXTREMITY W/O  and  W/CONT LT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT ELBOW UPPER EXTREMITY W/O  and  W/CONT RT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT ELBOW UPPER EXTREMITY W/CONTRAST BIL,72300035,CDM,352,RC,73201,HCPCS,Outpatient,,,2836.35,2127.26,,2609.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2552.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2552.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2751.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2836.35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2751.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2722.9,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1474.9,2836.35,
CT ELBOW UPPER EXTREMITY W/CONTRAST LT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT ELBOW UPPER EXTREMITY W/CONTRAST RT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT ELBOW UPPER EXTREMITY W/O CONTRAST BIL,72300033,CDM,352,RC,73200,HCPCS,Outpatient,,,2505.6,1879.2,,2305.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2330.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2505.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2405.38,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302.91,2505.6,
CT ELBOW UPPER EXTREMITY W/O CONTRAST LT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT ELBOW UPPER EXTREMITY W/O CONTRAST RT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT LOWER EXTREMITY W/O  and  W/CONTRAST MATRL BIL,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,6092.55,4569.41,,5605.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5666.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6092.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5848.85,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3168.13,6092.55,
CT FEMUR LOWER EXTREMITY W/O  and  W/CONTRAST LT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT FEMUR LOWER EXTREMITY W/O  and  W/CONTRAST RT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT FEMUR LOWER EXTREMITY W/CONTRAST BIL,72300043,CDM,352,RC,73701,HCPCS,Outpatient,,,4359.15,3269.36,,4010.42,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4054.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4359.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4184.78,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2266.76,4359.15,
CT FEMUR LOWER EXTREMITY W/CONTRAST LT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT FEMUR LOWER EXTREMITY W/CONTRAST RT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT FEMUR LOWER EXTREMITY W/O CONTRAST BIL,72300041,CDM,352,RC,73700,HCPCS,Outpatient,,,2963.25,2222.44,,2726.19,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2755.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2963.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2844.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2963.25,
CT FEMUR LOWER EXTREMITY W/O CONTRAST LT,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CT FEMUR LOWER EXTREMITY W/O CONTRAST RT,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CT FOOT LOWER EXTREMITY W/O  and  W/CONTRAST BIL,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,6092.55,4569.41,,5605.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5666.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6092.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5848.85,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3168.13,6092.55,
CT FOOT LOWER EXTREMITY W/O  and  W/CONTRAST LT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT FOOT LOWER EXTREMITY W/O  and  W/CONTRAST RT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT FOOT LOWER EXTREMITY W/CONTRAST BIL,72300043,CDM,352,RC,73701,HCPCS,Outpatient,,,4359.15,3269.36,,4010.42,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4054.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4359.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4184.78,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2266.76,4359.15,
CT FOOT LOWER EXTREMITY W/CONTRAST LT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT FOOT LOWER EXTREMITY W/CONTRAST RT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT FOOT LOWER EXTREMITY W/O CONTRAST BIL,72300041,CDM,352,RC,73700,HCPCS,Outpatient,,,2963.25,2222.44,,2726.19,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2755.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2963.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2844.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2963.25,
CT FOOT LOWER EXTREMITY W/O CONTRAST LT,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CT FOOT LOWER EXTREMITY W/O CONTRAST RT,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CT FOREARM UPPER EXTREMITY W/O  and  W/CONTRAST BIL,72300037,CDM,352,RC,73202,HCPCS,Outpatient,,,3099.6,2324.7,,2851.63,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2882.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3099.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2975.62,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1611.79,3099.6,
CT FOREARM UPPER EXTREMITY W/O  and  W/CONTRAST LT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT FOREARM UPPER EXTREMITY W/O  and  W/CONTRAST RT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT FOREARM UPPER EXTREMITY W/CONTRAST BIL,72300035,CDM,352,RC,73201,HCPCS,Outpatient,,,2836.35,2127.26,,2609.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2552.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2552.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2751.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2836.35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2751.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2722.9,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1474.9,2836.35,
CT FOREARM UPPER EXTREMITY W/O CONTRAST LT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT FOREARM UPPER EXTREMITY W/O CONTRAST RT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT FOREARM UPPER EXTREMITY W/O CONTRAST BIL,72300033,CDM,352,RC,73200,HCPCS,Outpatient,,,2505.6,1879.2,,2305.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2330.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2505.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2405.38,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302.91,2505.6,
CT FOREARM UPPER EXTREMITY W/O CONTRAST LT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT FOREARM UPPER EXTREMITY W/O CONTRAST RT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT GUIDANCE NEEDLE PLACEMENT,72300059,CDM,350,RC,77012,HCPCS,Outpatient,,,1341,1005.75,,1233.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,697.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1247.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1206.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1206.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1300.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1341,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,697.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1300.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1005.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1287.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,697.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1005.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1005.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.32,1341,
CT HAND UPPER EXTREMITY W/O  and  W/CONT BIL,72300037,CDM,352,RC,73202,HCPCS,Outpatient,,,3099.6,2324.7,,2851.63,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2882.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3099.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2975.62,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1611.79,3099.6,
CT HAND UPPER EXTREMITY W/O  and  W/CONT LT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT HAND UPPER EXTREMITY W/O  and  W/CONT RT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT HAND UPPER EXTREMITY W/CONTRAST BIL,72300035,CDM,352,RC,73201,HCPCS,Outpatient,,,2836.35,2127.26,,2609.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2552.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2552.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2751.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2836.35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2751.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2722.9,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1474.9,2836.35,
CT HAND UPPER EXTREMITY W/CONTRAST LT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT HAND UPPER EXTREMITY W/CONTRAST RT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT HAND UPPER EXTREMITY W/O CONTRAST BIL,72300033,CDM,352,RC,73200,HCPCS,Outpatient,,,2505.6,1879.2,,2305.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2330.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2505.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2405.38,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302.91,2505.6,
CT HAND UPPER EXTREMITY W/O CONTRAST LT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT HAND UPPER EXTREMITY W/O CONTRAST RT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT HEAD/BRAIN STROKE PROTOCOL,72300001,CDM,350,RC,70450,HCPCS,Outpatient,,,1752,1314,,1611.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1629.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1576.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1576.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1699.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,293.44,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1752,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1699.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1681.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,293.44,1752,
CT HIP LOWER EXTREMITY W/O  and  W/CONTRAST BIL,72300045,CDM,352,RC,73702,HCPCS,Outpatient,,,6092.55,4569.41,,5605.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5666.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6092.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5848.85,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3168.13,6092.55,
CT HIP LOWER EXTREMITY W/O  and  W/CONTRAST LT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT HIP LOWER EXTREMITY W/O  and  W/CONTRAST RT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT HIP LOWER EXTREMITY W/CONTRAST BIL,72300043,CDM,352,RC,73701,HCPCS,Outpatient,,,4359.15,3269.36,,4010.42,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4054.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4359.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4184.78,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2266.76,4359.15,
CT HIP LOWER EXTREMITY W/CONTRAST LT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT HIP LOWER EXTREMITY W/CONTRAST RT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT HIP LOWER EXTREMITY W/O CONTRAST BIL,72300041,CDM,352,RC,73700,HCPCS,Outpatient,,,2963.25,2222.44,,2726.19,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2755.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2963.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2844.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2963.25,
CT HIP LOWER EXTREMITY W/O CONTRAST LT,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CT HIP LOWER EXTREMITY W/O CONTRAST RT,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CT HUMERUS UPPER EXTREMITY W/O  and  W/CONT BIL,72300037,CDM,352,RC,73202,HCPCS,Outpatient,,,3099.6,2324.7,,2851.63,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2882.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3099.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2975.62,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1611.79,3099.6,
CT HUMERUS UPPER EXTREMITY W/O  and  W/CONT LT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT HUMERUS UPPER EXTREMITY W/O  and  W/CONT RT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT HUMERUS UPPER EXTREMITY W/CONTRAST BIL,72300035,CDM,352,RC,73201,HCPCS,Outpatient,,,2836.35,2127.26,,2609.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2552.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2552.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2751.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2836.35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2751.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2722.9,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1474.9,2836.35,
CT HUMERUS UPPER EXTREMITY W/CONTRAST LT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT HUMERUS UPPER EXTREMITY W/CONTRAST RT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT HUMERUS UPPER EXTREMITY W/O CONTRAST BIL,72300033,CDM,352,RC,73200,HCPCS,Outpatient,,,2505.6,1879.2,,2305.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2330.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2505.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2405.38,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302.91,2505.6,
CT HUMERUS UPPER EXTREMITY W/O CONTRAST LT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT HUMERUS UPPER EXTREMITY W/O CONTRAST RT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT KNEE LOWER EXTREMITY W/O  and  W/CONTRAST BIL,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,6092.55,4569.41,,5605.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5666.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6092.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5848.85,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3168.13,6092.55,
CT KNEE LOWER EXTREMITY W/O  and  W/CONTRAST LT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT KNEE LOWER EXTREMITY W/O  and  W/CONTRAST RT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT KNEE LOWER EXTREMITY W/CONTRAST BIL,72300043,CDM,352,RC,73701,HCPCS,Outpatient,,,4359.15,3269.36,,4010.42,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4054.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4359.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4184.78,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2266.76,4359.15,
CT KNEE LOWER EXTREMITY W/CONTRAST LT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT KNEE LOWER EXTREMITY W/CONTRAST RT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT KNEE LOWER EXTREMITY W/O CONTRAST BIL,72300041,CDM,352,RC,73700,HCPCS,Outpatient,,,2963.25,2222.44,,2726.19,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2755.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2963.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2844.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2963.25,
CT KNEE LOWER EXTREMITY W/O CONTRAST LT,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CT KNEE LOWER EXTREMITY W/O CONTRAST RT,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CT LIMITED/LOCALIZED FOLLOW UP STUDY,72300058,CDM,350,RC,76380,HCPCS,Outpatient,,,585,438.75,,538.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,304.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,544.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,526.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,526.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,567.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,585,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,304.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,567.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,438.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,561.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,304.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,438.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,304.2,585,
CT THORAX LOW DOSE LUNG CANCER SCREEN W/O CONT,72300018,CDM,352,RC,71271,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,465,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,450,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,450,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,485,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,485,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,480,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,260,500,
CT LEG LOWER EXTREMITY W/O  and  W/CONTRAST BIL,72300045,CDM,352,RC,73702,HCPCS,Outpatient,,,6092.55,4569.41,,5605.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5666.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5483.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6092.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5909.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5848.85,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3168.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4569.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3168.13,6092.55,
CT LEG LOWER EXTREMITY W/CONTRAST BIL,72300043,CDM,352,RC,73701,HCPCS,Outpatient,,,4359.15,3269.36,,4010.42,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4054.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3923.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4359.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4228.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4184.78,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3269.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2266.76,4359.15,
CT LOWER EXTREMITY W/O CONTRAST MATERIAL BIL,72300041,CDM,352,RC,73700,HCPCS,Outpatient,,,2963.25,2222.44,,2726.19,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2755.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2666.93,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2963.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2874.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2844.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1540.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2222.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2963.25,
CT MAXILLOFACIAL W/O  and  W/CONTRAST MATERIAL,72300009,CDM,350,RC,70488,HCPCS,Outpatient,,,3480,2610,,3201.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1809.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3236.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3132,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3375.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3480,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1809.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3375.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2610,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3340.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1809.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2610,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2610,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1809.6,3480,
CT MAXILLOFACIAL W/CONTRAST MATERIAL,72300008,CDM,350,RC,70487,HCPCS,Outpatient,,,2944,2208,,2708.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1530.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2737.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2649.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2649.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2855.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2944,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1530.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2855.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2208,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2826.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1530.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2208,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2208,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1530.88,2944,
CT MAXILLOFACIAL W/O CONTRAST MATERIAL,72300007,CDM,350,RC,70486,HCPCS,Outpatient,,,2273,1704.75,,2091.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1181.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2113.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2045.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2045.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2204.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,335.35,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2273,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1181.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2204.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1704.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2182.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1181.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1704.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1704.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,335.35,2273,
CT SOFT TISSUE NECK W/O  and  W/CONTRAST MATERIAL,72300012,CDM,351,RC,70492,HCPCS,Outpatient,,,3457,2592.75,,3180.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1797.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3215.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3111.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3111.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3353.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3457,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1797.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3353.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2592.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3318.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1797.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2592.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2592.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1797.64,3457,
CT SOFT TISSUE NECK W/CONTRAST MATERIAL,72300011,CDM,350,RC,70491,HCPCS,Outpatient,,,2886,2164.5,,2655.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1500.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2683.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2597.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2597.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2799.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2886,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1500.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2799.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2164.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2770.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1500.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2164.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2164.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1500.72,2886,
CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,72300010,CDM,350,RC,70490,HCPCS,Outpatient,,,2951,2213.25,,2714.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1534.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2744.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2655.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2655.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2862.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2951,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1534.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2862.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2213.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2832.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1534.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2213.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2213.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1534.52,2951,
CT ORBIT SELLA/POST FOSSA/EAR W/O  and  W/CONTRAST,72300006,CDM,350,RC,70482,HCPCS,Outpatient,,,5458,4093.5,,5021.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2838.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5075.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4912.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4912.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5294.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5458,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2838.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5294.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4093.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5239.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2838.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4093.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4093.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2838.16,5458,
CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,72300005,CDM,350,RC,70481,HCPCS,Outpatient,,,3757,2817.75,,3456.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1953.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3494.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3381.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3381.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3644.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3757,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1953.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3644.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2817.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3606.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1953.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2817.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2817.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1953.64,3757,
CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST,72300004,CDM,350,RC,70480,HCPCS,Outpatient,,,3647,2735.25,,3355.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1896.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3391.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3282.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3282.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3537.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,384.1,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3647,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1896.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3537.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2735.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3501.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1896.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2735.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2735.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,384.1,3647,
CT PELVIS W/O  and  W/CONTRAST MATERIAL,72300031,CDM,352,RC,72194,HCPCS,Outpatient,,,2276,1707,,2093.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1183.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2116.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2048.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2048.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2207.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2276,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1183.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2207.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1707,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2184.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1183.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1707,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1707,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1183.52,2276,
CT PELVIS W/CONTRAST MATERIAL,72300030,CDM,352,RC,72193,HCPCS,Outpatient,,,1983,1487.25,,1824.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1031.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1844.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1784.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1784.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1923.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1983,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1031.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1923.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1487.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1903.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1031.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1487.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1487.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1031.16,1983,
CT PELVIS W/O CONTRAST MATERIAL,72300029,CDM,352,RC,72192,HCPCS,Outpatient,,,1795,1346.25,,1651.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,933.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1669.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1615.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1615.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1741.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,334.38,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1795,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,933.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1741.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1346.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1723.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,933.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1346.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1346.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,334.38,1795,
CT SCAPULA UPPER EXTREMITY W/O  and  W/CONT BIL,72300037,CDM,352,RC,73202,HCPCS,Outpatient,,,3099.6,2324.7,,2851.63,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2882.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3099.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2975.62,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1611.79,3099.6,
CT SCAPULA UPPER EXTREMITY W/O  and  W/CONT LT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT SCAPULA UPPER EXTREMITY W/O  and  W/CONT RT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT SCAPULA UPPER EXTREMITY W/CONTRAST BIL,72300035,CDM,352,RC,73201,HCPCS,Outpatient,,,2836.35,2127.26,,2609.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2552.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2552.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2751.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2836.35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2751.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2722.9,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1474.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2127.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1474.9,2836.35,
CT SCAPULA UPPER EXTREMITY W/CONTRAST LT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT SCAPULA UPPER EXTREMITY W/CONTRAST RT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT SCAPULA UPPER EXTREMITY W/O CONTRAST BIL,72300033,CDM,352,RC,73200,HCPCS,Outpatient,,,2505.6,1879.2,,2305.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2330.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2505.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2405.38,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302.91,2505.6,
CT SCAPULA UPPER EXTREMITY W/O CONTRAST LT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT SCAPULA UPPER EXTREMITY W/O CONTRAST RT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT SHOULDER UPPER EXTREMITY W/O  and  W/CONT BIL,72300037,CDM,352,RC,73202,HCPCS,Outpatient,,,3099.6,2324.7,,2851.63,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2882.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3099.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2975.62,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1611.79,3099.6,
CT SHOULDER UPPER EXTREMITY W/O  and  W/CONT LT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT SHOULDER W/ + W/O CONTRAST RIGHT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT SHOULDER UPPER EXTREMITY W/CONTRAST BIL,72300035,CDM,352,RC,73201,HCPCS,Outpatient,,,2836.5,2127.38,,2609.58,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2552.85,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2552.85,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2751.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2836.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2751.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2723.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1474.98,2836.5,
CT SHOULDER UPPER EXTREMITY W/CONTRAST LT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT SHOULDER UPPER EXTREMITY W/CONTRAST RT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT SHOULDER UPPER EXTREMITY W/O CONTRAST BIL,72300033,CDM,352,RC,73200,HCPCS,Outpatient,,,2505.6,1879.2,,2305.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2330.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2505.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2405.38,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302.91,2505.6,
CT SHOULDER UPPER EXTREMITY W/O CONTRAST LT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT SHOULDER UPPER EXTREMITY W/O CONTRAST RT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT CERVICAL SPINE W/O  and W/CONTRAST MATERIAL,72300022,CDM,352,RC,72127,HCPCS,Outpatient,,,4133,3099.75,,3802.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2149.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3843.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3719.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3719.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4009.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4133,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2149.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4009.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3099.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3967.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2149.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3099.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2149.16,4133,
CT CERVICAL SPINE W/CONTRAST MATERIAL,72300021,CDM,352,RC,72126,HCPCS,Outpatient,,,3615,2711.25,,3325.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3361.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3615,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3470.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1879.8,3615,
CT CERVICAL SPINE W/O CONTRAST MATERIAL,72300020,CDM,352,RC,72125,HCPCS,Outpatient,,,2705,2028.75,,2488.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1406.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2515.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2434.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2434.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2623.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2705,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1406.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2623.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2028.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2596.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1406.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2028.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2028.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1406.6,2705,
CT LUMBAR SPINE W/O  and  W/CONTRAST MATERIAL,72300028,CDM,352,RC,72133,HCPCS,Outpatient,,,2476,1857,,2277.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1287.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2302.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2228.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2228.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2401.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2476,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1287.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2401.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1857,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2376.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1287.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1857,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1857,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1287.52,2476,
CT LUMBAR SPINE W/CONTRAST MATERIAL,72300027,CDM,352,RC,72132,HCPCS,Outpatient,,,2277,1707.75,,2094.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1184.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2117.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2049.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2049.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2208.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2277,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1184.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2208.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1707.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2185.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1184.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1707.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1707.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1184.04,2277,
CT LUMBAR SPINE W/O CONTRAST MATERIAL,72300026,CDM,352,RC,72131,HCPCS,Outpatient,,,2256,1692,,2075.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1173.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2098.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2030.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2030.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2188.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,353.87,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2256,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1173.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2188.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1692,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2165.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1173.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1692,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1692,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,353.87,2256,
CT THORACIC SPINE W/O  and  W/CONTRAST MATERIAL,72300025,CDM,352,RC,72130,HCPCS,Outpatient,,,3328,2496,,3061.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1730.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3095.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2995.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2995.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3228.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3328,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1730.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3228.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2496,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3194.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1730.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2496,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2496,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1730.56,3328,
CT THORACIC SPINE W/CONTRAST MATERIAL,72300024,CDM,352,RC,72129,HCPCS,Outpatient,,,2911,2183.25,,2678.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1513.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2707.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2619.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2619.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2823.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2911,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1513.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2823.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2183.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2794.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1513.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2183.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2183.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1513.72,2911,
CT THORACIC SPINE W/O CONTRAST MATERIAL,72300023,CDM,352,RC,72128,HCPCS,Outpatient,,,2618,1963.5,,2408.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1361.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2434.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2356.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2356.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2539.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2618,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1361.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2539.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1963.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2513.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1361.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1963.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1963.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1361.36,2618,
CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,72300025,CDM,352,RC,72130,HCPCS,Outpatient,,,3328,2496,,3061.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1730.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3095.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2995.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2995.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3228.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3328,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1730.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3228.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2496,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3194.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1730.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2496,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2496,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1730.56,3328,
CT THORACIC SPINE W/CONTRAST MATERIAL,72300024,CDM,352,RC,72129,HCPCS,Outpatient,,,2911,2183.25,,2678.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1513.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2707.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2619.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2619.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2823.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2911,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1513.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2823.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2183.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2794.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1513.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2183.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2183.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1513.72,2911,
CT SPINE THORACIC/LUMBAR W/O CONT,72300023,CDM,352,RC,72128,HCPCS,Outpatient,,,2618,1963.5,,2408.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1361.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2434.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2356.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2356.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2539.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2618,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1361.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2539.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1963.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2513.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1361.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1963.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1963.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1361.36,2618,
CT TIBIA/FIBULA W/ + W/O CONTRAST RIGHT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT TIBIA/FIBULA W/ + W/O CONTRAST LEFT,72300044,CDM,352,RC,73702,HCPCS,Outpatient,,,4513,3384.75,,4151.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4197.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4061.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4377.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4332.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2346.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2346.76,4513,
CT TIBIA/FIBULA W/ + W/O CONTRAST LEFT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT TIBIA/FIBULA W/ CONTRAST RIGHT,72300042,CDM,352,RC,73701,HCPCS,Outpatient,,,3229,2421.75,,2970.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3002.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2906.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3132.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3099.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1679.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2421.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1679.08,3229,
CT TIBIA/FIBULA LOWER EXTREMITY W/O CONTRAST LEFT,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CT TIBIA/FIBULA LOWER EXTREMITY W/O CONTRAST MATERIAL,72300040,CDM,352,RC,73700,HCPCS,Outpatient,,,2195,1646.25,,2019.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2041.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1975.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.58,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2129.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2107.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1141.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1646.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.58,2195,
CT WRIST UPPER EXTREMITY W/O  and  W/CONT BIL,72300037,CDM,352,RC,73202,HCPCS,Outpatient,,,3099.6,2324.7,,2851.63,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2882.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2789.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3099.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3006.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2975.62,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1611.79,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2324.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1611.79,3099.6,
CT WRIST UPPER EXTREMITY W/O  and  W/CONT LT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT WRIST UPPER EXTREMITY W/O  and  W/CONT RT,72300036,CDM,352,RC,73202,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2135.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2066.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2227.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2204.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1193.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1193.92,2296,
CT WRIST UPPER EXTREMITY W/CONTRAST BIL,72300035,CDM,352,RC,73201,HCPCS,Outpatient,,,2836.5,2127.38,,2609.58,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2552.85,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2552.85,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2751.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2836.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2751.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2723.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1474.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2127.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1474.98,2836.5,
CT WRIST UPPER EXTREMITY W/CONTRAST LT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT WRIST UPPER EXTREMITY W/CONTRAST RT,72300034,CDM,352,RC,73201,HCPCS,Outpatient,,,2101,1575.75,,1932.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1953.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1890.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2101,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2037.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2016.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1092.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1575.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1092.52,2101,
CT WRIST UPPER EXTREMITY W/O CONTRAST BIL,72300033,CDM,352,RC,73200,HCPCS,Outpatient,,,2505.6,1879.2,,2305.15,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2330.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2505.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2430.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2405.38,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1302.91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1879.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302.91,2505.6,
CT WRIST UPPER EXTREMITY W/O CONTRAST LT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
CT WRIST UPPER EXTREMITY W/O CONTRAST RT,72300032,CDM,352,RC,73200,HCPCS,Outpatient,,,1856,1392,,1707.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1726.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1670.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1800.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1781.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,965.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1392,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.12,1856,
XR FINGER MINIMUM 2 VIEWS LT,71800230,CDM,320,RC,73140,HCPCS,Outpatient,,,246,184.5,,226.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,228.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,221.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,221.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,238.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.46,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,246,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.46,246,
ISOVUE 300 300MG/ML,72300069,CDM,255,RC,Q9967,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.84,42,
MRI GADOLINIUM BASED MAGNEVIST 15ML,72900074,CDM,255,RC,A9579,HCPCS,Outpatient,,,150,112.5,,138,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,150,
MEMO NM AMINOPHYLLINE 250mg/10ML,73000032,CDM,255,RC,J0280,HCPCS,Outpatient,,,45.15,33.86,,41.54,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,40.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,43.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,33.86,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.34,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.86,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.86,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.48,45.15,
NM AMINOPHYLLINE 250MG/10ML INJ,73000032,CDM,636,RC,J0280,HCPCS,Outpatient,,,50,37.5,,46,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,46.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,48.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26,50,
NM IODINE I-123 SODIUM IODINE 100MCI,73000024,CDM,343,RC,A9516,HCPCS,Outpatient,,,223,167.25,,205.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,200.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,200.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,216.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,223,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.96,223,
NM REGADENOSON 0.1MG INJ,73000033,CDM,636,RC,J2785,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182,350,
NM TC99 MERTIATIDE 15MCI,73000031,CDM,343,RC,A9562,HCPCS,Outpatient,,,109,81.75,,100.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.68,109,
NM TC99 MERTIATIDE 15MCI,73000031,CDM,343,RC,A9562,HCPCS,Outpatient,,,95,71.25,,87.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,49.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,92.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,49.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,92.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,71.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,49.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.4,95,
NM TC99M LABELED RBC 30MCI,73000029,CDM,343,RC,A9560,HCPCS,Outpatient,,,428,321,,393.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,222.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,398.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,385.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,385.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,415.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,428,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,222.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,415.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,321,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,410.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,222.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,321,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,321,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222.56,428,
NM TC99M MAA 10MCI,73000027,CDM,343,RC,A9540,HCPCS,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,363,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.76,363,
NM TC99M MEBROFEN 15MCI,73000025,CDM,343,RC,A9537,HCPCS,Outpatient,,,229,171.75,,210.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,119.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,206.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,206.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,229,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,119.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,222.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,171.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,219.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,119.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,171.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.08,229,
NM TC99M OXIDRONATE 30MCI,73000030,CDM,343,RC,A9561,HCPCS,Outpatient,,,184,138,,169.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,171.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,165.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,165.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,178.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,184,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,178.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,176.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,95.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.68,184,
NM TC99M PENTETATE 25MCI,73000026,CDM,343,RC,A9539,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,219.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,212.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,212.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,228.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,236,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,228.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,226.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.72,236,
NM TC99M PERTECHNETATE MCI,73000023,CDM,343,RC,A9512,HCPCS,Outpatient,,,38,28.5,,34.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.76,38,
NM TC99M SESTAMIBI STDY,73000022,CDM,343,RC,A9500,HCPCS,Outpatient,,,491,368.25,,451.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,255.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,456.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,441.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,441.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,476.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,491,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,255.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,476.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,368.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,471.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,255.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,368.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,368.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,255.32,491,
NM TC99M SULF COL 20MCI,73000028,CDM,343,RC,A9541,HCPCS,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,363,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.76,363,
MEMO Sincalide (CCK) 5 mcg,78002898,CDM,636,RC,J2805,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182,350,
US NEEDLE BIOPSY BARD,730000312,CDM,272,RC,,,Outpatient,,,226,169.5,,207.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,219.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,226,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,219.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,117.52,226,
US NEEDLE BIOPSY TEMNO,730000313,CDM,272,RC,,,Outpatient,,,270,202.5,,248.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,140.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,243,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,243,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,261.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,270,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,140.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,202.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,259.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,140.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,202.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,202.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,140.4,270,
US TRAY THORACENT/PARACENTESIS,730000314,CDM,272,RC,,,Outpatient,,,335,251.25,,308.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,174.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,311.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,301.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,301.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,324.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,335,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,174.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,251.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,321.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,174.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,251.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.2,335,
US ULTRACLIP RIBBON TISSUE MARKER,730000315,CDM,278,RC,A4648,HCPCS,Outpatient,,,160,120,,147.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,144,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,160,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,155.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.2,160,
XR ISOVUE M 200-20ML,72300062,CDM,255,RC,Q9966,HCPCS,Outpatient,,,34,25.5,,31.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,32.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.68,34,
MG BREAST TISSUE SPECIMEN,71800424,CDM,320,RC,76098,HCPCS,Outpatient,,,594,445.5,,546.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,308.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,552.42,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,534.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,534.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,576.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,594,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,308.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,576.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,445.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,570.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,308.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,445.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,445.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,308.88,594,
XR DX MAMMOGRAPHY COMPUTER-AIDED DETECT BILAT,71800476,CDM,401,RC,77066,HCPCS,Outpatient,,,703,527.25,,646.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,365.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,653.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,632.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,632.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,681.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,703,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,365.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,681.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,527.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,674.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,365.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,527.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,527.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,365.56,703,
MG MAMMO DIAGNOSTIC BILATERAL W/TOMO,71800476,CDM,401,RC,77066,HCPCS,Outpatient,,,407,305.25,,374.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,211.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,378.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,366.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,366.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,394.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,407,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,211.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,394.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,305.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,390.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,211.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,305.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,211.64,407,
MG MAMMO DIAGNOSTIC LEFT,71800474,CDM,401,RC,77065,HCPCS,Outpatient,,,338,253.5,,310.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,314.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,338,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,324.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,175.76,338,
MG MAMMO DIAGNOSTIC LEFT W/TOMO,71800474,CDM,401,RC,77065,HCPCS,Outpatient,,,338,253.5,,310.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,314.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,338,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,324.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,175.76,338,
MG MAMMO DIAGNOSTIC RIGHT,71800474,CDM,401,RC,77065,HCPCS,Outpatient,,,338,253.5,,310.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,314.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,338,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,324.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,175.76,338,
MG MAMMO DIAGNOSTIC RIGHT W/TOMO,71800474,CDM,401,RC,77065,HCPCS,Outpatient,,,338,253.5,,310.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,314.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,338,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,324.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,175.76,338,
MG MAMMO DIGITAL SCREENING BILATERAL,71800478,CDM,403,RC,77067,HCPCS,Outpatient,,,272,204,,250.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,252.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,244.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,244.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,263.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,272,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,263.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.44,272,
MG MAMMO DIGITAL SCREENING LEFT,71800482,CDM,403,RC,77067,HCPCS,Outpatient,,,289,216.75,,265.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,277.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.28,289,
MG MAMMO DIGITAL SCREENING RIGHT,71800482,CDM,403,RC,77067,HCPCS,Outpatient,,,289,216.75,,265.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,277.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.28,289,
MG MAMMO IMPLANT DIAGNOSTIC BILATERAL W/TOMO,71800476,CDM,401,RC,77066,HCPCS,Outpatient,,,439,329.25,,403.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,228.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,408.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,395.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,395.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,425.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,439,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,228.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,425.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,329.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,421.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,228.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,329.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,228.28,439,
MG MAMMO IMPLANT DIAGNOSTIC LEFT W/TOMO,71800474,CDM,401,RC,77065,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,315,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,163.8,315,
MG MAMMO IMPLANT DIAGNOSTIC RIGHT W/TOMO,71800474,CDM,401,RC,77065,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,315,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,163.8,315,
MG MAMMO IMPLANT SCREENING BILATERAL W/TOMO,71800478,CDM,403,RC,77067,HCPCS,Outpatient,,,289,216.75,,265.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,277.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.28,289,
MG MAMMO IMPLANT SCREENING LEFT W/TOMO,71800482,CDM,403,RC,77067,HCPCS,Outpatient,,,289,216.75,,265.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,277.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.28,289,
MG MAMMO IMPLANT SCREENING RIGHT W/TOMO,71800482,CDM,403,RC,77067,HCPCS,Outpatient,,,289,216.75,,265.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,277.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.28,289,
MG MAMMO SCREENING BILATERAL,71800478,CDM,403,RC,77067,HCPCS,Outpatient,,,272,204,,250.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,252.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,244.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,244.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,263.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,272,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,263.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.44,272,
MG MAMMO SCREENING BILATERAL W/TOMO,71800478,CDM,403,RC,77067,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.04,327,
MG MAMMO SCREENING LEFT W/TOMO,71800482,CDM,403,RC,77067,HCPCS,Outpatient,,,289,216.75,,265.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,277.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.28,289,
MG MAMMO SCREENING RIGHT W/TOMO,71800482,CDM,403,RC,77067,HCPCS,Outpatient,,,289,216.75,,265.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,277.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.28,289,
MRA ABDOMEN W/WO CONTRAST MATERIAL,72900072,CDM,618,RC,74185,HCPCS,Outpatient,,,1905,1428.75,,1752.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,990.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1771.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1714.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1714.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1847.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1905,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,990.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1847.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1428.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1828.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,990.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1428.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1428.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,990.6,1905,
MRA ABDOMEN W/ CONTRAST,72900070,CDM,618,RC,74185,HCPCS,Outpatient,,,1938,1453.5,,1782.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1007.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1802.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1744.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1744.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1879.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1938,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1007.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1879.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1453.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1860.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1007.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1453.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1453.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1007.76,1938,
MRA ABDOMEN W/O CONTRAST,72900071,CDM,618,RC,74185,HCPCS,Outpatient,,,1905,1428.75,,1752.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,990.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1771.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1714.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1714.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1847.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1905,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,990.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1847.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1428.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1828.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,990.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1428.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1428.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,990.6,1905,
MRA BRAIN/HEAD W/ + W/O CONTRAST,72900006,CDM,615,RC,70546,HCPCS,Outpatient,,,4300,3225,,3956,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2236,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3999,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3870,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3870,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4171,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4300,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2236,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4171,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4128,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2236,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2236,4300,
MRA BRAIN/HEAD W/ CONTRAST,72900005,CDM,615,RC,70545,HCPCS,Outpatient,,,4061,3045.75,,3736.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2111.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3776.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3654.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3654.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3939.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,686.3,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4061,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2111.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3939.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3045.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3898.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2111.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3045.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3045.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,686.3,4061,
MRA BRAIN/HEAD W/O CONTRAST,72900004,CDM,615,RC,70544,HCPCS,Outpatient,,,3434,2575.5,,3159.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1785.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3193.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3090.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3090.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3330.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5683.38,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3434,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1785.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3330.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2575.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3296.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1785.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2575.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2575.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1785.68,5683.38,
MRA CHEST W/ + W/O CONTRAST,72900018,CDM,618,RC,71555,HCPCS,Outpatient,,,2325,1743.75,,2139,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1209,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2162.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2092.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2092.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2325,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1209,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2255.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1743.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2232,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1209,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1743.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1743.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1209,2325,
MRA CHEST W/ CONTRAST,72900016,CDM,618,RC,71555,HCPCS,Outpatient,,,2325,1743.75,,2139,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1209,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2162.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2092.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2092.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2325,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1209,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2255.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1743.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2232,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1209,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1743.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1743.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1209,2325,
MRA CHEST W/O CONTRAST,72900017,CDM,618,RC,71555,HCPCS,Outpatient,,,2325,1743.75,,2139,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1209,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2162.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2092.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2092.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2255.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2325,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1209,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2255.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1743.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2232,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1209,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1743.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1743.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1209,2325,
MRA LOWER EXTREMITY W/ + W/O CNT LEFT,72900065,CDM,616,RC,73725,HCPCS,Outpatient,,,1932,1449,,1777.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1796.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1738.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1738.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1874.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1932,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1874.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1854.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1004.64,1932,
MRA LOWER EXTREMITY W/ + W/O CNT RIGHT,72900065,CDM,616,RC,73725,HCPCS,Outpatient,,,1932,1449,,1777.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1796.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1738.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1738.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1874.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1932,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1874.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1854.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1004.64,1932,
MRA LOWER EXTREMITY W/ CONTRAST LEFT,72900061,CDM,616,RC,73725,HCPCS,Outpatient,,,1932,1449,,1777.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1796.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1738.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1738.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1874.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1932,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1874.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1854.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1004.64,1932,
MRA LOWER EXTREMITY W/ CONTRAST RIGHT,72900061,CDM,616,RC,73725,HCPCS,Outpatient,,,1932,1449,,1777.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1796.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1738.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1738.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1874.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1932,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1874.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1854.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1004.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1449,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1004.64,1932,
MRA LOWER EXTREMITY W/ CONTRAST BILAT,72900062,CDM,616,RC,73725,HCPCS,Outpatient,,,2608.2,1956.15,,2399.54,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1356.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2425.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2347.38,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2347.38,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2529.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2608.2,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1356.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2529.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1956.15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2503.87,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1356.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1956.15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1956.15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1356.26,2608.2,
MRA LOWER EXTREMITY W/O CONTRAST LEFT,72900063,CDM,616,RC,73725,HCPCS,Outpatient,,,1953,1464.75,,1796.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1015.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1816.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1757.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1757.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1894.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1953,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1015.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1894.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1464.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1874.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1015.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1464.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1464.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1015.56,1953,
MRA LOWER EXTREMITY W/O CONTRAST RIGHT,72900063,CDM,616,RC,73725,HCPCS,Outpatient,,,1953,1464.75,,1796.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1015.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1816.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1757.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1757.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1894.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1953,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1015.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1894.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1464.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1874.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1015.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1464.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1464.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1015.56,1953,
MRA LOWER EXTREMITY W/O CONTRAST BILAT,72900063,CDM,616,RC,73725,HCPCS,Outpatient,,,2636.55,1977.41,,2425.63,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1371.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2451.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2372.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2372.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2557.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2636.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1371.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2557.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1977.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2531.09,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1371.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1977.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1977.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1371.01,2636.55,
MRA NECK W/O  and W/CONTRAST MATERIAL,72900009,CDM,615,RC,70549,HCPCS,Outpatient,,,3593,2694.75,,3305.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1868.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3341.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3233.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3233.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3485.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3593,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1868.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3485.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2694.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3449.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1868.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2694.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2694.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1868.36,3593,
MRA NECK W/ CONTRAST,72900008,CDM,615,RC,70548,HCPCS,Outpatient,,,1810,1357.5,,1665.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,941.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1683.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1629,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1629,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1755.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1810,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,941.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1755.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1357.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1737.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,941.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1357.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1357.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,941.2,1810,
MRA NECK W/O CONTRAST,72900007,CDM,615,RC,70547,HCPCS,Outpatient,,,3434,2575.5,,3159.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1785.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3193.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3090.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3090.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3330.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3434,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1785.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3330.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2575.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3296.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1785.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2575.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2575.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1785.68,3434,
MRA PELVIS W/ + W/O CONTRAST,72900033,CDM,618,RC,72198,HCPCS,Outpatient,,,1900,1425,,1748,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,988,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1767,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1710,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1710,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1843,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1900,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,988,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1843,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1425,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1824,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,988,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1425,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1425,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,988,1900,
MRA PELVIS W/ CONTRAST,72900031,CDM,618,RC,72198,HCPCS,Outpatient,,,1900,1425,,1748,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,988,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1767,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1710,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1710,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1843,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1900,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,988,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1843,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1425,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1824,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,988,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1425,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1425,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,988,1900,
MRA PELVIS W/O CONTRAST,72900032,CDM,618,RC,72198,HCPCS,Outpatient,,,1900,1425,,1748,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,988,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1767,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1710,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1710,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1843,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1900,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,988,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1843,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1425,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1824,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,988,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1425,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1425,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,988,1900,
MRA UPPER EXTREMITY W/ + W/O CNT LEFT,72900046,CDM,618,RC,73225,HCPCS,Outpatient,,,2378,1783.5,,2187.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2211.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2378,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2282.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1236.56,2378,
MRA UPPER EXTREMITY W/ + W/O CNT RIGHT,72900046,CDM,618,RC,73225,HCPCS,Outpatient,,,2378,1783.5,,2187.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2211.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2378,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2282.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1236.56,2378,
MRA UPPER EXTREMITY W/ + W/O CNT BILAT,72900046,CDM,618,RC,73225,HCPCS,Outpatient,,,2378,1783.5,,2187.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2211.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2378,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2282.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1236.56,2378,
MRA UPPER EXTREMITY W/ CONTRAST LEFT,72900047,CDM,618,RC,73225,HCPCS,Outpatient,,,2378,1783.5,,2187.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2211.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2378,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2282.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1236.56,2378,
MRA UPPER EXTREMITY W/ CONTRAST RIGHT,72900047,CDM,618,RC,73225,HCPCS,Outpatient,,,2378,1783.5,,2187.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2211.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2378,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2282.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1236.56,2378,
MRA UPPER EXTREMITY W/ CONTRAST BILAT,72900047,CDM,618,RC,73225,HCPCS,Outpatient,,,2378,1783.5,,2187.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2211.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2378,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2282.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1236.56,2378,
MRA UPPER EXTREMITY WO  CONTRAST LEFT,72900048,CDM,618,RC,73225,HCPCS,Outpatient,,,2378,1783.5,,2187.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2211.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2378,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2282.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1236.56,2378,
MRA UPPER EXTREMITY WO  CONTRAST RT,72900048,CDM,618,RC,73225,HCPCS,Outpatient,,,2378,1783.5,,2187.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2211.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2378,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2282.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1236.56,2378,
MRA UPPER EXTREMITY WO  CONTRAST BIL,72900048,CDM,618,RC,73225,HCPCS,Outpatient,,,2378,1783.5,,2187.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2211.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2140.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2378,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2306.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2282.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1236.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1783.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1236.56,2378,
MRI ABDOMEN W/O  and  W/CONTRAST MATERIAL,72900069,CDM,614,RC,74183,HCPCS,Outpatient,,,3266,2449.5,,3004.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1698.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3037.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2939.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2939.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3168.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3266,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1698.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3168.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2449.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3135.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1698.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2449.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2449.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1698.32,3266,
MRI ABDOMEN W/CONTRAST MATERIAL,72900068,CDM,614,RC,74182,HCPCS,Outpatient,,,2261,1695.75,,2080.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1175.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2102.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2034.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2034.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2193.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2261,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1175.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2193.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1695.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2170.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1175.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1695.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1695.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1175.72,2261,
MRI ABDOMEN W/O CONTRAST MATERIAL,72900067,CDM,614,RC,74181,HCPCS,Outpatient,,,2415,1811.25,,2221.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1255.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2245.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2173.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2173.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2342.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2415,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1255.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2342.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1811.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2318.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1255.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1811.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1811.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1255.8,2415,
MRI ANKLE W/ + W/O CONTRAST BILATERAL,72900060,CDM,614,RC,73723,HCPCS,Outpatient,,,4233.6,3175.2,,3894.91,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2201.47,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3937.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3810.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3810.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4106.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912.47,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4233.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2201.47,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4106.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3175.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4064.26,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2201.47,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3175.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3175.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912.47,4233.6,
MRI ANKLE W/ + W/O CONTRAST LEFT,72900059,CDM,614,RC,73723,HCPCS,Outpatient,,,3136,2352,,2885.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2916.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912.47,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3136,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3010.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912.47,3136,
MRI ANKLE W/ + W/O CONTRAST RIGHT,72900059,CDM,614,RC,73723,HCPCS,Outpatient,,,3136,2352,,2885.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2916.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912.47,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3136,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3010.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912.47,3136,
MRI ANKLE W/ CONTRAST BILATERAL,72900058,CDM,614,RC,73722,HCPCS,Outpatient,,,3743.55,2807.66,,3444.07,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1946.65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3481.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3369.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3369.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3631.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,652.18,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3743.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1946.65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3631.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2807.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3593.81,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1946.65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2807.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2807.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,652.18,3743.55,
MRI ANKLE W/ CONTRAST LEFT,72900057,CDM,614,RC,73722,HCPCS,Outpatient,,,2773,2079.75,,2551.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2578.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,652.18,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2773,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2662.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,652.18,2773,
MRI ANKLE W/ CONTRAST RIGHT,72900057,CDM,614,RC,73722,HCPCS,Outpatient,,,2773,2079.75,,2551.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2578.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,652.18,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2773,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2662.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,652.18,2773,
MRI ANKLE W/O CONTRAST BILATERAL,72900056,CDM,614,RC,73721,HCPCS,Outpatient,,,3218.4,2413.8,,2960.93,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1673.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2993.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2896.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2896.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3121.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,603.94,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3218.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1673.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3121.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2413.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3089.66,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1673.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2413.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2413.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.94,3218.4,
MRI ANKLE W/O CONTRAST LEFT,72900055,CDM,614,RC,73721,HCPCS,Outpatient,,,2384,1788,,2193.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2217.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,603.94,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2384,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2288.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.94,2384,
MRI ANKLE W/O CONTRAST RIGHT,72900055,CDM,614,RC,73721,HCPCS,Outpatient,,,2384,1788,,2193.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2217.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,603.94,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2384,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2288.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.94,2384,
MRI BRACHIAL PLEXUS W/ + W/O CONTRAST,72900045,CDM,614,RC,73223,HCPCS,Outpatient,,,3505,2628.75,,3224.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3259.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,676.4,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3364.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676.4,3505,
MRI BRACHIAL PLEXUS W/ CONTRAST,72900042,CDM,614,RC,73222,HCPCS,Outpatient,,,2814,2110.5,,2588.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2617.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,664.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2701.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.85,2814,
MRI BRACHIAL PLEXUS W/O CONTRAST,72900040,CDM,614,RC,73221,HCPCS,Outpatient,,,2435,1826.25,,2240.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2264.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.02,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2435,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2337.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.02,2435,
MRI BRAIN W/ + W/O CONTRAST,72900012,CDM,611,RC,70553,HCPCS,Outpatient,,,3833,2874.75,,3526.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1993.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3564.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3449.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3449.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3718.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3833,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1993.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3718.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2874.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3679.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1993.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2874.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2874.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1993.16,3833,
MRI BRAIN STEM W/CONTRAST MATERIAL,71800057,CDM,611,RC,70552,HCPCS,Outpatient,,,4061,3045.75,,3736.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2111.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3776.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3654.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3654.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3939.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4061,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2111.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3939.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3045.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3898.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2111.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3045.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3045.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2111.72,4061,
MRI BRAIN W/O CONTRAST,72900010,CDM,611,RC,70551,HCPCS,Outpatient,,,2636,1977,,2425.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1370.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2451.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2372.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2372.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2556.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2636,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1370.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2556.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1977,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2530.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1370.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1977,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1977,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1370.72,2636,
MRI CHEST W/ + W/O CONTRAST,72900015,CDM,614,RC,71552,HCPCS,Outpatient,,,5012,3759,,4611.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2606.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4661.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4510.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4510.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4861.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5012,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2606.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4861.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3759,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4811.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2606.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3759,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3759,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2606.24,5012,
MRI CHEST W/CONTRAST MATERIAL,72900014,CDM,614,RC,71551,HCPCS,Outpatient,,,1991,1493.25,,1831.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1035.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1851.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1791.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1791.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1931.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1991,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1035.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1931.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1493.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1911.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1035.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1493.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1493.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1035.32,1991,
MRI CHEST W/O CONTRAST MATERIAL,72900013,CDM,614,RC,71550,HCPCS,Outpatient,,,3726,2794.5,,3427.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1937.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3465.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3353.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3353.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3614.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3726,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1937.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3614.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2794.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3576.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1937.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2794.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2794.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1937.52,3726,
MRI ELBOW W/ + W/O CONTRAST BILATERAL,72900045,CDM,614,RC,73223,HCPCS,Outpatient,,,4731.75,3548.81,,4353.21,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2460.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4400.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4258.58,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4258.58,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4589.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,676.4,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4731.75,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2460.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4589.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3548.81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4542.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2460.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3548.81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3548.81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676.4,4731.75,
MRI ELBOW W/ + W/O CONTRAST LEFT,72900044,CDM,614,RC,73223,HCPCS,Outpatient,,,3505,2628.75,,3224.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3259.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,676.4,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3364.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676.4,3505,
MRI ELBOW W/ + W/O CONTRAST RIGHT,72900044,CDM,614,RC,73223,HCPCS,Outpatient,,,3505,2628.75,,3224.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3259.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,676.4,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3364.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676.4,3505,
MRI ELBOW W/ CONTRAST BILATERAL,72900043,CDM,614,RC,73222,HCPCS,Outpatient,,,4148.9,3111.68,,3816.99,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2157.43,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3858.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3734.01,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3734.01,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4024.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,664.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4148.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2157.43,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4024.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3111.68,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3982.94,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2157.43,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3111.68,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3111.68,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.85,4148.9,
MRI ELBOW W/ CONTRAST LEFT,72900042,CDM,614,RC,73222,HCPCS,Outpatient,,,2814,2110.5,,2588.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2617.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,664.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2701.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.85,2814,
MRI ELBOW W/ CONTRAST RIGHT,72900042,CDM,614,RC,73222,HCPCS,Outpatient,,,2814,2110.5,,2588.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2617.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,664.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2701.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.85,2814,
MRI ELBOW W/O CONTRAST BILATERAL,72900041,CDM,614,RC,73221,HCPCS,Outpatient,,,3287.25,2465.44,,3024.27,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1709.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3057.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2958.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2958.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3188.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.02,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3287.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1709.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3188.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2465.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3155.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1709.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2465.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2465.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.02,3287.25,
MRI ELBOW W/O CONTRAST LEFT,72900040,CDM,614,RC,73221,HCPCS,Outpatient,,,2435,1826.25,,2240.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2264.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.02,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2435,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2337.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.02,2435,
MRI ELBOW W/O CONTRAST RIGHT,72900040,CDM,614,RC,73221,HCPCS,Outpatient,,,2435,1826.25,,2240.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2264.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.02,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2435,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2337.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.02,2435,
MRI ORBIT FACE  and  NECK W/O  and  W/CONTRAST MATRL,72900003,CDM,610,RC,70543,HCPCS,Outpatient,,,3833,2874.75,,3526.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1993.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3564.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3449.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3449.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3718.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3833,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1993.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3718.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2874.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3679.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1993.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2874.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2874.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1993.16,3833,
MRI ORBIT FACE  and  NECK W/CONTRAST MATERIAL,72900002,CDM,610,RC,70542,HCPCS,Outpatient,,,2002,1501.5,,1841.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1041.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1861.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1801.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1801.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1941.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2002,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1041.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1941.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1501.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1921.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1041.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1501.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1501.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1041.04,2002,
MRI ORBIT FACE  and /NECK W/O CONTRAST,72900001,CDM,610,RC,70540,HCPCS,Outpatient,,,3434,2575.5,,3159.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1785.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3193.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3090.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3090.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3330.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3434,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1785.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3330.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2575.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3296.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1785.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2575.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2575.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1785.68,3434,
MRI FEMUR W/ + W/O CONTRAST BILATERAL,72900054,CDM,614,RC,73720,HCPCS,Outpatient,,,4008.15,3006.11,,3687.5,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2084.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3727.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3607.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3607.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3887.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,694.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4008.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2084.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3887.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3006.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3847.82,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2084.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3006.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3006.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,694.92,4008.15,
MRI FEMUR W/ + W/O CONTRAST LEFT,72900053,CDM,614,RC,73720,HCPCS,Outpatient,,,2969,2226.75,,2731.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2761.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,694.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2969,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2850.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,694.92,2969,
MRI FEMUR W/ + W/O CONTRAST RIGHT,72900053,CDM,614,RC,73720,HCPCS,Outpatient,,,2969,2226.75,,2731.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2761.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,694.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2969,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2850.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,694.92,2969,
MRI FEMUR W/ CONTRAST BILATERAL,72900052,CDM,614,RC,73719,HCPCS,Outpatient,,,3477.6,2608.2,,3199.39,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1808.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3234.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3129.84,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3129.84,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3373.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,673.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3477.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1808.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3373.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2608.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3338.5,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1808.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2608.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2608.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,673.62,3477.6,
MRI FEMUR W/ CONTRAST LEFT,72900051,CDM,614,RC,73719,HCPCS,Outpatient,,,2576,1932,,2369.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2395.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,673.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2576,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2472.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,673.62,2576,
MRI FEMUR W/ CONTRAST RIGHT,72900051,CDM,614,RC,73719,HCPCS,Outpatient,,,2576,1932,,2369.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2395.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,673.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2576,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2472.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,673.62,2576,
MRI FEMUR W/O CONTRAST BILATERAL,72900050,CDM,614,RC,73718,HCPCS,Outpatient,,,2840.4,2130.3,,2613.17,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1477.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2641.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2556.36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2556.36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2755.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,607.33,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2840.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1477.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2755.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2130.3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2726.78,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1477.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2130.3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2130.3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,607.33,2840.4,
MRI FEMUR W/O CONTRAST LEFT,72900049,CDM,614,RC,73718,HCPCS,Outpatient,,,2104,1578,,1935.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1956.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,607.33,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2019.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,607.33,2104,
MRI FEMUR W/O CONTRAST RIGHT,72900049,CDM,614,RC,73718,HCPCS,Outpatient,,,2104,1578,,1935.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1956.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,607.33,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2019.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,607.33,2104,
MRI FOOT W/ + W/O CONTRAST BILATERAL,72900054,CDM,614,RC,73720,HCPCS,Outpatient,,,4008.15,3006.11,,3687.5,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2084.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3727.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3607.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3607.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3887.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,694.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4008.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2084.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3887.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3006.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3847.82,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2084.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3006.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3006.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,694.92,4008.15,
MRI FOOT W/ + W/O CONTRAST LEFT,72900053,CDM,614,RC,73720,HCPCS,Outpatient,,,2969,2226.75,,2731.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2761.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,694.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2969,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2850.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,694.92,2969,
MRI FOOT W/ + W/O CONTRAST RIGHT,72900053,CDM,614,RC,73720,HCPCS,Outpatient,,,2969,2226.75,,2731.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2761.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,694.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2969,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2850.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,694.92,2969,
MRI FOOT W/ CONTRAST BILATERAL,72900052,CDM,614,RC,73719,HCPCS,Outpatient,,,3477.6,2608.2,,3199.39,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1808.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3234.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3129.84,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3129.84,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3373.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,673.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3477.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1808.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3373.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2608.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3338.5,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1808.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2608.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2608.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,673.62,3477.6,
MRI FOOT W/ CONTRAST LEFT,72900051,CDM,614,RC,73719,HCPCS,Outpatient,,,2576,1932,,2369.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2395.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,673.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2576,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2472.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,673.62,2576,
MRI FOOT W/ CONTRAST RIGHT,72900051,CDM,614,RC,73719,HCPCS,Outpatient,,,2576,1932,,2369.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2395.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,673.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2576,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2472.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,673.62,2576,
MRI FOOT W/O CONTRAST BILATERAL,72900050,CDM,614,RC,73718,HCPCS,Outpatient,,,2840.4,2130.3,,2613.17,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1477.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2641.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2556.36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2556.36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2755.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,607.33,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2840.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1477.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2755.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2130.3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2726.78,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1477.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2130.3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2130.3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,607.33,2840.4,
MRI FOOT W/O CONTRAST LEFT,72900049,CDM,614,RC,73718,HCPCS,Outpatient,,,2104,1578,,1935.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1956.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,607.33,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2019.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,607.33,2104,
MRI FOOT W/O CONTRAST RIGHT,72900049,CDM,614,RC,73718,HCPCS,Outpatient,,,2104,1578,,1935.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1956.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,607.33,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2019.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,607.33,2104,
MRI FOREARM W/ + W/O CONTRAST BILATERAL,72900039,CDM,614,RC,73220,HCPCS,Outpatient,,,4880.25,3660.19,,4489.83,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2537.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4538.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4392.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4392.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4733.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,697.84,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4880.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2537.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4733.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3660.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4685.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2537.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3660.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3660.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.84,4880.25,
MRI FOREARM W/ + W/O CONTRAST LEFT,72900038,CDM,614,RC,73220,HCPCS,Outpatient,,,3615,2711.25,,3325.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3361.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,697.84,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3615,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3470.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.84,3615,
MRI FOREARM W/ + W/O CONTRAST RIGHT,72900038,CDM,614,RC,73220,HCPCS,Outpatient,,,3615,2711.25,,3325.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3361.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,697.84,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3615,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3470.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.84,3615,
MRI FOREARM W/ CONTRAST BILATERAL,72900037,CDM,614,RC,73219,HCPCS,Outpatient,,,2259.9,1694.93,,2079.11,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1175.15,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2101.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2033.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2033.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2192.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,689.22,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2259.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1175.15,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2192.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1694.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2169.5,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1175.15,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1694.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1694.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,689.22,2259.9,
MRI FOREARM W/ CONTRAST LEFT,72900036,CDM,614,RC,73219,HCPCS,Outpatient,,,1674,1255.5,,1540.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1556.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,689.22,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1674,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1607.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,689.22,1674,
MRI FOREARM W/ CONTRAST RIGHT,72900036,CDM,614,RC,73219,HCPCS,Outpatient,,,1674,1255.5,,1540.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1556.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,689.22,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1674,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1607.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,689.22,1674,
MRI FOREARM UPPER EXTREMITY OTH THAN JT W/O CONTRST BIL,72900035,CDM,614,RC,73218,HCPCS,Outpatient,,,3487.05,2615.29,,3208.09,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1813.27,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3242.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3138.35,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3138.35,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3382.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606.36,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3487.05,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1813.27,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3382.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2615.29,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3347.57,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1813.27,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2615.29,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2615.29,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.36,3487.05,
MRI FOREARM UPPER EXTREMITY OTH THAN JT W/O CONTRST LEFT,72900034,CDM,614,RC,73218,HCPCS,Outpatient,,,2583,1937.25,,2376.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2402.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606.36,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2583,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2479.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.36,2583,
MRI FOREARM UPPER EXTREMITY OTH THAN JT W/O CONTRST RIGHT,72900034,CDM,614,RC,73218,HCPCS,Outpatient,,,2583,1937.25,,2376.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2402.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606.36,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2583,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2479.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.36,2583,
MRI HAND W/ + W/O CONTRAST BILATERAL,72900039,CDM,614,RC,73220,HCPCS,Outpatient,,,4880.25,3660.19,,4489.83,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2537.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4538.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4392.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4392.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4733.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,697.84,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4880.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2537.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4733.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3660.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4685.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2537.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3660.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3660.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.84,4880.25,
MRI HAND W/ + W/O CONTRAST LEFT,72900038,CDM,614,RC,73220,HCPCS,Outpatient,,,3615,2711.25,,3325.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3361.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,697.84,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3615,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3470.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.84,3615,
MRI HAND W/ + W/O CONTRAST RIGHT,72900038,CDM,614,RC,73220,HCPCS,Outpatient,,,3615,2711.25,,3325.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3361.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,697.84,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3615,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3470.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.84,3615,
MRI HAND W/ CONTRAST BILATERAL,72900037,CDM,614,RC,73219,HCPCS,Outpatient,,,2259.9,1694.93,,2079.11,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1175.15,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2101.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2033.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2033.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2192.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,689.22,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2259.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1175.15,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2192.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1694.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2169.5,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1175.15,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1694.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1694.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,689.22,2259.9,
MRI HAND W/ CONTRAST LEFT,72900036,CDM,614,RC,73219,HCPCS,Outpatient,,,1674,1255.5,,1540.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1556.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,689.22,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1674,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1607.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,689.22,1674,
MRI HAND W/ CONTRAST RIGHT,72900036,CDM,614,RC,73219,HCPCS,Outpatient,,,1674,1255.5,,1540.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1556.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,689.22,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1674,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1607.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,689.22,1674,
MRI HAND UPPER EXTREMITY OTH THAN JT W/O CONTRST BIL,72900035,CDM,614,RC,73218,HCPCS,Outpatient,,,3487.05,2615.29,,3208.09,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1813.27,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3242.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3138.35,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3138.35,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3382.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606.36,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3487.05,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1813.27,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3382.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2615.29,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3347.57,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1813.27,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2615.29,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2615.29,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.36,3487.05,
MRI HAND UPPER EXTREMITY OTH THAN JT W/O CONTRAST LEFT,72900034,CDM,614,RC,73218,HCPCS,Outpatient,,,2583,1937.25,,2376.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2402.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606.36,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2583,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2479.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.36,2583,
MRI HAND UPPER EXTREMITY OTH THAN JT W/O CONTRAST RIGHT,72900034,CDM,614,RC,73218,HCPCS,Outpatient,,,2583,1937.25,,2376.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2402.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606.36,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2583,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2479.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.36,2583,
MRI HIP W/ + W/O CONTRAST BILATERAL,72900060,CDM,614,RC,73723,HCPCS,Outpatient,,,4233.6,3175.2,,3894.91,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2201.47,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3937.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3810.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3810.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4106.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912.47,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4233.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2201.47,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4106.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3175.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4064.26,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2201.47,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3175.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3175.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912.47,4233.6,
MRI HIP W/ + W/O CONTRAST LEFT,72900059,CDM,614,RC,73723,HCPCS,Outpatient,,,3136,2352,,2885.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2916.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912.47,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3136,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3010.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912.47,3136,
MRI HIP W/ + W/O CONTRAST RIGHT,72900059,CDM,614,RC,73723,HCPCS,Outpatient,,,3136,2352,,2885.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2916.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912.47,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3136,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3010.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912.47,3136,
MRI HIP W/ CONTRAST BILATERAL,72900058,CDM,614,RC,73722,HCPCS,Outpatient,,,3743.55,2807.66,,3444.07,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1946.65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3481.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3369.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3369.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3631.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,652.18,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3743.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1946.65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3631.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2807.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3593.81,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1946.65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2807.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2807.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,652.18,3743.55,
MRI HIP W/ CONTRAST LEFT,72900057,CDM,614,RC,73722,HCPCS,Outpatient,,,2773,2079.75,,2551.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2578.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,652.18,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2773,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2662.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,652.18,2773,
MRI HIP W/ CONTRAST RIGHT,72900057,CDM,614,RC,73722,HCPCS,Outpatient,,,2773,2079.75,,2551.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2578.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,652.18,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2773,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2662.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,652.18,2773,
MRI HIP W/O CONTRAST BILATERAL,72900056,CDM,614,RC,73721,HCPCS,Outpatient,,,3218.4,2413.8,,2960.93,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1673.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2993.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2896.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2896.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3121.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,603.94,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3218.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1673.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3121.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2413.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3089.66,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1673.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2413.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2413.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.94,3218.4,
MRI HIP W/O CONTRAST LEFT,72900055,CDM,614,RC,73721,HCPCS,Outpatient,,,2384,1788,,2193.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2217.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,603.94,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2384,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2288.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.94,2384,
MRI HIP W/O CONTRAST RIGHT,72900055,CDM,614,RC,73721,HCPCS,Outpatient,,,2384,1788,,2193.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2217.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,603.94,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2384,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2288.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.94,2384,
MRI HUMERUS W/ + W/O CONTRAST BILATERAL,72900039,CDM,614,RC,73220,HCPCS,Outpatient,,,4880.25,3660.19,,4489.83,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2537.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4538.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4392.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4392.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4733.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,697.84,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4880.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2537.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4733.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3660.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4685.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2537.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3660.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3660.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.84,4880.25,
MRI HUMERUS W/ + W/O CONTRAST LEFT,72900038,CDM,614,RC,73220,HCPCS,Outpatient,,,3615,2711.25,,3325.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3361.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3253.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,697.84,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3615,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3506.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3470.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1879.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2711.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.84,3615,
MRI HUMERUS W/ + W/O CONTRAST RIGHT,72900038,CDM,614,RC,73220,HCPCS,Outpatient,,,4720,3540,,4342.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2454.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4389.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4248,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4248,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4578.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,697.84,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4720,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2454.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4578.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3540,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4531.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2454.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3540,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3540,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,697.84,4720,
MRI HUMERUS W/ CONTRAST BILATERAL,72900037,CDM,614,RC,73219,HCPCS,Outpatient,,,2259.9,1694.93,,2079.11,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1175.15,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2101.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2033.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2033.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2192.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,689.22,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2259.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1175.15,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2192.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1694.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2169.5,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1175.15,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1694.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1694.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,689.22,2259.9,
MRI HUMERUS W/ CONTRAST LEFT,72900036,CDM,614,RC,73219,HCPCS,Outpatient,,,1674,1255.5,,1540.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1556.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,689.22,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1674,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1607.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,689.22,1674,
MRI HUMERUS W/ CONTRAST RIGHT,72900036,CDM,614,RC,73219,HCPCS,Outpatient,,,1674,1255.5,,1540.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1556.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,689.22,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1674,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1607.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,689.22,1674,
MRI HUMERUS UPPER EXTREMITY OTH THAN JT W/O CONTRST BIL,72900035,CDM,614,RC,73218,HCPCS,Outpatient,,,3487.05,2615.29,,3208.09,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1813.27,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3242.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3138.35,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3138.35,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3382.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606.36,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3487.05,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1813.27,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3382.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2615.29,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3347.57,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1813.27,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2615.29,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2615.29,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.36,3487.05,
MRI HUMERUS UPPER EXTREMITY OTH THAN JT W/O CONTRST LEFT,72900034,CDM,614,RC,73218,HCPCS,Outpatient,,,2583,1937.25,,2376.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2402.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606.36,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2583,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2479.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.36,2583,
MRI HUMERUS UPPER EXTREMITY OTH THAN JT W/O CONTRST RIGHT,72900034,CDM,614,RC,73218,HCPCS,Outpatient,,,2583,1937.25,,2376.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2402.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606.36,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2583,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2505.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2479.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1343.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1937.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.36,2583,
MRI KNEE W/ + W/O CONTRAST LEFT,72900059,CDM,614,RC,73723,HCPCS,Outpatient,,,3136,2352,,2885.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2916.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912.47,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3136,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3010.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912.47,3136,
MRI KNEE W/ + W/O CONTRAST RIGHT,72900059,CDM,614,RC,73723,HCPCS,Outpatient,,,3136,2352,,2885.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2916.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2822.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912.47,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3136,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3041.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3010.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1630.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2352,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912.47,3136,
MRI KNEE W/ CONTRAST BILATERAL,72900058,CDM,614,RC,73722,HCPCS,Outpatient,,,3743.55,2807.66,,3444.07,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1946.65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3481.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3369.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3369.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3631.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,652.18,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3743.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1946.65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3631.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2807.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3593.81,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1946.65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2807.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2807.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,652.18,3743.55,
MRI KNEE W/ CONTRAST LEFT,72900057,CDM,614,RC,73722,HCPCS,Outpatient,,,2773,2079.75,,2551.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2578.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,652.18,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2773,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2662.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,652.18,2773,
MRI KNEE W/ CONTRAST RIGHT,72900057,CDM,614,RC,73722,HCPCS,Outpatient,,,2773,2079.75,,2551.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2578.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2495.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,652.18,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2773,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2689.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2662.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1441.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2079.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,652.18,2773,
MRI KNEE W/ + W/O CONTRAST BILATERAL,72900060,CDM,614,RC,73723,HCPCS,Outpatient,,,4233.6,3175.2,,3894.91,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2201.47,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3937.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3810.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3810.24,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4106.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912.47,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4233.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2201.47,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4106.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3175.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4064.26,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2201.47,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3175.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3175.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912.47,4233.6,
MRI KNEE W/O CONTRAST BILATERAL,72900056,CDM,614,RC,73721,HCPCS,Outpatient,,,3218.4,2413.8,,2960.93,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1673.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2993.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2896.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2896.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3121.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,603.94,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3218.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1673.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3121.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2413.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3089.66,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1673.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2413.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2413.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.94,3218.4,
MRI KNEE W/O CONTRAST LEFT,72900055,CDM,614,RC,73721,HCPCS,Outpatient,,,2384,1788,,2193.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2217.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,603.94,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2384,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2288.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.94,2384,
MRI KNEE W/ CONTRAST RIGHT,72900055,CDM,614,RC,73721,HCPCS,Outpatient,,,2384,1788,,2193.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2217.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2145.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,603.94,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2384,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2312.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2288.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1239.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1788,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.94,2384,
MRI PELVIS BEFORE AND AFTER CONTRAST,72900030,CDM,614,RC,72197,HCPCS,Outpatient,,,4640,3480,,4268.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2412.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4315.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4176,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4176,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4500.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,919.3,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4640,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2412.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4500.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3480,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4454.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2412.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3480,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3480,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,919.3,4640,
MRI PELVIS W/ CONTRAST,72900029,CDM,614,RC,72196,HCPCS,Outpatient,,,1991,1493.25,,1831.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1035.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1851.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1791.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1791.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1931.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,695.08,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1991,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1035.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1931.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1493.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1911.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1035.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1493.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1493.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,695.08,1991,
MRI PELVIS W/O CONTRAST,72900028,CDM,614,RC,72195,HCPCS,Outpatient,,,3381,2535.75,,3110.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1758.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3144.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3042.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3042.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3279.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,620.99,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3381,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1758.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3279.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2535.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3245.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1758.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2535.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2535.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,620.99,3381,
MRI SACRUM/COCCYX W/ + W/O CONTRAST,72900030,CDM,614,RC,72197,HCPCS,Outpatient,,,4640,3480,,4268.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2412.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4315.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4176,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4176,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4500.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,919.3,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4640,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2412.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4500.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3480,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4454.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2412.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3480,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3480,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,919.3,4640,
MRI SACRUM/COCCYX W/ CONTRAST,72900029,CDM,614,RC,72196,HCPCS,Outpatient,,,1991,1493.25,,1831.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1035.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1851.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1791.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1791.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1931.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,695.08,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1991,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1035.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1931.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1493.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1911.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1035.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1493.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1493.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,695.08,1991,
MRI SACRUM/COCCYX W/O CONTRAST,72900028,CDM,614,RC,72195,HCPCS,Outpatient,,,3381,2535.75,,3110.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1758.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3144.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3042.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3042.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3279.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,620.99,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3381,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1758.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3279.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2535.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3245.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1758.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2535.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2535.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,620.99,3381,
MRI SHOULDER W/ + W/O CONTRAST BILATERAL,72900045,CDM,614,RC,73223,HCPCS,Outpatient,,,4731.75,3548.81,,4353.21,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2460.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4400.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4258.58,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4258.58,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4589.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,676.4,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4731.75,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2460.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4589.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3548.81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4542.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2460.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3548.81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3548.81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676.4,4731.75,
MRI SHOULDER W/ + W/O CONTRAST LEFT,72900044,CDM,614,RC,73223,HCPCS,Outpatient,,,3505,2628.75,,3224.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3259.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,676.4,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3364.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676.4,3505,
MRI SHOULDER W/ + W/O CONTRAST RIGHT,72900044,CDM,614,RC,73223,HCPCS,Outpatient,,,3505,2628.75,,3224.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3259.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,676.4,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3364.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676.4,3505,
MRI SHOULDER W/ CONTRAST BILATERAL,72900043,CDM,614,RC,73222,HCPCS,Outpatient,,,3798.9,2849.18,,3494.99,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1975.43,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3532.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3419.01,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3419.01,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3684.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,664.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3798.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1975.43,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3684.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2849.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3646.94,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1975.43,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2849.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2849.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.85,3798.9,
MRI SHOULDER W/ CONTRAST LEFT,72900042,CDM,614,RC,73222,HCPCS,Outpatient,,,2814,2110.5,,2588.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2617.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,664.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2701.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.85,2814,
MRI SHOULDER W/ CONTRAST RIGHT,72900042,CDM,614,RC,73222,HCPCS,Outpatient,,,2814,2110.5,,2588.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2617.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,664.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2701.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.85,2814,
MRI SHOULDER W/O CONTRAST BILATERAL,72900041,CDM,614,RC,73221,HCPCS,Outpatient,,,3287.25,2465.44,,3024.27,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1709.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3057.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2958.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2958.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3188.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.02,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3287.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1709.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3188.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2465.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3155.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1709.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2465.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2465.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.02,3287.25,
MRI SHOULDER W/O CONTRAST LEFT,72900040,CDM,614,RC,73221,HCPCS,Outpatient,,,2435,1826.25,,2240.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2264.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.02,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2435,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2337.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.02,2435,
MRI SHOULDER W/O CONTRAST RIGHT,72900040,CDM,614,RC,73221,HCPCS,Outpatient,,,2435,1826.25,,2240.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2264.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.02,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2435,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2337.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.02,2435,
MRI SPINE CERVICAL W/ + W/O CONTRAST,72900025,CDM,612,RC,72156,HCPCS,Outpatient,,,3429,2571.75,,3154.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1783.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3188.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3086.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3086.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3326.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,945.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3429,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1783.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3326.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2571.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3291.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1783.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2571.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2571.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,945.62,3429,
MRI SPINE CERVICAL W/ CONTRAST,72900020,CDM,612,RC,72142,HCPCS,Outpatient,,,2217,1662.75,,2039.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1152.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2061.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1995.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1995.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2150.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5737,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2217,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1152.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2150.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1662.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2128.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1152.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1662.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1662.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1152.84,5737,
MRI SPINE CERVICAL W/O CONTRAST,72900019,CDM,612,RC,72141,HCPCS,Outpatient,,,2987,2240.25,,2748.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1553.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2777.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2688.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2688.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2897.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5603.43,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2987,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1553.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2897.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2240.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2867.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1553.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2240.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2240.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1553.24,5603.43,
MRI SPINE LUMBAR W/ + W/O CONTRAST,72900027,CDM,612,RC,72158,HCPCS,Outpatient,,,3401,2550.75,,3128.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1768.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3162.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3060.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3060.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3298.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,930.99,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3401,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1768.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3298.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2550.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3264.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1768.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2550.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2550.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,930.99,3401,
MRI SPINE LUMBAR W/ CONTRAST,72900024,CDM,612,RC,72149,HCPCS,Outpatient,,,3116,2337,,2866.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1620.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2897.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2804.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2804.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3022.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,749.67,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1620.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3022.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2337,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2991.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1620.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2337,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2337,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,749.67,3116,
MRI SPINE LUMBAR W/O CONTRAST,72900023,CDM,612,RC,72148,HCPCS,Outpatient,,,3033,2274.75,,2790.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1577.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2820.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2729.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2729.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2942.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,614.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3033,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1577.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2942.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2274.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2911.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1577.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2274.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2274.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,614.16,3033,
MRI SPINE THORACIC W/ + W/O CONTRAST,72900026,CDM,612,RC,72157,HCPCS,Outpatient,,,3343,2507.25,,3075.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1738.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3108.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3008.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3008.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3242.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,925.14,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3343,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1738.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3242.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2507.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3209.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1738.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2507.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2507.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,925.14,3343,
MRI SPINE THORACIC W/ CONTRAST,72900022,CDM,612,RC,72147,HCPCS,Outpatient,,,2201,1650.75,,2024.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1144.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2046.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1980.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1980.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2134.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,714.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2201,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1144.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2134.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1650.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2112.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1144.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1650.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1650.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,714.57,2201,
MRI SPINE THORACIC W/O CONTRAST,72900021,CDM,612,RC,72146,HCPCS,Outpatient,,,2911,2183.25,,2678.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1513.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2707.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2619.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2619.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2823.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5631.71,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2911,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1513.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2823.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2183.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2794.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1513.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2183.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2183.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1513.72,5631.71,
MRI TIBIA/FIBULA W/ + W/O CONTRAST LEFT,72900053,CDM,614,RC,73720,HCPCS,Outpatient,,,2969,2226.75,,2731.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2761.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,694.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2969,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2850.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,694.92,2969,
MRI TIBIA/FIBULA W/ + W/O CONTRAST RIGHT,72900053,CDM,614,RC,73720,HCPCS,Outpatient,,,2969,2226.75,,2731.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2761.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2672.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,694.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2969,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2879.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2850.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1543.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2226.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,694.92,2969,
MRI TIBIA/FIBULA W/ + W/O CONTRAST BILAT,72900054,CDM,614,RC,73720,HCPCS,Outpatient,,,4008.15,3006.11,,3687.5,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2084.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3727.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3607.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3607.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3887.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,694.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4008.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2084.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3887.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3006.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3847.82,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2084.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3006.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3006.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,694.92,4008.15,
MRI TIBIA/FIBULA W/ CONTRAST BILATERAL,72900052,CDM,614,RC,73719,HCPCS,Outpatient,,,3477.6,2608.2,,3199.39,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1808.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3234.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3129.84,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3129.84,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3373.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,673.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3477.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1808.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3373.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2608.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3338.5,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1808.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2608.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2608.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,673.62,3477.6,
MRI TIBIA/FIBULA W/ CONTRAST LEFT,72900051,CDM,614,RC,73719,HCPCS,Outpatient,,,2576,1932,,2369.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2395.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,673.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2576,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2472.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,673.62,2576,
MRI TIBIA/FIBULA W/ CONTRAST RIGHT,72900051,CDM,614,RC,73719,HCPCS,Outpatient,,,2576,1932,,2369.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2395.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2318.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,673.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2576,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2498.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2472.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1339.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1932,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,673.62,2576,
MRI TIBIA/FIBULA W/O CONTRAST BILATERAL,72900050,CDM,614,RC,73718,HCPCS,Outpatient,,,2840.4,2130.3,,2613.17,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1477.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2641.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2556.36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2556.36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2755.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,607.33,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2840.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1477.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2755.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2130.3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2726.78,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1477.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2130.3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2130.3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,607.33,2840.4,
MRI TIBIA/FIBULA W/O CONTRAST LEFT,72900049,CDM,614,RC,73718,HCPCS,Outpatient,,,2104,1578,,1935.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1956.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,607.33,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2019.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,607.33,2104,
MRI TIBIA/FIBULA W/O CONTRAST RIGHT,72900049,CDM,614,RC,73718,HCPCS,Outpatient,,,2104,1578,,1935.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1956.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1893.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,607.33,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2104,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2040.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2019.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1094.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1578,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,607.33,2104,
MRI WRIST W/ + W/O CONTRAST BILATERAL,72900045,CDM,614,RC,73223,HCPCS,Outpatient,,,4731.75,3548.81,,4353.21,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2460.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4400.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4258.58,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4258.58,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4589.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,676.4,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,4731.75,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2460.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4589.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3548.81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4542.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2460.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3548.81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3548.81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676.4,4731.75,
MRI WRIST W/ + W/O CONTRAST LEFT,72900044,CDM,614,RC,73223,HCPCS,Outpatient,,,3505,2628.75,,3224.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3259.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,676.4,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3364.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676.4,3505,
MRI WRIST W/ + W/O CONTRAST RIGHT,72900044,CDM,614,RC,73223,HCPCS,Outpatient,,,3505,2628.75,,3224.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3259.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3154.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,676.4,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3399.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3364.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1822.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2628.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676.4,3505,
MRI WRIST W/ CONTRAST BILATERAL,72900043,CDM,614,RC,73222,HCPCS,Outpatient,,,3798.9,2849.18,,3494.99,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1975.43,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3532.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3419.01,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3419.01,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3684.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,664.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3798.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1975.43,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3684.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2849.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3646.94,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1975.43,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2849.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2849.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.85,3798.9,
MRI WRIST W/ CONTRAST LEFT,72900042,CDM,614,RC,73222,HCPCS,Outpatient,,,2814,2110.5,,2588.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2617.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,664.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2701.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.85,2814,
MRI WRIST W/ CONTRAST RIGHT,72900042,CDM,614,RC,73222,HCPCS,Outpatient,,,2814,2110.5,,2588.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2617.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2532.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,664.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2729.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2701.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1463.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2110.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.85,2814,
MRI WRIST W/O CONTRAST BILATERAL,72900041,CDM,614,RC,73221,HCPCS,Outpatient,,,3287.25,2465.44,,3024.27,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1709.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3057.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2958.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2958.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3188.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.02,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,3287.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1709.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3188.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2465.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3155.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1709.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2465.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2465.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.02,3287.25,
MRI WRIST W/O CONTRAST LEFT,72900040,CDM,614,RC,73221,HCPCS,Outpatient,,,2435,1826.25,,2240.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2264.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.02,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2435,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2337.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.02,2435,
MRI WRIST W/O CONTRAST RIGHT,72900040,CDM,614,RC,73221,HCPCS,Outpatient,,,2435,1826.25,,2240.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2264.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2191.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,581.02,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2435,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2361.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2337.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1266.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1826.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,581.02,2435,
NM BONE IMAGING LIMITED,73000011,CDM,341,RC,78300,HCPCS,Outpatient,,,1520,1140,,1398.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,790.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1413.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1368,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1368,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1474.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1520,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,790.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1474.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1140,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1459.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,790.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1140,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1140,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,790.4,1520,
NM BONE IMAGING WHOLE BODY,73000012,CDM,341,RC,78306,HCPCS,Outpatient,,,2012,1509,,1851.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1046.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1871.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1810.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1810.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1951.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2012,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1046.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1951.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1509,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1931.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1046.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1509,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1509,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1046.24,2012,
NM BONE THREE PHASE STUDY,73000013,CDM,341,RC,78315,HCPCS,Outpatient,,,2312,1734,,2127.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1202.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2150.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2080.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2080.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2242.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2312,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1202.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2242.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1734,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2219.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1202.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1734,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1734,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1202.24,2312,
NM CARDIAC BLOOD POOL GATED REST+STRESS,73000015,CDM,341,RC,78472,HCPCS,Outpatient,,,2167,1625.25,,1993.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1126.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2015.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1950.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1950.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2101.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2167,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1126.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2101.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1625.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2080.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1126.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1625.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1625.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1126.84,2167,
NM GASTRIC EMPTYING STUDY,73000007,CDM,341,RC,78264,HCPCS,Outpatient,,,1623,1217.25,,1493.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1509.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1460.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1460.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1574.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1623,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1574.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1558.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,843.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1217.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,843.96,1623,
NM GASTROINTESTINAL BLOOD LOSS IMAGING,73000009,CDM,341,RC,78278,HCPCS,Outpatient,,,1829,1371.75,,1682.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,951.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1700.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1646.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1646.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1774.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1829,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,951.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1774.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1371.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1755.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,951.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1371.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1371.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,951.08,1829,
NM HEPATOBILIARY IMAGING,73000005,CDM,341,RC,78226,HCPCS,Outpatient,,,1783,1337.25,,1640.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,927.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1658.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1604.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1604.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1729.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1783,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,927.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1729.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1337.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1711.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,927.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1337.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1337.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,927.16,1783,
NM HEPATOBILIARY IMAGING W/ DRUG,73000006,CDM,341,RC,78227,HCPCS,Outpatient,,,2415,1811.25,,2221.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1255.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2245.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2173.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2173.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2342.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2415,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1255.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2342.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1811.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2318.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1255.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1811.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1811.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1255.8,2415,
NM INTESTINE IMAGING MECKELS,73000010,CDM,341,RC,78290,HCPCS,Outpatient,,,1870,1402.5,,1720.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,972.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1739.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1683,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1683,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1813.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1870,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,972.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1813.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1402.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1795.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,972.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1402.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1402.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,972.4,1870,
NM KIDNEY IMAGING MULTIPLE W/+W/O PHARM,73000020,CDM,341,RC,78709,HCPCS,Outpatient,,,2329,1746.75,,2142.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1211.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2165.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2096.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2096.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2259.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2329,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1211.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2259.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1746.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2235.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1211.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1746.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1746.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1211.08,2329,
NM KIDNEY IMAGING SINGLE W/ PHARM,73000019,CDM,341,RC,78708,HCPCS,Outpatient,,,1115,836.25,,1025.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,579.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1036.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1003.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1003.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1081.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1115,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,579.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1081.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,836.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1070.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,579.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,836.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,836.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,579.8,1115,
NM LUNG PERFUSION IMAGING,73000017,CDM,341,RC,78580,HCPCS,Outpatient,,,1300,975,,1196,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,676,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1209,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1170,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1170,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1261,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1300,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,676,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1261,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,975,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1248,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,676,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,975,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,975,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,676,1300,
NM LUNG VENT/PERF IMAGING,73000018,CDM,341,RC,78582,HCPCS,Outpatient,,,1831,1373.25,,1684.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,952.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1702.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1647.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1647.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1776.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1831,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,952.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1776.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1373.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1757.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,952.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1373.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1373.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,952.12,1831,
NM LUNG VENTILATION IMAGING,73000016,CDM,341,RC,78579,HCPCS,Outpatient,,,1026,769.5,,943.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,533.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,954.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,923.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,923.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,995.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1026,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,533.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,995.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,769.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,984.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,533.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,769.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,769.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,533.52,1026,
NM MYOCARDIAL SPECT REST AND STRESS,73000014,CDM,341,RC,78452,HCPCS,Outpatient,,,3170,2377.5,,2916.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1648.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2948.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2853,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2853,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3074.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3170,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1648.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3074.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2377.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3043.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1648.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2377.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2377.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1648.4,3170,
NM PARATHYROID IMAGING,73000004,CDM,341,RC,78070,HCPCS,Outpatient,,,1542,1156.5,,1418.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,801.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1434.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1387.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1387.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1495.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1542,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,801.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1495.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1156.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1480.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,801.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1156.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1156.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,801.84,1542,
NM THYROID IMAGE W/ UPTAKE SNGL OR MULTI,73000003,CDM,341,RC,78014,HCPCS,Outpatient,,,1430,1072.5,,1315.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,743.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1329.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1287,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1287,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1387.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1430,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,743.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1387.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1072.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1372.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,743.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1072.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1072.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,743.6,1430,
NM THYROID IMAGING,73000002,CDM,341,RC,78013,HCPCS,Outpatient,,,1130,847.5,,1039.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,587.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1050.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1017,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1017,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1096.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1130,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,587.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1096.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,847.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1084.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,587.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,847.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,847.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,587.6,1130,
NM THYROID UPTAKE SINGLE OR MULTI,73000001,CDM,341,RC,78012,HCPCS,Outpatient,,,1288,966,,1184.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,669.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1197.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1159.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1159.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1249.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1288,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,669.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1249.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,966,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1236.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,669.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,966,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,966,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,669.76,1288,
NM UREA BREATH TEST C-14 ISOTOPIC ANALYSIS,73000008,CDM,341,RC,78268,HCPCS,Outpatient,,,4975,3731.25,,4577,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2587,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4626.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4477.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4477.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4825.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4975,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2587,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4825.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3731.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4776,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2587,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3731.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3731.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2587,4975,
US AAA SCREENING,72600008,CDM,402,RC,76706,HCPCS,Outpatient,,,840,630,,772.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,436.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,781.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,756,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,756,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,814.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,840,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,436.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,814.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,630,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,806.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,436.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,630,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,630,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,436.8,840,
US ABDOMEN COMPLETE,72600006,CDM,402,RC,76700,HCPCS,Outpatient,,,1289,966.75,,1185.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1198.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,188.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1237.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.62,1289,
US ABDOMEN LIMITED,72600007,CDM,402,RC,76705,HCPCS,Outpatient,,,660,495,,607.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,343.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,613.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,594,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,594,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,640.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,139.54,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,660,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,343.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,640.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,495,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,633.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,343.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,495,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,495,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.54,660,
US BIOPSY LIVER,78001482,CDM,402,RC,47000,HCPCS,Outpatient,,,2732,2049,,2513.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1420.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2540.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2458.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2458.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2650.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2732,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1420.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2650.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2049,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2622.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1420.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2049,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2049,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1420.64,2732,
US BIOPSY LYMPH NODE BILATERAL,78002217,CDM,402,RC,38505,HCPCS,Outpatient,,,2619,1964.25,,2409.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1361.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2435.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2357.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2357.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2540.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2619,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1361.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2540.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1964.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2514.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1361.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1964.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1964.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1361.88,2619,
US BIOPSY LYMPH NODE LEFT,78002201,CDM,402,RC,38505,HCPCS,Outpatient,,,2619,1964.25,,2409.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1361.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2435.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2357.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2357.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2540.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2619,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1361.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2540.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1964.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2514.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1361.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1964.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1964.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1361.88,2619,
US BIOPSY LYMPH NODE RIGHT,78002201,CDM,402,RC,38505,HCPCS,Outpatient,,,2619,1964.25,,2409.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1361.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2435.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2357.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2357.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2540.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2619,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1361.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2540.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1964.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2514.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1361.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1964.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1964.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1361.88,2619,
BIOPSY SOFT TISSUE OF NECK OR THORAX,78002197,CDM,402,RC,21550,HCPCS,Outpatient,,,414,310.5,,380.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,215.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,385.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,372.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,372.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,401.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,414,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,215.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,401.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,310.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,397.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,215.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,310.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,310.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,215.28,414,
FINE NEEDLE ASPIRATION BX W/US GDN EA ADD'L,78002853,CDM,402,RC,10006,HCPCS,Outpatient,,,1213,909.75,,1115.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,630.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1128.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1091.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1091.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1176.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1213,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,630.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1176.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,909.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1164.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,630.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,909.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,909.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,630.76,1213,
FINE NEEDLE ASPIRATION BX W/US GDN EA ADD'L,78002853,CDM,402,RC,10006,HCPCS,Outpatient,,,1213,909.75,,1115.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,630.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1128.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1091.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1091.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1176.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1213,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,630.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1176.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,909.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1164.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,630.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,909.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,909.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,630.76,1213,
BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUIDE RT,78002195,CDM,402,RC,19083,HCPCS,Outpatient,,,3744,2808,,3444.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1946.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3481.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3369.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3369.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3631.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3744,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1946.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3631.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2808,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3594.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1946.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2808,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2808,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1946.88,3744,
BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUIDE RT,78002195,CDM,402,RC,19083,HCPCS,Outpatient,,,3744,2808,,3444.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1946.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3481.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3369.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3369.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3631.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3744,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1946.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3631.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2808,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3594.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1946.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2808,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2808,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1946.88,3744,
US BREAST COMPLETE BILAT,72600046,CDM,402,RC,76641,HCPCS,Outpatient,,,518,388.5,,476.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,481.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,466.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,466.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,502.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,518,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,502.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,497.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.36,518,
US BREAST COMPLETE LEFT,72600045,CDM,402,RC,76641,HCPCS,Outpatient,,,518,388.5,,476.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,481.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,466.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,466.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,502.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,518,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,502.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,497.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.36,518,
US BREAST COMPLETE RIGHT,72600045,CDM,402,RC,76641,HCPCS,Outpatient,,,518,388.5,,476.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,481.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,466.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,466.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,502.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,518,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,502.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,497.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,269.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,388.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.36,518,
PUNCTURE ASPIRATION OF CYST OF BREAST BILATERAL,78002213,CDM,402,RC,19000,HCPCS,Outpatient,,,112,84,,103.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,100.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.24,112,
PUNCTURE ASPIRATION OF BREAST CYST EACH ADDITIONAL,78002278,CDM,402,RC,19001,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,286,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,274.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.72,286,
PUNCTURE ASPIRATION OF CYST OF BREAST LEFT,78002193,CDM,402,RC,19000,HCPCS,Outpatient,,,813,609.75,,747.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,422.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,756.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,731.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,731.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,788.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,813,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,422.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,788.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,609.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,780.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,422.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,609.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,609.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,422.76,813,
PUNCTURE ASPIRATION OF CYST OF BREAST RIGHT,78002193,CDM,402,RC,19000,HCPCS,Outpatient,,,813,609.75,,747.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,422.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,756.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,731.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,731.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,788.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,813,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,422.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,788.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,609.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,780.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,422.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,609.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,609.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,422.76,813,
US BREAST LIMITED BILAT,72600005,CDM,402,RC,76642,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,437.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,423,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,423,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,455.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,470,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,455.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,451.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.4,470,
US BREAST LIMITED LEFT,72600004,CDM,402,RC,76642,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,437.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,423,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,423,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,455.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,470,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,455.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,451.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.4,470,
US BREAST LIMITED RIGHT,72600004,CDM,402,RC,76642,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,437.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,423,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,423,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,455.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,470,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,455.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,451.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,244.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,352.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.4,470,
US CAROTID DUPLEX BILATERAL,72600038,CDM,402,RC,93880,HCPCS,Outpatient,,,2567,1925.25,,2361.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1334.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2387.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2310.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2310.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2489.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2567,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1334.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2489.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1925.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2464.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1334.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1925.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1925.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1334.84,2567,
US CHEST,72600003,CDM,402,RC,76604,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,465,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,450,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,450,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,485,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.22,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,485,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,480,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.22,500,
US ECHO 2D COMP W/ COLOR FLOW DOPPLER,72600035,CDM,483,RC,93306,HCPCS,Outpatient,,,2246,1684.5,,2066.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1167.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2088.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2021.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2021.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2178.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,315.65,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2246,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1167.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2178.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1684.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2156.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1167.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1684.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1684.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,315.65,2246,
US ECHO 2D LIMITED,72600036,CDM,483,RC,93308,HCPCS,Outpatient,,,881,660.75,,810.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,458.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,819.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,792.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,792.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,854.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,881,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,458.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,854.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,660.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,845.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,458.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,660.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,660.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,458.12,881,
US ENCEPHALOGRAM,72600001,CDM,402,RC,76506,HCPCS,Outpatient,,,257,192.75,,236.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,133.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,231.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,231.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,249.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,166.49,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,257,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,133.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,249.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,192.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,246.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,133.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,192.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.64,257,
US EXTREMITY NON-VASC REAL-TIME IMG LMTD LT,72600029,CDM,402,RC,76882,HCPCS,Outpatient,,,546,409.5,,502.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,507.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,546,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,283.92,546,
US EXTREMITY NON-VASC REAL-TIME IMG LMTD RT,72600029,CDM,402,RC,76882,HCPCS,Outpatient,,,546,409.5,,502.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,507.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,546,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,283.92,546,
US EXTREMITY NON-VASC REAL-TIME IMG LMTD BIL,72600029,CDM,402,RC,76882,HCPCS,Outpatient,,,523,392.25,,481.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,271.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,486.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,470.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,470.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,507.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,523,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,271.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,507.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,392.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,502.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,271.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,392.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,392.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,271.96,523,
US FETAL BIOPHYSICAL PROFILE W/ NON-STR,72600021,CDM,402,RC,76818,HCPCS,Outpatient,,,946,709.5,,870.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,491.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,879.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,851.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,851.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,917.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,946,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,491.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,917.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,709.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,908.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,491.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,709.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,709.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,491.92,946,
US FETAL BIOPHYSICAL PROFLE W/O NON-STRESS TEST,72600022,CDM,402,RC,76819,HCPCS,Outpatient,,,700,525,,644,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,364,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,651,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,630,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,630,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,679,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,700,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,364,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,679,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,525,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,672,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,364,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,525,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,525,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,364,700,
FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION,78000001,CDM,402,RC,10005,HCPCS,Outpatient,,,1784,1338,,1641.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,927.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1659.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1605.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1605.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1730.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1784,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,927.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1730.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1338,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1712.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,927.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1338,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1338,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,927.68,1784,
US GALLBLADDER,72600007,CDM,402,RC,76705,HCPCS,Outpatient,,,660,495,,607.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,343.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,613.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,594,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,594,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,640.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,139.54,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,660,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,343.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,640.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,495,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,633.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,343.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,495,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,495,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.54,660,
US GUIDED NEEDLE PLACEMENT,72600031,CDM,402,RC,76942,HCPCS,Outpatient,,,720,540,,662.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,374.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,669.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,648,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,648,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,698.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,720,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,374.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,698.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,540,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,691.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,374.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,540,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,540,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,374.4,720,
US HEAD/NECK SOFT TISSUE,72600002,CDM,402,RC,76536,HCPCS,Outpatient,,,769,576.75,,707.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,399.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,715.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,692.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,692.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,745.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,150.13,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,769,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,399.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,745.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,576.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,738.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,399.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,576.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,576.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.13,769,
US HIPS INFANT DYNAMIC,72600030,CDM,402,RC,76885,HCPCS,Outpatient,,,711,533.25,,654.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,369.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,661.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,639.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,689.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,711,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,369.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,689.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,533.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,682.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,369.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,533.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,533.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,369.72,711,
US LOWER EXT VENOUS DUPLEX BILATERAL,72600043,CDM,402,RC,93970,HCPCS,Outpatient,,,1973,1479.75,,1815.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1025.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1834.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1775.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1775.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1913.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1973,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1025.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1913.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1479.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1894.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1025.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1479.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1479.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1025.96,1973,
US LOWER EXT VENOUS DUPLEX LEFT,72600044,CDM,402,RC,93971,HCPCS,Outpatient,,,817,612.75,,751.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,759.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,735.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,735.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,792.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,817,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,792.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,784.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,424.84,817,
US LOWER EXT VENOUS DUPLEX RIGHT,72600044,CDM,402,RC,93971,HCPCS,Outpatient,,,817,612.75,,751.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,759.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,735.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,735.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,792.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,817,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,792.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,784.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,424.84,817,
US OB DETAILED COMPLETE EA ADDL GEST,72600017,CDM,402,RC,76812,HCPCS,Outpatient,,,642,481.5,,590.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,333.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,597.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,577.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,577.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,622.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,642,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,333.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,622.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,481.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,616.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,333.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,481.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,481.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,333.84,642,
US OB DETAILED COMPLETE FIRST GEST,72600016,CDM,402,RC,76811,HCPCS,Outpatient,,,1078,808.5,,991.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,560.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1002.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,970.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,970.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1045.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1078,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,560.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1045.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,808.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1034.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,560.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,808.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,808.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,560.56,1078,
US OB DETAILED MULTI,72600016,CDM,402,RC,76811,HCPCS,Outpatient,,,1078,808.5,,991.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,560.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1002.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,970.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,970.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1045.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1078,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,560.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1045.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,808.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1034.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,560.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,808.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,808.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,560.56,1078,
US OB FOLLOW UP,72600019,CDM,402,RC,76816,HCPCS,Outpatient,,,564,423,,518.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,293.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,524.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,507.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,507.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,547.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,564,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,293.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,547.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,423,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,541.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,293.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,423,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,423,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,293.28,564,
US OB GREATER THAN 14 WEEKS EA ADDL GEST,72600015,CDM,402,RC,76810,HCPCS,Outpatient,,,302,226.5,,277.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,157.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,271.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,271.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,292.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,302,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,157.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,226.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,289.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,157.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,226.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,157.04,302,
US OB GREATER THAN 14 WEEKS MULTI,72600014,CDM,402,RC,76805,HCPCS,Outpatient,,,932,699,,857.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,484.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,866.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,838.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,838.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,904.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,932,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,484.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,904.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,699,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,894.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,484.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,699,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,699,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,484.64,932,
US OB GREATER THAN 14 WEEKS SINGLE,72600014,CDM,402,RC,76805,HCPCS,Outpatient,,,932,699,,857.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,484.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,866.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,838.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,838.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,904.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,932,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,484.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,904.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,699,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,894.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,484.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,699,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,699,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,484.64,932,
US OB LESS THAN 14 WEEKS EA ADDL GEST,72600013,CDM,402,RC,76802,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,277.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,289.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,298,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,289.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,286.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.96,298,
US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,72600012,CDM,402,RC,76801,HCPCS,Outpatient,,,819,614.25,,753.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,425.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,761.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,737.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,737.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,794.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,819,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,425.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,794.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,614.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,786.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,425.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,614.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,614.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,425.88,819,
US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,72600012,CDM,402,RC,76801,HCPCS,Outpatient,,,819,614.25,,753.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,425.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,761.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,737.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,737.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,794.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,819,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,425.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,794.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,614.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,786.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,425.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,614.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,614.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,425.88,819,
US OB LIMITED,72600018,CDM,402,RC,76815,HCPCS,Outpatient,,,485,363.75,,446.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,252.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,451.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,436.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,436.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,470.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,485,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,252.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,470.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,363.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,465.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,252.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,363.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,363.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,252.2,485,
US OB TRANSVAGINAL,72600020,CDM,402,RC,76817,HCPCS,Outpatient,,,809,606.75,,744.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,420.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,752.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,728.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,728.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,784.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,809,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,420.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,784.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,776.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,420.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,606.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,420.68,809,
ABDOMINAL PARACENTESIS DX/THER W/IMAGING GUIDANCE,78001497,CDM,402,RC,49083,HCPCS,Outpatient,,,1768,1326,,1626.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,919.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1644.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1591.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1591.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1714.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1768,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,919.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1714.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1326,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1697.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,919.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1326,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1326,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,919.36,1768,
US PELVIC COMPLETE,72600026,CDM,402,RC,76856,HCPCS,Outpatient,,,1010,757.5,,929.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,525.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,939.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,909,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,909,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,979.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,166.49,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1010,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,525.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,979.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,757.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,969.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,525.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,757.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,757.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.49,1010,
US PELVIC LTD,72600027,CDM,402,RC,76857,HCPCS,Outpatient,,,623,467.25,,573.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,323.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,579.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,560.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,560.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,604.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,623,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,323.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,604.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,467.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,598.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,323.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,467.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,467.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.92,623,
US RETROPERITONEAL COMPLETE,72600009,CDM,402,RC,76770,HCPCS,Outpatient,,,907,680.25,,834.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,471.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,843.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,816.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,816.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,879.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,176.11,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,907,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,471.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,879.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,680.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,870.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,471.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,680.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,680.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,176.11,907,
US RETROPERITONEAL LIMITED,72600010,CDM,402,RC,76775,HCPCS,Outpatient,,,596,447,,548.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,309.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,554.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,536.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,536.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,578.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,145.31,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,596,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,309.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,578.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,447,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,572.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,309.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,447,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,447,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,145.31,596,
US SCROTUM (CONTENTS),72600028,CDM,402,RC,76870,HCPCS,Outpatient,,,711,533.25,,654.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,369.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,661.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,639.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,689.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,159.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,711,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,369.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,689.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,533.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,682.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,369.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,533.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,533.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,159.75,711,
US ABDOMINAL REAL TIME W/IMAGE LIMITED,72600007,CDM,402,RC,76705,HCPCS,Outpatient,,,660,495,,607.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,343.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,613.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,594,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,594,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,640.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,139.54,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,660,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,343.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,640.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,495,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,633.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,343.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,495,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,495,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.54,660,
US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,72600027,CDM,402,RC,76857,HCPCS,Outpatient,,,623,467.25,,573.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,323.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,579.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,560.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,560.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,604.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,623,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,323.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,604.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,467.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,598.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,323.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,467.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,467.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.92,623,
US CHEST REAL TIME W/IMAGE DOCUMENTATION,72600003,CDM,402,RC,76604,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,465,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,450,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,450,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,485,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.22,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,485,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,480,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,260,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,375,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.22,500,
US SOFT TISSUE GROIN,72600029,CDM,402,RC,76882,HCPCS,Outpatient,,,546,409.5,,502.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,507.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,546,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,283.92,546,
US SPINAL CANAL,72600011,CDM,402,RC,76800,HCPCS,Outpatient,,,691,518.25,,635.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,359.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,642.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,621.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,621.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,670.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,187.66,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,691,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,359.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,670.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,518.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,663.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,359.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,518.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,518.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,187.66,691,
THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING,78001280,CDM,402,RC,32555,HCPCS,Outpatient,,,4072,3054,,3746.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2117.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3786.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3664.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3664.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3949.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4072,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2117.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3949.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3054,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3909.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2117.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3054,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3054,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2117.44,4072,
US THYROID,72600002,CDM,402,RC,76536,HCPCS,Outpatient,,,769,576.75,,707.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,399.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,715.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,692.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,692.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,745.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,150.13,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,769,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,399.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,745.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,576.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,738.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,399.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,576.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,576.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.13,769,
US TRANSVAGINAL NON-OB,72600024,CDM,402,RC,76830,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,664.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,643.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,643.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,693.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,166.49,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,715,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,693.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,686.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.49,715,
US UPPER EXT VENOUS DUPLEX BILATERAL,72600043,CDM,402,RC,93970,HCPCS,Outpatient,,,1973,1479.75,,1815.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1025.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1834.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1775.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1775.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1913.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1973,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1025.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1913.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1479.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1894.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1025.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1479.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1479.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1025.96,1973,
US UPPER EXT VENOUS DUPLEX LEFT,72600044,CDM,402,RC,93971,HCPCS,Outpatient,,,817,612.75,,751.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,759.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,735.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,735.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,792.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,817,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,792.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,784.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,424.84,817,
US UPPER EXT VENOUS DUPLEX RIGHT,72600044,CDM,402,RC,93971,HCPCS,Outpatient,,,817,612.75,,751.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,759.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,735.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,735.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,792.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,817,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,792.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,784.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,424.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,612.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,424.84,817,
XR A-C JOINTS BI W/WO WEIGHTED DISTR,71800182,CDM,320,RC,73050,HCPCS,Outpatient,,,413,309.75,,379.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,214.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,384.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,371.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,371.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,400.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,413,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,214.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,400.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,309.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,396.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,214.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,309.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,309.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51,413,
XR ABDOMEN 1 VIEW,71800351,CDM,320,RC,74018,HCPCS,Outpatient,,,320,240,,294.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,166.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,297.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,288,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,288,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,310.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,320,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,166.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,310.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,240,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,307.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,166.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.4,320,
XR ABDOMEN 2 VIEWS,71800515,CDM,320,RC,74019,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,205.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,367.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,355.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,355.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,383.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,395,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,205.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,383.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,296.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,205.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,296.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,296.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,205.4,395,
XR ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,71800355,CDM,320,RC,74022,HCPCS,Outpatient,,,499,374.25,,459.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,259.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,464.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,449.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,449.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,484.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,499,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,259.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,484.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,374.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,479.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,259.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,374.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,374.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,259.48,499,
XR ANKLE 2 VIEWS BILATERAL,71800301,CDM,320,RC,73600,HCPCS,Outpatient,,,421.2,315.9,,387.5,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,219.02,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,391.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,379.08,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,379.08,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,408.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,421.2,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,219.02,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,408.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,315.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,404.35,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,219.02,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,315.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,315.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,421.2,
XR ANKLE 2 VIEWS LEFT,71800299,CDM,320,RC,73600,HCPCS,Outpatient,,,312,234,,287.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,312,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,299.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,312,
XR ANKLE 2 VIEWS RIGHT,71800299,CDM,320,RC,73600,HCPCS,Outpatient,,,312,234,,287.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,312,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,299.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,312,
XR ANKLE COMPLETE MINIMUM 3 VIEWS BILATERAL,71800305,CDM,320,RC,73610,HCPCS,Outpatient,,,477.9,358.43,,439.67,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,248.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,444.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,430.11,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,430.11,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,463.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,477.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,248.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,463.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,358.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,458.78,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,248.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,358.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,358.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,477.9,
XR ANKLE COMPLETE 3+ VIEWS LEFT,71800303,CDM,320,RC,73610,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,354,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,339.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,354,
XR ANKLE COMPLETE 3+ VIEWS RIGHT,71800303,CDM,320,RC,73610,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,354,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,339.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,354,
XR ANKLE ARTHROGRAPHY RS and I BILATERAL,71800309,CDM,320,RC,73615,HCPCS,Outpatient,,,1035.7,776.78,,952.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,538.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,963.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,932.13,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,932.13,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1004.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1035.7,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,538.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1004.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,776.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,994.27,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,538.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,776.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,776.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,538.56,1035.7,
XR ANKLE ARTHROGRAPHY RS and I LEFT,71800307,CDM,320,RC,73615,HCPCS,Outpatient,,,671,503.25,,617.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,348.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,624.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,603.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,603.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,650.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,671,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,348.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,650.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,503.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,644.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,348.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,503.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,503.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.92,671,
XR ANKLE ARTHROGRAPHY RS and I RIGHT,71800307,CDM,320,RC,73615,HCPCS,Outpatient,,,671,503.25,,617.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,348.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,624.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,603.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,603.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,650.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,671,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,348.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,650.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,503.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,644.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,348.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,503.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,503.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.92,671,
XR ELBOW ARTHROGRAPHY RS and I BILATERAL,71800200,CDM,320,RC,73085,HCPCS,Outpatient,,,607.5,455.63,,558.9,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,315.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,564.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,546.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,546.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,589.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,607.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,315.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,589.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,455.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,583.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,315.9,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,455.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,455.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,315.9,607.5,
XR ELBOW ARTHROGRAPHY RS and I LEFT,71800198,CDM,320,RC,73085,HCPCS,Outpatient,,,450,337.5,,414,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,234,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,418.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,405,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,405,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,436.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,450,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,234,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,436.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,337.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,432,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,234,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,337.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234,450,
XR ELBOW ARTHROGRAPHY RS and I RIGHT,71800198,CDM,320,RC,73085,HCPCS,Outpatient,,,450,337.5,,414,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,234,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,418.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,405,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,405,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,436.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,450,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,234,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,436.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,337.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,432,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,234,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,337.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234,450,
XR HIP ARTHROGRAPHY RSI BILATERAL,71800267,CDM,320,RC,73525,HCPCS,Outpatient,,,1026,769.5,,943.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,533.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,954.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,923.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,923.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,995.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1026,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,533.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,995.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,769.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,984.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,533.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,769.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,769.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,533.52,1026,
XR HIP ARTHROGRAPHY RSI LEFT,71800265,CDM,320,RC,73525,HCPCS,Outpatient,,,760,570,,699.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,395.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,706.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,684,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,684,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,737.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,760,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,395.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,737.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,570,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,729.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,395.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,570,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,570,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,395.2,760,
XR HIP ARTHROGRAPHY RSI RIGHT,71800265,CDM,320,RC,73525,HCPCS,Outpatient,,,760,570,,699.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,395.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,706.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,684,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,684,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,737.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,760,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,395.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,737.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,570,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,729.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,395.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,570,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,570,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,395.2,760,
XR ARTHROGRAM INJECTION ANKLE BILAT,78000938,CDM,320,RC,27648,HCPCS,Outpatient,,,394,295.5,,362.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,204.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,366.42,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,354.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,354.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,382.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,394,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,204.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,382.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,295.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,378.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,204.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,295.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,295.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,204.88,394,
XR ARTHROGRAM INJECTION ANKLE LEFT,78000936,CDM,320,RC,27648,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,244.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,236.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,236.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,255.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,263,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,255.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,252.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.76,263,
XR ARTHROGRAM INJECTION ANKLE RIGHT,78000936,CDM,320,RC,27648,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,244.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,236.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,236.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,255.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,263,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,255.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,252.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.76,263,
XR ARTHROGRAM INJECTION ELBOW BILAT,78000505,CDM,320,RC,24220,HCPCS,Outpatient,,,477,357.75,,438.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,248.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,443.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,429.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,429.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,462.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,477,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,248.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,462.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,357.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,457.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,248.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,357.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,248.04,477,
XR ARTHROGRAM INJECTION ELBOW LEFT,78000503,CDM,320,RC,24220,HCPCS,Outpatient,,,318,238.5,,292.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,295.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,286.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,286.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,308.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,318,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,308.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,305.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,165.36,318,
XR ARTHROGRAM INJECTION ELBOW RIGHT,78000503,CDM,320,RC,24220,HCPCS,Outpatient,,,318,238.5,,292.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,295.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,286.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,286.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,308.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,318,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,308.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,305.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,165.36,318,
XR ARTHROGRAM INJECTION HIP BILAT,78002215,CDM,320,RC,27093,HCPCS,Outpatient,,,1023.3,767.48,,941.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,532.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,951.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,920.97,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,920.97,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,992.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1023.3,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,532.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,992.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,767.48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,982.37,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,532.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,767.48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,767.48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,532.12,1023.3,
XR ARTHROGRAM INJECTION HIP LEFT,78002199,CDM,320,RC,27093,HCPCS,Outpatient,,,758,568.5,,697.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,704.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,682.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,682.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,735.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,758,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,735.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,727.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.16,758,
XR ARTHROGRAM INJECTION HIP RIGHT,78002199,CDM,320,RC,27093,HCPCS,Outpatient,,,758,568.5,,697.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,704.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,682.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,682.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,735.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,758,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,735.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,727.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.16,758,
XR ARTHROGRAM INJECTION KNEE BILAT,78000835,CDM,320,RC,27369,HCPCS,Outpatient,,,915.3,686.48,,842.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,475.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,851.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,823.77,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,823.77,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,887.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,915.3,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,475.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,887.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,686.48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,878.69,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,475.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,686.48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,686.48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,475.96,915.3,
XR ARTHROGRAM INJECTION KNEE LEFT,78000833,CDM,320,RC,27369,HCPCS,Outpatient,,,678,508.5,,623.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,630.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,610.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,610.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,678,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,657.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,650.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,352.56,678,
XR ARTHROGRAM INJECTION KNEE RIGHT,78000833,CDM,320,RC,27369,HCPCS,Outpatient,,,678,508.5,,623.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,630.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,610.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,610.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,678,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,657.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,650.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,352.56,678,
INJECTION SHOULDER ARTHROGRAPHY LEFT,78000428,CDM,320,RC,23350,HCPCS,Outpatient,,,464,348,,426.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,241.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,431.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,417.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,417.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,450.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,464,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,241.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,450.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,348,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,445.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,241.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,348,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,241.28,464,
INJECTION SHOULDER ARTHROGRAPHY RIGHT,78000428,CDM,320,RC,23350,HCPCS,Outpatient,,,464,348,,426.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,241.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,431.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,417.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,417.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,450.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,464,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,241.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,450.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,348,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,445.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,241.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,348,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,241.28,464,
INJECTION SHOULDER ARTHROGRAPHY BILATERAL,78000430,CDM,320,RC,23350,HCPCS,Outpatient,,,626.4,469.8,,576.29,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,325.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,582.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,563.76,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,563.76,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,607.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,626.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,325.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,607.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,469.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,601.34,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,325.73,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,469.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,469.8,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,325.73,626.4,
XR ARTHROGRAM INJECTION WRIST BILAT,78000585,CDM,320,RC,25246,HCPCS,Outpatient,,,513,384.75,,471.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,477.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,461.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,461.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,497.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,513,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,497.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,492.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,266.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,384.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,266.76,513,
XR ARTHROGRAM INJECTION WRIST LEFT,78000583,CDM,320,RC,25246,HCPCS,Outpatient,,,522,391.5,,480.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,271.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,485.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,469.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,469.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,506.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,522,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,271.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,506.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,391.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,501.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,271.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,391.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,391.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,271.44,522,
XR ARTHROGRAM INJECTION WRIST RIGHT,78000583,CDM,320,RC,25246,HCPCS,Outpatient,,,522,391.5,,480.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,271.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,485.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,469.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,469.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,506.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,522,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,271.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,506.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,391.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,501.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,271.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,391.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,391.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,271.44,522,
XR KNEE ARTHROGRAPHY RSI BILATERAL,71800289,CDM,320,RC,73580,HCPCS,Outpatient,,,1475.55,1106.66,,1357.51,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,767.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1372.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1328,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1328,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1431.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1475.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,767.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1431.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1106.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1416.53,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,767.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1106.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1106.66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,767.29,1475.55,
XR KNEE ARTHROGRAPHY RSI,71800287,CDM,320,RC,73580,HCPCS,Outpatient,,,1093,819.75,,1005.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,568.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1016.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,983.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,983.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1060.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1093,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,568.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1060.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,819.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1049.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,568.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,819.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,568.36,1093,
XR KNEE ARTHROGRAPHY RSI,71800287,CDM,320,RC,73580,HCPCS,Outpatient,,,1093,819.75,,1005.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,568.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1016.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,983.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,983.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1060.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1093,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,568.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1060.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,819.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1049.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,568.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,819.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,568.36,1093,
XR SHOULDER ARTHROGRAPHY RSI BILATERAL,71800180,CDM,320,RC,73040,HCPCS,Outpatient,,,1693,1269.75,,1557.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,880.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1574.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1523.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1523.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1642.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,143.39,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1693,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,880.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1642.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1269.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1625.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,880.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1269.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1269.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.39,1693,
XR SHOULDER ARTHROGRAPHY RSI,71800178,CDM,320,RC,73040,HCPCS,Outpatient,,,1254,940.5,,1153.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,652.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1166.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1128.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1128.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1216.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,143.39,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1254,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,652.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1216.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,940.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1203.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,652.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,940.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,940.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.39,1254,
XR SHOULDER ARTHROGRAPHY RSI,71800178,CDM,320,RC,73040,HCPCS,Outpatient,,,1254,940.5,,1153.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,652.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1166.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1128.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1128.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1216.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,143.39,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1254,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,652.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1216.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,940.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1203.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,652.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,940.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,940.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.39,1254,
XR WRIST ARTHROGRAPHY RSI BILATERAL,71800220,CDM,320,RC,73115,HCPCS,Outpatient,,,1254.15,940.61,,1153.82,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,652.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1166.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1128.74,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1128.74,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1216.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1254.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,652.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1216.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,940.61,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1203.98,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,652.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,940.61,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,940.61,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,652.16,1254.15,
XR WRIST ARTHROGRAPHY RS and I LEFT,71800218,CDM,320,RC,73115,HCPCS,Outpatient,,,929,696.75,,854.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,483.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,863.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,836.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,836.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,901.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,929,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,483.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,901.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,696.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,891.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,483.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,696.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,696.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,483.08,929,
XR WRIST ARTHROGRAPHY RS and I RIGHT,71800218,CDM,320,RC,73115,HCPCS,Outpatient,,,929,696.75,,854.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,483.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,863.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,836.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,836.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,901.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,929,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,483.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,901.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,696.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,891.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,483.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,696.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,696.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,483.08,929,
XR BARIUM ENEMA COMPLETE,71800379,CDM,320,RC,74270,HCPCS,Outpatient,,,749,561.75,,689.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,389.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,696.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,674.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,674.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,726.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,749,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,389.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,726.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,561.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,719.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,389.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,561.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,561.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,389.48,749,
XR BARIUM ENEMA W/ AIR COMPLETE,71800381,CDM,320,RC,74280,HCPCS,Outpatient,,,991,743.25,,911.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,515.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,921.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,891.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,891.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,961.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,991,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,515.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,961.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,743.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,951.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,515.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,743.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,743.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,515.32,991,
XR BONE AGE STUDIES,71800484,CDM,320,RC,77072,HCPCS,Outpatient,,,316,237,,290.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,164.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,293.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,284.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,284.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,306.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,316,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,164.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,237,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,303.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,164.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,237,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.32,316,
XR BONE LENGTH STUDY,71800486,CDM,320,RC,77073,HCPCS,Outpatient,,,384,288,,353.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,199.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,357.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,345.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,345.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,372.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,384,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,199.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,372.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,288,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,368.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,199.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,288,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,199.68,384,
XR CALCANEUS MINIMUM 2 VIEWS BILATERAL,71800321,CDM,320,RC,73650,HCPCS,Outpatient,,,361.8,271.35,,332.86,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,336.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,325.62,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,325.62,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,350.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,361.8,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,350.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,271.35,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,347.33,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,271.35,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,271.35,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,361.8,
XR CALCANEUS MINIMUM 2 VIEWS LT,71800319,CDM,320,RC,73650,HCPCS,Outpatient,,,268,201,,246.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,139.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,249.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,241.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,241.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,259.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,268,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,139.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,259.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,201,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,257.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,139.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,268,
XR CALCANEUS MINIMUM 2 VIEWS RT,71800319,CDM,320,RC,73650,HCPCS,Outpatient,,,268,201,,246.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,139.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,249.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,241.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,241.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,259.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,268,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,139.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,259.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,201,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,257.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,139.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,268,
XR CHEST SINGLE VIEW,71800060,CDM,324,RC,71045,HCPCS,Outpatient,,,270,202.5,,248.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,140.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,243,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,243,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,261.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,270,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,140.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,202.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,259.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,140.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,202.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,202.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,140.4,270,
XR CHEST 1 VIEW PORTABLE,71800060,CDM,324,RC,71045,HCPCS,Outpatient,,,270,202.5,,248.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,140.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,243,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,243,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,261.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,270,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,140.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,202.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,259.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,140.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,202.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,202.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,140.4,270,
XR CHEST 2 VIEWS,71800062,CDM,324,RC,71046,HCPCS,Outpatient,,,332,249,,305.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,172.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,308.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,298.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,298.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,322.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,332,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,172.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,322.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,249,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,172.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,249,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,249,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.64,332,
XR CHOLANGIOGRAM IN OR,71800385,CDM,320,RC,74300,HCPCS,Outpatient,,,839,629.25,,771.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,436.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,780.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,755.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,755.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,813.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,839,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,436.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,813.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,629.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,805.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,436.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,629.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,629.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,436.28,839,
XR CHOLANGIOGRAM IN OR ADD SET(S),71800387,CDM,320,RC,74301,HCPCS,Outpatient,,,344,258,,316.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,178.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,319.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,309.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,309.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,333.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,344,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,178.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,333.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,258,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,330.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,178.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,258,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,178.88,344,
XR CLAVICLE COMPLETE BILATERAL,71800164,CDM,320,RC,73000,HCPCS,Outpatient,,,441.45,331.09,,406.13,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,410.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,397.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,441.45,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,428.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,423.79,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,441.45,
XR CLAVICLE COMPLETE LEFT,71800162,CDM,320,RC,73000,HCPCS,Outpatient,,,435,326.25,,400.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,226.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,404.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,391.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,391.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,421.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,435,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,226.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,421.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,417.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,226.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,326.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,435,
XR CLAVICLE COMPLETE RIGHT,71800162,CDM,320,RC,73000,HCPCS,Outpatient,,,435,326.25,,400.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,226.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,404.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,391.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,391.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,421.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,435,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,226.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,421.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,417.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,226.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,326.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,435,
XR COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,71800381,CDM,320,RC,74280,HCPCS,Outpatient,,,1020,765,,938.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,530.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,948.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,918,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,918,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,989.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1020,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,530.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,989.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,765,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,979.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,530.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,765,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,765,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,530.4,1020,
XR CYSTOGRAM,71800404,CDM,320,RC,74430,HCPCS,Outpatient,,,531,398.25,,488.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,276.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,493.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,477.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,477.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,515.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,531,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,276.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,515.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,398.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,509.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,276.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,398.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,398.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.12,531,
XR ELBOW 1 VIEW BILATERAL,71800190,CDM,320,RC,73070,HCPCS,Outpatient,,,406.35,304.76,,373.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,211.3,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,377.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,365.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,365.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,394.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,406.35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,211.3,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,394.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,304.76,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,390.1,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,211.3,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.76,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,304.76,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,406.35,
XR ELBOW 1 VIEW LEFT,71800188,CDM,320,RC,73070,HCPCS,Outpatient,,,301,225.75,,276.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,301,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,301,
XR ELBOW 1 VIEW RIGHT,71800188,CDM,320,RC,73070,HCPCS,Outpatient,,,301,225.75,,276.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,301,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,301,
XR ELBOW 2 VIEWS BILATERAL,71800191,CDM,320,RC,73070,HCPCS,Outpatient,,,372.6,279.45,,342.79,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,193.75,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,346.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,335.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,335.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,361.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,372.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,193.75,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,361.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,279.45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357.7,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,193.75,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,279.45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,372.6,
XR ELBOW 2 VIEWS LEFT,71800189,CDM,320,RC,73070,HCPCS,Outpatient,,,276,207,,253.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,143.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,256.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,248.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,248.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,267.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,276,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,143.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,207,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,264.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,143.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,207,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,276,
XR ELBOW 2 VIEWS RIGHT,71800189,CDM,320,RC,73070,HCPCS,Outpatient,,,276,207,,253.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,143.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,256.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,248.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,248.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,267.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,276,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,143.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,207,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,264.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,143.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,207,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,276,
XR ELBOW COMPLETE 3+ VIEWS BILATERAL,71800196,CDM,320,RC,73080,HCPCS,Outpatient,,,523.8,392.85,,481.9,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,272.38,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,487.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,471.42,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,471.42,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,508.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.12,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,523.8,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,272.38,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,508.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,392.85,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,502.85,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,272.38,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,392.85,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,392.85,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.12,523.8,
XR ELBOW COMPLETE 3+ VIEWS LEFT,71800194,CDM,320,RC,73080,HCPCS,Outpatient,,,388,291,,356.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,360.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.12,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,388,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,372.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.12,388,
XR ELBOW COMPLETE 3+ VIEWS RIGHT,71800194,CDM,320,RC,73080,HCPCS,Outpatient,,,388,291,,356.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,360.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.12,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,388,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,372.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.12,388,
XR ESOPHAGUS,71800370,CDM,320,RC,74220,HCPCS,Outpatient,,,616,462,,566.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,320.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,572.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,554.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,554.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,597.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,616,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,320.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,597.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,462,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,591.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,320.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,462,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,462,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,320.32,616,
XR FACET INJECTION CERV/THOR LV1 LEFT,78001756,CDM,320,RC,64490,HCPCS,Outpatient,,,2923,2192.25,,2689.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2718.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2630.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2630.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2835.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2923,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2835.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2806.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1519.96,2923,
XR FACET INJECTION CERV/THOR LV1 RIGHT,78001756,CDM,320,RC,64490,HCPCS,Outpatient,,,2923,2192.25,,2689.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2718.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2630.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2630.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2835.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2923,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2835.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2806.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1519.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2192.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1519.96,2923,
XR FACET INJECTION CERV/THOR LV2 LEFT,78001758,CDM,320,RC,64491,HCPCS,Outpatient,,,3215,2411.25,,2957.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1671.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2989.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2893.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2893.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3118.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3215,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1671.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3118.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2411.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3086.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1671.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2411.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2411.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1671.8,3215,
XR FACET INJECTION CERV/THOR LV2 RIGHT,78001758,CDM,320,RC,64491,HCPCS,Outpatient,,,3215,2411.25,,2957.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1671.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2989.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2893.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2893.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3118.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3215,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1671.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3118.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2411.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3086.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1671.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2411.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2411.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1671.8,3215,
XR FACET INJECTION CERV/THOR LV3+ RIGHT,78001760,CDM,320,RC,64492,HCPCS,Outpatient,,,3507,2630.25,,3226.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1823.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3261.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3156.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3156.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3401.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1823.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3401.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2630.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3366.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1823.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2630.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2630.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1823.64,3507,
XR FACET INJECTION CERV/THOR LV3+ LEFT,78001760,CDM,320,RC,64492,HCPCS,Outpatient,,,3507,2630.25,,3226.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1823.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3261.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3156.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3156.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3401.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1823.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3401.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2630.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3366.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1823.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2630.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2630.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1823.64,3507,
XR FACET INJECTION LUMB/SACR LV1 LEFT,78001762,CDM,320,RC,64493,HCPCS,Outpatient,,,2630,1972.5,,2419.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1367.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2445.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2367,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2367,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2551.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2630,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1367.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2551.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1972.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2524.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1367.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1972.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1972.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1367.6,2630,
XR FACET INJECTION LUMB/SACR LV1 RIGHT,78001762,CDM,320,RC,64493,HCPCS,Outpatient,,,2630,1972.5,,2419.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1367.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2445.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2367,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2367,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2551.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2630,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1367.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2551.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1972.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2524.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1367.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1972.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1972.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1367.6,2630,
XR FACET INJECTION LUMB/SACR LV2 LEFT,78001764,CDM,320,RC,64494,HCPCS,Outpatient,,,1500,1125,,1380,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,780,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1395,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1350,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1350,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1455,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,780,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1455,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1440,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,780,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,780,1500,
XR FACET INJECTION LUMB/SACR LV2 RIGHT,78001764,CDM,320,RC,64494,HCPCS,Outpatient,,,1500,1125,,1380,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,780,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1395,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1350,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1350,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1455,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,780,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1455,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1440,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,780,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,780,1500,
XR FACET INJECTION LUMB/SACR LV3+ LEFT,78001766,CDM,320,RC,64495,HCPCS,Outpatient,,,1526,1144.5,,1403.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,793.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1419.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1373.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1373.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1480.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1526,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,793.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1480.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1144.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1464.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,793.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1144.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1144.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,793.52,1526,
XR FACET INJECTION LUMB/SACR LV3+ RIGHT,78001766,CDM,320,RC,64495,HCPCS,Outpatient,,,1526,1144.5,,1403.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,793.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1419.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1373.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1373.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1480.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1526,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,793.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1480.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1144.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1464.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,793.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1144.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1144.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,793.52,1526,
XR FACIAL BONES 3+ VIEWS,71800010,CDM,320,RC,70150,HCPCS,Outpatient,,,480,360,,441.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,249.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,446.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,432,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,432,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,465.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60.45,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,480,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,249.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,465.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,360,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,460.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,249.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,360,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,360,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.45,480,
XR FACIAL BONES < 3 VIEWS,71800008,CDM,320,RC,70140,HCPCS,Outpatient,,,525,393.75,,483,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,488.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,525,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,504,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.85,525,
XR FEMUR 2 VIEWS BILAT,71800269,CDM,320,RC,73552,HCPCS,Outpatient,,,473.85,355.39,,435.94,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,246.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,440.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,426.47,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,426.47,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,459.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,473.85,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,246.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,459.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,355.39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,454.9,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,246.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,355.39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,355.39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,246.4,473.85,
XR FEMUR 2 VIEWS LEFT,71800269,CDM,320,RC,73552,HCPCS,Outpatient,,,351,263.25,,322.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,326.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,340.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,351,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,340.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,263.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,263.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182.52,351,
XR FEMUR 2 VIEWS RIGHT,71800269,CDM,320,RC,73552,HCPCS,Outpatient,,,351,263.25,,322.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,326.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,340.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,351,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,340.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,263.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,263.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182.52,351,
XR FINGER MINIMUM 2 VIEWS BILATERAL,71800521,CDM,320,RC,73140,HCPCS,Outpatient,,,332.1,249.08,,305.53,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,172.69,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,308.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,298.89,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,298.89,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,322.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.46,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,332.1,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,172.69,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,322.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,249.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318.82,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,172.69,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,249.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,249.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.46,332.1,
XR FINGER MINIMUM 2 VIEWS,71800230,CDM,320,RC,73140,HCPCS,Outpatient,,,246,184.5,,226.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,228.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,221.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,221.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,238.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.46,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,246,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.46,246,
XR FINGER MINIMUM 2 VIEWS RT,71800230,CDM,320,RC,73140,HCPCS,Outpatient,,,246,184.5,,226.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,228.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,221.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,221.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,238.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.46,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,246,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.46,246,
XR FINGER MINIMUM 2 VIEWS RT,71800230,CDM,320,RC,73140,HCPCS,Outpatient,,,246,184.5,,226.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,228.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,221.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,221.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,238.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.46,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,246,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,127.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.46,246,
XR FLUORO GUIDANCE NEEDLE LOC SPINE,71800468,CDM,320,RC,77003,HCPCS,Outpatient,,,398,298.5,,366.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,206.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,370.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,358.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,358.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,386.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,398,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,206.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,386.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,298.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,382.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,206.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,298.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,298.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,206.96,398,
XR FLUORO GUIDANCE NEEDLE PLACEMENT,71800466,CDM,320,RC,77002,HCPCS,Outpatient,,,698,523.5,,642.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,649.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,628.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,628.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,677.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,698,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,677.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,670.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,362.96,698,
XR FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,71800466,CDM,320,RC,77002,HCPCS,Outpatient,,,552,414,,507.84,92,,,percent of total billed charges,92% of total billed charges,287.04,52,,,percent of total billed charges,52% of total billed charges,513.36,93,,,percent of total billed charges,93% of total billed charges,496.8,90,,,percent of total billed charges,90% of total billed charges,496.8,90,,,percent of total billed charges,90% of total billed charges,535.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,287.04,52,,,percent of total billed charges,52% of total billed charges,535.44,97,,,percent of total billed charges,97% of total billed charges,414,75,,,percent of total billed charges,75% of total billed charges,529.92,96,,,percent of total billed charges,96% of total billed charges,287.04,52,,,percent of total billed charges,52% of total billed charges,414,75,,,percent of total billed charges,75% of total billed charges,414,75,,,percent of total billed charges,75% of total billed charges,287.04,535.44,
XR FLUOROSCOPY UNDER 1 HOUR,71800420,CDM,320,RC,76000,HCPCS,Outpatient,,,684,513,,629.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,355.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,636.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,615.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,615.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,663.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,684,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,355.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,663.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,513,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,656.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,355.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,513,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,513,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,355.68,684,
XR FOOT 2 VIEWS BILATERAL,71800313,CDM,320,RC,73620,HCPCS,Outpatient,,,504.9,378.68,,464.51,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,262.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,469.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,454.41,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,454.41,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,489.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,504.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,262.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,489.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,378.68,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,484.7,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,262.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,378.68,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,378.68,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.57,504.9,
XR FOOT 2 VIEWS LEFT,71800311,CDM,320,RC,73620,HCPCS,Outpatient,,,374,280.5,,344.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,194.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,347.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,336.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,336.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,362.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,374,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,194.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,362.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,280.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,194.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,280.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.57,374,
XR FOOT 2 VIEWS RIGHT,71800311,CDM,320,RC,73620,HCPCS,Outpatient,,,374,280.5,,344.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,194.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,347.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,336.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,336.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,362.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,374,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,194.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,362.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,280.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,194.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,280.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.57,374,
XR FOOT COMPLETE 3+ VIEWS BILATERAL,71800317,CDM,320,RC,73630,HCPCS,Outpatient,,,441.45,331.09,,406.13,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,410.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,397.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.34,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,441.45,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,428.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,423.79,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.34,441.45,
XR FOOT COMPLETE 3+ VIEWS LEFT,71800315,CDM,320,RC,73630,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.34,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.34,327,
XR FOOT COMPLETE 3+ VIEWS RIGHT,71800315,CDM,320,RC,73630,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.34,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.34,327,
XR FOREARM 2 VIEWS BILATERAL,71800317,CDM,320,RC,73090,HCPCS,Outpatient,,,441.45,331.09,,406.13,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,410.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,397.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,441.45,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,428.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,423.79,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,441.45,
XR FOREARM 2 VIEWS LEFT,71800315,CDM,320,RC,73090,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,327,
XR FOREARM 2 VIEWS RIGHT,71800315,CDM,320,RC,73090,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,327,
XR FOREIGN BODY LOCALIZATION CHILD 1 VW,71800422,CDM,320,RC,76010,HCPCS,Outpatient,,,235,176.25,,216.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,122.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,218.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,211.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,211.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,227.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,235,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,122.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,227.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,176.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,122.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,176.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,176.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.2,235,
XR FOREIGN BODY LOCALIZATION EYE,71800002,CDM,320,RC,70030,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.6,330,
XR HAND 2 VIEWS BILATERAL,71800224,CDM,320,RC,73120,HCPCS,Outpatient,,,425.25,318.94,,391.23,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,221.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,395.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,382.73,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,382.73,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,412.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,425.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,221.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,412.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,318.94,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,408.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,221.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.94,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318.94,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,425.25,
XR HAND 2 VIEWS LEFT,71800222,CDM,320,RC,73120,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,315,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,315,
XR HAND 2 VIEWS RIGHT,71800222,CDM,320,RC,73120,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.53,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,315,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.53,315,
XR HAND COMPLETE 3+ VIEWS BILATERAL,71800228,CDM,320,RC,73130,HCPCS,Outpatient,,,472.5,354.38,,434.7,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.7,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,439.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,425.25,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,425.25,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,458.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,472.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.7,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,458.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.7,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,472.5,
XR HAND COMPLETE 3+ VIEWS LEFT,71800226,CDM,320,RC,73130,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,350,
XR HAND COMPLETE 3+ VIEWS RIGHT,71800226,CDM,320,RC,73130,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,350,
XR HIP 1 VIEW LEFT,71800255,CDM,320,RC,73501,HCPCS,Outpatient,,,290,217.5,,266.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,269.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,261,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,261,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,281.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,290,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,278.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.8,290,
XR HIP 1 VIEW RIGHT,71800255,CDM,320,RC,73501,HCPCS,Outpatient,,,290,217.5,,266.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,269.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,261,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,261,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,281.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,290,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,278.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.8,290,
XR HIP WITH PELVIS 1 VIEW BILATERAL,71800257,CDM,320,RC,73501,HCPCS,Outpatient,,,255,191.25,,234.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,237.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,255,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.6,255,
XR HIP 1 VIEW W/ AP PELVIS LEFT,71800255,CDM,320,RC,73501,HCPCS,Outpatient,,,290,217.5,,266.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,269.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,261,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,261,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,281.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,290,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,278.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.8,290,
XR HIP 1 VIEW W/ AP PELVIS RIGHT,71800255,CDM,320,RC,73501,HCPCS,Outpatient,,,290,217.5,,266.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,269.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,261,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,261,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,281.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,290,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,278.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,217.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.8,290,
XR HIP 2-3 VIEWS LEFT,71800259,CDM,320,RC,73502,HCPCS,Outpatient,,,277,207.75,,254.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,257.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,277,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.04,277,
XR HIP 2-3 VIEWS RIGHT,71800259,CDM,320,RC,73502,HCPCS,Outpatient,,,277,207.75,,254.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,257.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,277,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.04,277,
XR HIP 2-3 VIEWS W/AP PELVIS LEFT,71800259,CDM,320,RC,73502,HCPCS,Outpatient,,,277,207.75,,254.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,257.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,277,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.04,277,
XR HIP 2-3 VIEWS W/AP PELVIS RIGHT,71800259,CDM,320,RC,73502,HCPCS,Outpatient,,,277,207.75,,254.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,257.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,277,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.04,277,
XR HIPS 2 VIEWS W/AP PELVIS BILAT,71800263,CDM,320,RC,73521,HCPCS,Outpatient,,,465,348.75,,427.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,241.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,432.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,418.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,418.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,451.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,465,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,241.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,451.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,348.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,446.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,241.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,348.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,241.8,465,
XR HUMERUS BILAT,71800186,CDM,320,RC,73060,HCPCS,Outpatient,,,412.2,309.15,,379.22,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,214.34,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,383.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,370.98,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,370.98,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,399.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,412.2,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,214.34,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,399.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,309.15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,395.71,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,214.34,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,309.15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,309.15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,412.2,
XR HUMERUS LEFT,71800184,CDM,320,RC,73060,HCPCS,Outpatient,,,312,234,,287.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,312,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,299.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,312,
XR HUMERUS RIGHT,71800184,CDM,320,RC,73060,HCPCS,Outpatient,,,312,234,,287.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,312,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,299.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,312,
XR HYSTEROSALPINGOGRAPHY,71800414,CDM,320,RC,74740,HCPCS,Outpatient,,,989,741.75,,909.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,514.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,919.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,890.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,890.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,959.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,989,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,514.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,959.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,741.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,949.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,514.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,741.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,741.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,514.28,989,
XR IVP,71800396,CDM,320,RC,74400,HCPCS,Outpatient,,,1059,794.25,,974.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,550.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,984.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,953.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,953.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1027.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,144.35,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1059,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,550.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1027.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,794.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1016.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,550.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,794.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.35,1059,
INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,78000352,CDM,320,RC,20552,HCPCS,Outpatient,,,1421,1065.75,,1307.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,738.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1321.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1278.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1278.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1378.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1421,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,738.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1378.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1065.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1364.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,738.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1065.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1065.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,738.92,1421,
ARTHROCENTESIS ASPIR and /INJ INTERM JT/BURS W/O US LEFT,78000362,CDM,320,RC,20605,HCPCS,Outpatient,,,692,519,,636.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,643.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,692,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.84,692,
ARTHROCENTESIS ASPIR and /INJ INTERM JT/BURS W/O US RIGHT,78000362,CDM,320,RC,20605,HCPCS,Outpatient,,,692,519,,636.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,643.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,692,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.84,692,
ARTHROCENTESIS ASPIR and /INJ INTERM JT/BURS W/O US BILAT,78000364,CDM,320,RC,20605,HCPCS,Outpatient,,,692,519,,636.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,643.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,622.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,692,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,671.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,664.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,359.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,519,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.84,692,
ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA W/O US LT,78000368,CDM,320,RC,20610,HCPCS,Outpatient,,,854,640.5,,785.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,794.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,768.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,768.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,828.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,854,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,828.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,444.08,854,
ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA W/O US RT,78000368,CDM,320,RC,20610,HCPCS,Outpatient,,,854,640.5,,785.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,794.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,768.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,768.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,828.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,854,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,828.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,444.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,640.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,444.08,854,
ARTHROCENT ASPIR/INJ MAJOR JT/BURSA W/O US BIL,78000370,CDM,320,RC,20610,HCPCS,Outpatient,,,1152.9,864.68,,1060.67,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,599.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1072.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1037.61,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1037.61,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1118.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1152.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,599.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1118.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,864.68,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1106.78,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,599.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,864.68,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,864.68,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,599.51,1152.9,
ARTHROCENTESIS ASPIR and /INJ SMALL JT/BURSA W/O US LEFT,78000356,CDM,320,RC,20600,HCPCS,Outpatient,,,644,483,,592.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,598.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,579.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,579.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,624.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,644,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,624.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,618.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,334.88,644,
ARTHROCENTESIS ASPIR and /INJ SMALL JT/BURSA W/O US RIGHT,78000356,CDM,320,RC,20600,HCPCS,Outpatient,,,644,483,,592.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,598.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,579.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,579.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,624.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,644,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,624.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,618.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,334.88,644,
ARTHROCENTESIS ASPIR and /INJ SMALL JT/BURSA W/O US BILAT,78000358,CDM,320,RC,20600,HCPCS,Outpatient,,,644,483,,592.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,598.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,579.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,579.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,624.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,644,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,624.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,618.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,334.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,483,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,334.88,644,
XR KNEE 1 VIEW STANDING AP BILATERAL,71800285,CDM,320,RC,73565,HCPCS,Outpatient,,,408,306,,375.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,212.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,379.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,367.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,367.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,395.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4619,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,408,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,212.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,395.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,306,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,391.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,212.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,306,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,212.16,4619,
XR KNEE 1 OR 2 VIEWS BILATERAL,71800275,CDM,320,RC,73560,HCPCS,Outpatient,,,434.7,326.03,,399.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,226.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,404.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,391.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,391.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,421.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,434.7,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,226.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,421.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,326.03,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,417.31,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,226.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,326.03,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.03,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,434.7,
XR KNEE 1 OR 2 VIEWS LEFT,71800273,CDM,320,RC,73560,HCPCS,Outpatient,,,322,241.5,,296.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,299.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,289.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,289.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,312.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,322,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,312.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,309.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,322,
XR KNEE 1 OR 2 VIEWS RIGHT,71800273,CDM,320,RC,73560,HCPCS,Outpatient,,,322,241.5,,296.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,299.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,289.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,289.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,312.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,322,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,312.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,309.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,167.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,241.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,322,
XR KNEE 3 VIEWS BILATERAL,71800279,CDM,320,RC,73562,HCPCS,Outpatient,,,476.55,357.41,,438.43,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,247.81,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,443.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,428.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,462.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,476.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,247.81,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,462.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,357.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,457.49,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,247.81,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,357.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.16,476.55,
XR KNEE 3 VIEWS LEFT,71800277,CDM,320,RC,73562,HCPCS,Outpatient,,,353,264.75,,324.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,183.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,328.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,317.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,342.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,353,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,183.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,342.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,264.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,338.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,183.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,264.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,264.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.16,353,
XR KNEE 3 VIEWS RIGHT,71800277,CDM,320,RC,73562,HCPCS,Outpatient,,,353,264.75,,324.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,183.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,328.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,317.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,342.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,353,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,183.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,342.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,264.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,338.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,183.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,264.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,264.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.16,353,
XR KNEE COMPLETE 4+ VIEWS BILATERAL,71800283,CDM,320,RC,73564,HCPCS,Outpatient,,,409,306.75,,376.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,212.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,380.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,368.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,368.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,396.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,55.82,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,409,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,212.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,396.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,306.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,392.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,212.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,306.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.82,409,
XR KNEE COMPLETE 4+ VIEWS LEFT,71800281,CDM,320,RC,73564,HCPCS,Outpatient,,,381,285.75,,350.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,342.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,342.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,55.82,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,381,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,369.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,365.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.82,381,
XR KNEE COMPLETE 4+ VIEWS RIGHT,71800281,CDM,320,RC,73564,HCPCS,Outpatient,,,381,285.75,,350.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,342.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,342.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,55.82,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,381,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,369.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,365.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.82,381,
XR LOWER EXTREMITY INFANT 2 VIEWS BILAT,71800297,CDM,320,RC,73592,HCPCS,Outpatient,,,441.45,331.09,,406.13,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,410.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,397.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,441.45,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,428.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,423.79,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,229.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,229.55,441.45,
XR LOWER EXTREMITY INFANT 2 VIEWS LEFT,71800295,CDM,320,RC,73592,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.04,327,
XR LOWER EXTREMITY INFANT 2 VIEWS RIGHT,71800295,CDM,320,RC,73592,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.04,327,
XR MANDIBLE COMPLETE 4+ VIEWS,71800006,CDM,320,RC,70110,HCPCS,Outpatient,,,600,450,,552,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,312,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,558,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,540,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,540,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,582,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,55.56,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,600,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,312,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,582,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,450,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,576,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,312,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,450,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,450,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.56,600,
XR MANDIBLE LESS THAN 4 VIEWS,71800004,CDM,320,RC,70100,HCPCS,Outpatient,,,487,365.25,,448.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,253.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,452.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,438.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,438.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,472.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.89,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,487,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,253.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,472.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,365.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,467.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,253.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,365.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,365.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.89,487,
XR MODIFIED BARIUM SWALLOW,71800372,CDM,320,RC,74230,HCPCS,Outpatient,,,479,359.25,,440.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,445.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,464.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,479,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,464.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,459.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,249.08,479,
MYELOGRAPHY VIA LUMBAR INJECTION S  and  I 2+ REGN,78002211,CDM,320,RC,62305,HCPCS,Outpatient,,,2000,1500,,1840,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1040,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1860,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1800,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1800,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1940,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2000,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1040,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1940,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1500,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1920,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1040,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1500,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1500,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1040,2000,
MYELOGRAPHY LUMBAR INJECTION CERVCAL WITH S  and  I,78002205,CDM,320,RC,62302,HCPCS,Outpatient,,,2556,1917,,2351.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1329.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2377.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2300.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2300.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2479.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2556,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1329.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2479.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1917,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2453.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1329.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1917,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1917,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1329.12,2556,
MYELOGRAPHY LUMBAR INJECT LUMBOSACRAL WI/S  and  I,78002209,CDM,320,RC,62304,HCPCS,Outpatient,,,2690,2017.5,,2474.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1398.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2501.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2421,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2421,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2609.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2690,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1398.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2609.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2017.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2582.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1398.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2017.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2017.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1398.8,2690,
MYELOGRAPHY LUMBAR INJECT THORACIC WITH S  and  I,78002207,CDM,320,RC,62303,HCPCS,Outpatient,,,2556,1917,,2351.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1329.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2377.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2300.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2300.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2479.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2556,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1329.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2479.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1917,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2453.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1329.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1917,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1917,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1329.12,2556,
XR NASAL BONES 3+ VIEWS,71800012,CDM,320,RC,70160,HCPCS,Outpatient,,,410,307.5,,377.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,381.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,369,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.85,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,410,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,397.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.85,410,
XR NECK SOFT TISSUE,71800030,CDM,320,RC,70360,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,277.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,289.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,298,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,289.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,286.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.96,298,
XR ORBITS COMPLETE,71800014,CDM,320,RC,70200,HCPCS,Outpatient,,,425,318.75,,391,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,395.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,382.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,382.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,412.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,65.32,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,425,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,412.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,408,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.32,425,
XR OSSEOUS SURVEY COMPLETE,71800490,CDM,320,RC,77075,HCPCS,Outpatient,,,722,541.5,,664.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,375.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,671.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,649.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,649.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,700.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,722,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,375.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,700.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,541.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,693.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,375.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,541.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,541.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,375.44,722,
XR OSSEOUS SURVEY INFANT,71800492,CDM,320,RC,77076,HCPCS,Outpatient,,,415,311.25,,381.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,385.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,373.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,373.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,402.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,415,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,402.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,398.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,215.8,415,
XR OSSEOUS SURVEY LIMITED,71800488,CDM,320,RC,77074,HCPCS,Outpatient,,,390,292.5,,358.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,202.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,362.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,351,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,351,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,378.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,390,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,202.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,378.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,292.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,374.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,202.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,202.8,390,
XR PELVIS 1 OR 2 VIEWS,71800131,CDM,320,RC,72170,HCPCS,Outpatient,,,415,311.25,,381.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,385.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,373.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,373.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,402.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,41.38,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,415,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,402.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,398.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.38,415,
XR PELVIS COMPLETE 3+ VIEWS,71800133,CDM,320,RC,72190,HCPCS,Outpatient,,,523,392.25,,481.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,271.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,486.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,470.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,470.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,507.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60.63,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,523,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,271.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,507.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,392.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,502.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,271.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,392.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,392.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.63,523,
XR PERC TUBE/DRAINAGE CATH CHNG W/ CONT,71800417,CDM,320,RC,75984,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,216.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,386.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,374.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,374.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,403.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,416,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,216.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,403.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,312,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,399.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,216.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,312,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,312,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.32,416,
XR RIBS 2 VIEWS LEFT,71800064,CDM,324,RC,71100,HCPCS,Outpatient,,,338,253.5,,310.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,314.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,53.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,338,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,324.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.62,338,
XR RIBS 2 VIEWS RIGHT,71800064,CDM,324,RC,71100,HCPCS,Outpatient,,,338,253.5,,310.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,314.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,304.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,53.62,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,338,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,327.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,324.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,175.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,253.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.62,338,
XR RIBS 3 VIEWS BILATERAL,71800068,CDM,324,RC,71110,HCPCS,Outpatient,,,566,424.5,,520.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,294.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,526.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,509.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,509.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,549.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,566,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,294.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,549.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,424.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,543.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,294.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,424.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,424.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,294.32,566,
XR RIBS W/ PA CHEST BILATERAL,71800070,CDM,324,RC,71111,HCPCS,Outpatient,,,538,403.5,,494.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,279.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,500.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,484.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,484.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,521.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,72.14,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,538,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,279.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,521.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,403.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,516.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,279.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,403.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,403.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.14,538,
XR RIBS W/ PA CHEST LEFT,71800066,CDM,324,RC,71101,HCPCS,Outpatient,,,424,318,,390.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,220.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,394.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,411.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60.45,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,424,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,220.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,411.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,318,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,407.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,220.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.45,424,
XR RIBS W/ PA CHEST RIGHT,71800066,CDM,324,RC,71101,HCPCS,Outpatient,,,424,318,,390.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,220.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,394.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,411.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60.45,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,424,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,220.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,411.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,318,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,407.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,220.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.45,424,
INJECTION SI JOINT ARTHRY and /ANES/STEROID W/IMA BIL,78000766,CDM,320,RC,27096,HCPCS,Outpatient,,,3670.65,2752.99,,3377,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1908.74,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3413.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3303.59,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3303.59,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3560.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3670.65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1908.74,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3560.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2752.99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3523.82,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1908.74,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2752.99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2752.99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1908.74,3670.65,
INJECTION SI JOINT ARTHRGRPHY and /ANES/STEROID W/IMA LEFT,78000764,CDM,320,RC,27096,HCPCS,Outpatient,,,2719,2039.25,,2501.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2528.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2447.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2447.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2637.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2719,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2610.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1413.88,2719,
INJECTION SI JOINT ARTHRGRPHY and /ANES/STEROID W/IMA RIGHT,78000764,CDM,320,RC,27096,HCPCS,Outpatient,,,2719,2039.25,,2501.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2528.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2447.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2447.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2637.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2719,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2637.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2610.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1413.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2039.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1413.88,2719,
XR SACROILIAC JOINTS 1 OR 2 VIEWS,71800146,CDM,320,RC,72202,HCPCS,Outpatient,,,410,307.5,,377.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,381.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,369,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,410,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,397.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51,410,
XR SACROILIAC JOINTS 3+ VIEWS,71800144,CDM,320,RC,72200,HCPCS,Outpatient,,,362,271.5,,333.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,336.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,325.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,325.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,351.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,46.19,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,362,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,351.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,271.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,347.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,271.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,271.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.19,362,
XR SACRUM/COCCYX 2+ VIEWS,71800148,CDM,320,RC,72220,HCPCS,Outpatient,,,337,252.75,,310.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,175.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,313.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,303.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,303.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,337,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,175.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,326.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,252.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,323.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,175.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,252.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,252.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.16,337,
XR SCAPULA COMPLETE BILATERAL,71800168,CDM,320,RC,73010,HCPCS,Outpatient,,,461.6,346.2,,424.67,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,240.03,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,429.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,415.44,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,415.44,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,447.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,461.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,240.03,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,447.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,346.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,443.14,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,240.03,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,346.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,346.2,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,461.6,
XR SCAPULA LEFT,71800166,CDM,320,RC,73010,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,216.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,386.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,374.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,374.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,403.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,416,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,216.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,403.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,312,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,399.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,216.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,312,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,312,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,416,
XR SCAPULA RIGHT,71800166,CDM,320,RC,73010,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,216.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,386.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,374.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,374.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,403.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,44.27,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,416,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,216.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,403.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,312,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,399.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,216.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,312,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,312,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.27,416,
XR SHOULDER 1 VIEW BILAT,71800172,CDM,320,RC,73020,HCPCS,Outpatient,,,409,306.75,,376.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,212.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,380.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,368.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,368.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,396.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,409,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,212.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,396.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,306.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,392.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,212.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,306.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.57,409,
XR SHOULDER 1 VIEW LEFT,71800170,CDM,320,RC,73020,HCPCS,Outpatient,,,303,227.25,,278.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,272.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,272.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,293.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,303,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,293.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,290.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.57,303,
XR SHOULDER 1 VIEW RIGHT,71800170,CDM,320,RC,73020,HCPCS,Outpatient,,,303,227.25,,278.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,272.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,272.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,293.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,303,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,293.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,290.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,157.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.57,303,
XR SHOULDER COMPLETE 2+ VIEWS BILAT,71800176,CDM,320,RC,73030,HCPCS,Outpatient,,,457.65,343.24,,421.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,237.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,425.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,411.89,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,411.89,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,443.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.12,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,457.65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,237.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,443.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,343.24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,439.34,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,237.98,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,343.24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,343.24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.12,457.65,
XR SHOULDER COMPLETE 2+ VIEWS LEFT,71800174,CDM,320,RC,73030,HCPCS,Outpatient,,,339,254.25,,311.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,176.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,315.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,305.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,305.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,328.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.12,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,339,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,176.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,328.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,254.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,325.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,176.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,254.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,254.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.12,339,
XR SHOULDER COMPLETE 2+ VIEWS RIGHT,71800174,CDM,320,RC,73030,HCPCS,Outpatient,,,339,254.25,,311.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,176.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,315.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,305.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,305.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,328.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.12,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,339,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,176.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,328.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,254.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,325.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,176.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,254.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,254.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.12,339,
XR SINUSES PARANASAL < 3 VIEWS,71800016,CDM,320,RC,70210,HCPCS,Outpatient,,,455,341.25,,418.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,236.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,423.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,409.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,409.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,441.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.66,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,455,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,236.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,441.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,341.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,436.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,236.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,341.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,341.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.66,455,
XR SINUSES PARANASAL COMPLETE,71800018,CDM,320,RC,70220,HCPCS,Outpatient,,,498,373.5,,458.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,258.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,463.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,448.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,448.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,483.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,63.52,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,498,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,258.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,483.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,373.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,478.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,258.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,373.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,373.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.52,498,
XR SKULL < 4 VIEWS,71800020,CDM,320,RC,70250,HCPCS,Outpatient,,,451,338.25,,414.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,234.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,419.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,405.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,405.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,437.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.04,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,451,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,234.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,437.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,338.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,432.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,234.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,338.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,338.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.04,451,
XR SKULL COMPLETE,71800022,CDM,320,RC,70260,HCPCS,Outpatient,,,758,568.5,,697.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,704.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,682.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,682.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,735.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,70.25,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,758,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,735.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,727.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,394.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,568.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.25,758,
XR SMALL BOWEL W/ MULTIPLE SERIES,71800377,CDM,320,RC,74250,HCPCS,Outpatient,,,725,543.75,,667,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,377,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,674.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,652.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,652.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,703.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,725,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,377,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,703.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,543.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,696,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,377,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,543.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,543.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,377,725,
DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT,78001717,CDM,320,RC,62328,HCPCS,Outpatient,,,2099,1574.25,,1931.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1091.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1952.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1889.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1889.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2036.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2099,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1091.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2036.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1574.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2015.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1091.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1574.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1574.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1091.48,2099,
XR SPINE 1 VIEW SPECIFY LEVEL,71800087,CDM,320,RC,72020,HCPCS,Outpatient,,,289,216.75,,265.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,277.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.28,289,
XR SPINE CERVICAL 2 OR 3 VIEWS,71800089,CDM,320,RC,72040,HCPCS,Outpatient,,,424,318,,390.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,220.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,394.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,411.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51.93,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,424,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,220.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,411.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,318,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,407.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,220.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.93,424,
XR SPINE CERVICAL 4 OR 5 VIEWS,71800091,CDM,320,RC,72050,HCPCS,Outpatient,,,748,561,,688.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,388.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,695.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,673.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,673.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,725.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,72.14,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,748,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,388.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,725.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,561,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,718.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,388.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,561,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,561,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.14,748,
XR SPINE CERVICAL 6 OR MORE VIEWS,71800093,CDM,320,RC,72052,HCPCS,Outpatient,,,998,748.5,,918.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,518.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,928.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,898.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,898.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,968.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,89.69,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,998,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,518.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,968.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,748.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,958.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,518.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,748.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,748.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.69,998,
XR SPINE LUMBOSACRAL 2/3 VIEWS,71800105,CDM,320,RC,72100,HCPCS,Outpatient,,,425,318.75,,391,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,395.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,382.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,382.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,412.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,72.99,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,425,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,412.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,408,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.99,425,
XR SPINE LUMBOSACRAL 4+ VIEWS,71800107,CDM,320,RC,72110,HCPCS,Outpatient,,,526,394.5,,483.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,273.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,489.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,473.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,473.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,510.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,102.99,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,526,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,273.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,510.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,394.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,504.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,273.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,394.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.99,526,
XR SPINE LUMBOSACRAL BENDING 2-3 VIEWS,71800111,CDM,320,RC,72120,HCPCS,Outpatient,,,431,323.25,,396.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,400.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,387.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,387.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,418.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,65.87,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,431,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,418.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,413.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.87,431,
XR SPINE LUMBOSACRAL W/ BENDING 6+ VIEWS,71800109,CDM,320,RC,72114,HCPCS,Outpatient,,,635,476.25,,584.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,330.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,590.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,571.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,571.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,615.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.21,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,635,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,330.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,615.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,476.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,609.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,330.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,476.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,476.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.21,635,
XR SPINE SCOLIOSIS 2-3 VIEWS,71800103,CDM,320,RC,72082,HCPCS,Outpatient,,,536,402,,493.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,278.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,498.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,482.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,482.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,519.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,536,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,278.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,519.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,402,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,514.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,278.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,402,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,402,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,278.72,536,
XR SPINE THORACIC 2 VIEWS,71800095,CDM,320,RC,72070,HCPCS,Outpatient,,,475,356.25,,437,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,247,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,441.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,427.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,427.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,460.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.93,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,475,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,247,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,460.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,356.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,247,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,356.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,356.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.93,475,
XR SPINE THORACIC 3 VIEWS,71800097,CDM,320,RC,72072,HCPCS,Outpatient,,,591,443.25,,543.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,307.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,549.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,531.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,531.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,573.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,56.92,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,591,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,307.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,573.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,443.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,567.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,307.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,443.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,443.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.92,591,
XR SPINE THORACOLUMBAR 2+ VIEWS,71800099,CDM,320,RC,72080,HCPCS,Outpatient,,,563,422.25,,517.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,292.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,523.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,506.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,506.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,546.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,54.99,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,563,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,292.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,546.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,422.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,540.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,292.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,422.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,422.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.99,563,
XR STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,71800074,CDM,320,RC,71130,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,58.49,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,288,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.49,288,
XR STERNUM 2+ VIEWS,71800072,CDM,324,RC,71120,HCPCS,Outpatient,,,591,443.25,,543.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,307.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,549.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,531.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,531.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,573.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51.66,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,591,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,307.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,573.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,443.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,567.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,307.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,443.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,443.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.66,591,
XR TIBIA/FIBULA BILATERAL,71800293,CDM,320,RC,73590,HCPCS,Outpatient,,,440.1,330.08,,404.89,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,228.85,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,396.09,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,396.09,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,426.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,440.1,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,228.85,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,426.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,330.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,422.5,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,228.85,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,330.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,330.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,440.1,
XR TIBIA/FIBULA LEFT,71800291,CDM,320,RC,73590,HCPCS,Outpatient,,,326,244.5,,299.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,169.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,303.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,293.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,293.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,316.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,326,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,169.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,316.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,244.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,312.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,169.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,244.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,326,
XR TIBIA/FIBULA RIGHT,71800291,CDM,320,RC,73590,HCPCS,Outpatient,,,326,244.5,,299.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,169.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,303.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,293.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,293.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,316.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.42,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,326,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,169.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,316.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,244.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,312.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,169.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,244.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.42,326,
XR TOE(S) 2+ VIEWS BILAT,71800323,CDM,320,RC,73660,HCPCS,Outpatient,,,329.4,247.05,,303.05,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,171.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,296.46,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,296.46,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,319.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,329.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,171.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,319.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,247.05,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.22,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,171.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.05,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.05,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.57,329.4,
XR TOE MINIMUM 2 VIEWS LT,71800323,CDM,320,RC,73660,HCPCS,Outpatient,,,244,183,,224.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,219.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,219.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,236.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,244,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.57,244,
XR TOE MINIMUM 2 VIEWS RT,71800323,CDM,320,RC,73660,HCPCS,Outpatient,,,244,183,,224.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,219.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,219.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,236.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,244,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.57,244,
XR TOE MINIMUM 2 VIEWS,71800323,CDM,320,RC,73660,HCPCS,Outpatient,,,244,183,,224.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,219.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,219.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,236.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,244,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.57,244,
XR UPPER EXTREMITY INFANT MINIMUM 2 VIEWS BIL,71800208,CDM,320,RC,73092,HCPCS,Outpatient,,,405,303.75,,372.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,210.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,376.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,364.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,364.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,392.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,405,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,210.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,392.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,303.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,388.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,210.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,303.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,303.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.6,405,
XR UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,71800206,CDM,320,RC,73092,HCPCS,Outpatient,,,300,225,,276,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,300,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156,300,
XR UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,71800206,CDM,320,RC,73092,HCPCS,Outpatient,,,300,225,,276,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,300,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156,300,
XR UPPER GI TRC SINGLE CONTRAST STUDY,71800375,CDM,320,RC,74240,HCPCS,Outpatient,,,1088,816,,1000.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,565.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1011.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,979.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,979.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1055.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1088,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,565.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1055.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,816,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1044.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,565.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,816,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,816,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,565.76,1088,
XR UPPER GI TRC DOUBLE CONTRAST STUDY,71800517,CDM,320,RC,74246,HCPCS,Outpatient,,,1292,969,,1188.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,671.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1201.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1162.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1162.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1253.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1292,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,671.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1253.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,969,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1240.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,671.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,969,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,969,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,671.84,1292,
XR URETHROCYSTOGRAPHY RETROGRADE RS and I,71800408,CDM,320,RC,74450,HCPCS,Outpatient,,,913,684.75,,839.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,474.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,849.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,821.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,821.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,885.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,913,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,474.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,885.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,684.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,876.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,474.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,684.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,684.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,474.76,913,
XR URETHROCYSTOGRAPHY VOIDING RS and I,71800410,CDM,320,RC,74455,HCPCS,Outpatient,,,878,658.5,,807.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,816.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,790.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,790.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,851.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,878,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,851.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.56,878,
XR UROGRAPHY ANTEGRADE RS and I,71800402,CDM,320,RC,74425,HCPCS,Outpatient,,,995,746.25,,915.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,517.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,925.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,895.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,895.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,965.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87.57,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,995,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,517.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,965.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,746.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,955.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,517.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,746.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,746.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.57,995,
XR URINARY TRACT EXAM WITH CONTRAST,71800400,CDM,320,RC,74420,HCPCS,Outpatient,,,969,726.75,,891.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,503.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,901.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,872.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,872.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,939.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.05,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,969,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,503.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,939.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,726.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,930.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,503.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,726.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,726.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.05,969,
XR WRIST 2 VIEWS BILATERAL,71800212,CDM,320,RC,73100,HCPCS,Outpatient,,,367.2,275.4,,337.82,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,190.94,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,341.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,330.48,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,330.48,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,356.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,41.38,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,367.2,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,190.94,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,356.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,275.4,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,352.51,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,190.94,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,275.4,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,275.4,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.38,367.2,
XR WRIST 2 VIEWS,71800210,CDM,320,RC,73100,HCPCS,Outpatient,,,272,204,,250.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,252.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,244.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,244.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,263.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,41.38,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,272,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,263.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.38,272,
XR WRIST 2 VIEWS,71800210,CDM,320,RC,73100,HCPCS,Outpatient,,,272,204,,250.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,252.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,244.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,244.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,263.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,41.38,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,272,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,263.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,141.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,204,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.38,272,
XR WRIST COMPLETE MINIMUM 3 VIEWS BILATERAL,71800216,CDM,320,RC,73110,HCPCS,Outpatient,,,425.25,318.94,,391.23,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,221.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,395.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,382.73,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,382.73,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,412.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,425.25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,221.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,412.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,318.94,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,408.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,221.13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.94,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318.94,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.16,425.25,
XR WRIST COMPLETE MINIMUM 3 VIEWS,71800214,CDM,320,RC,73110,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,315,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.16,315,
XR WRIST COMPLETE MINIMUM 3 VIEWS,71800214,CDM,320,RC,73110,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,315,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.16,315,
ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,78001340,CDM,410,RC,36600,HCPCS,Outpatient,,,349,261.75,,321.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,349,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,335.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.48,349,
OXYGEN PER HOUR,74000029,CDM,270,RC,,,Outpatient,,,14.83,11.12,,13.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,7.71,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,13.35,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,13.35,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,14.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.83,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,7.71,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,14.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,11.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,7.71,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7.71,14.83,
US ECHO TRANWTHRC 2D W/WOM-MODE COMP SPEC and CLR D,72600035,CDM,410,RC,93306,HCPCS,Outpatient,,,2246,1684.5,,2066.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1167.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2088.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2021.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2021.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2178.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,315.65,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,2246,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1167.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2178.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1684.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2156.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1167.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1684.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1684.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,315.65,2246,
RT AEROSOL PRESSURIZED/NONPRESSURIZED INHALATION TX INITIAL,74000005,CDM,410,RC,94640,HCPCS,Outpatient,,,188,141,,172.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.76,188,
DEMO/EVAL PATIENT USE OF AEROSOL GEN NEB MDI OR IPPB SUBS,74000010,CDM,410,RC,94664,HCPCS,Outpatient,,,218,163.5,,200.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,113.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,202.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,196.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,196.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,211.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,218,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,113.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,211.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,163.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,209.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,113.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,163.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,163.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.36,218,
DEMO/EVAL PATIENT USE OF AEROSOL GENERATOR NEBLIZER MDI OR I,74000010,CDM,410,RC,94664,HCPCS,Outpatient,,,218,163.5,,200.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,113.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,202.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,196.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,196.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,211.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,218,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,113.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,211.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,163.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,209.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,113.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,163.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,163.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.36,218,
CPAP VENTILATION CPAP INITIATION  and  MGMT,74000009,CDM,410,RC,94660,HCPCS,Outpatient,,,1092,819,,1004.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1015.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,982.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,982.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1059.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1092,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1059.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1048.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,567.84,1092,
CPAP VENTILATION CPAP INITIATION  and  MGMT SUBS,74000009,CDM,410,RC,94660,HCPCS,Outpatient,,,1092,819,,1004.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1015.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,982.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,982.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1059.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1092,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1059.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1048.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,567.84,1092,
CPAP VENTILATION CPAP INITIATION  and  MGMT INITIAL,74000009,CDM,410,RC,94660,HCPCS,Outpatient,,,1092,819,,1004.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1015.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,982.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,982.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1059.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1092,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1059.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1048.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,567.84,1092,
CPAP VENTILATION CPAP INITIATION  and  MGMT SUBS,74000009,CDM,410,RC,94660,HCPCS,Outpatient,,,1092,819,,1004.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1015.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,982.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,982.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1059.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1092,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1059.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1048.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,567.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,819,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,567.84,1092,
MANIP CHEST WALL FACILITATE LUNG FUNCTION SUBSQ,44000011,CDM,410,RC,94667,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65,125,
CARDIOPULMONARY RESUSCITATION,68500001,CDM,410,RC,92950,HCPCS,Outpatient,,,1466,1099.5,,1348.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,762.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1363.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1319.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1319.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1422.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1466,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,762.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1422.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1099.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1407.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,762.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1099.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1099.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,762.32,1466,
RT INCENTIVE SPIROMETRY INITIAL,74000005,CDM,410,RC,94640,HCPCS,Outpatient,,,188,141,,172.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.76,188,
RT INCENTIVE SPIROMETRY SUBSEQUENT,74000005,CDM,410,RC,94640,HCPCS,Outpatient,,,188,141,,172.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.76,188,
RT METER DOSE INHALER INITIAL,74000005,CDM,410,RC,94640,HCPCS,Outpatient,,,188,141,,172.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.76,188,
RT METER DOSE INHALER SUBSEQUENT,74000016,CDM,410,RC,94640,HCPCS,Outpatient,,,188,141,,172.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.76,188,
OXYGEN PER SESSION/DAY,74000023,CDM,270,RC,,,Outpatient,,,356,267,,327.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,185.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,345.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,356,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,185.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,345.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,267,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,341.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,185.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,267,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.12,356,
OXYGEN PER SESSION/DAY,74000023,CDM,270,RC,,,Outpatient,,,356,267,,327.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,185.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,345.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,356,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,185.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,345.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,267,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,341.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,185.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,267,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.12,356,
MANIP CHEST WALL TO FACILITATE LUNG FUCTN INITIAL,74000011,CDM,410,RC,94667,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65,125,
MANIP CHEST WALL TO FACILITATE LUNG FUCTN,74000011,CDM,410,RC,94667,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65,125,
PULSE OXIMETRY SINGLE DETERMINATION,44000012,CDM,410,RC,94668,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,162,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.24,162,
VENTILATION ASSIST  MGMT INPATIENT 1ST DAY,74000002,CDM,410,RC,94002,HCPCS,Outpatient,,,3198,2398.5,,2942.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1662.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2974.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2878.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2878.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3102.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3198,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1662.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3102.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2398.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3070.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1662.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2398.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2398.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1662.96,3198,
VENTILATION ASSIST  and  MGMT INPATIENT EA SUBSEQUENT DAY,74000003,CDM,410,RC,94003,HCPCS,Outpatient,,,2303,1727.25,,2118.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1197.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2141.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2072.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2072.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2233.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2303,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1197.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2233.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1727.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2210.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1197.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1727.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1727.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1197.56,2303,
PULMONARY STRESS TESTING 6-MINUTE WALK,74000004,CDM,410,RC,94618,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
MULTIPLE SLEEP LATENCY,74100001,CDM,740,RC,95805,HCPCS,Outpatient,,,2653,1989.75,,2440.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1379.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2467.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2387.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2387.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2573.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2653,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1379.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2573.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1989.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2546.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1379.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1989.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1989.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1379.56,2653,
SLEEP STD AIRFLOW HRT RATE and O2 SAT EFFORT UNATT,74100002G,CDM,740,RC,95806,HCPCS,Outpatient,,,684,513,,629.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,355.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,636.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,615.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,615.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,663.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,684,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,355.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,663.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,513,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,656.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,355.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,513,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,513,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,355.68,684,
POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND,74100003G,CDM,740,RC,95810,HCPCS,Outpatient,,,4184,3138,,3849.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2175.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3891.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3765.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3765.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4058.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4184,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2175.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4058.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4016.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2175.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3138,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2175.68,4184,
POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTD,74100004G,CDM,740,RC,95811,HCPCS,Outpatient,,,4883,3662.25,,4492.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2539.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4541.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4394.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4394.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4736.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4883,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2539.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4736.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3662.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4687.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2539.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3662.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3662.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2539.16,4883,
SCREW CANCELLOUS 4.0MM,41687,CDM,278,RC,C1713,HCPCS,Outpatient,,,69,51.75,,63.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.88,69,
PROBE ELECTROSURGICAL BIPOLAR XL ANGLED 90DEG,43633,CDM,272,RC,A4649,HCPCS,Outpatient,,,732,549,,673.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,380.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,680.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,658.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,658.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,710.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,732,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,380.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,710.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,549,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,702.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,380.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,549,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,549,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,380.64,732,
ACTIFLIP SUTURE PASSER,5160016,CDM,272,RC,,,Outpatient,,,1313,984.75,,1207.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,682.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1221.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1181.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1181.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1273.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1313,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,682.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1273.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,984.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1260.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,682.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,984.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,984.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,682.76,1313,
AEROBIKA AEROSOL DEVICE 22MM,40272,CDM,270,RC,,,Outpatient,,,160,120,,147.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,144,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,160,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,155.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,83.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.2,160,
AEROCHAMBER,41758,CDM,272,RC,,,Outpatient,,,41,30.75,,37.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,39.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.32,41,
SYRINGE ESOPHAGEAL INFLATION ALLIANCE II,40462,CDM,272,RC,A4649,HCPCS,Outpatient,,,154,115.5,,141.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,143.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.08,154,
ANCHOR PEEK KNOTLESS 4.5X20MM,5135002,CDM,278,RC,C1713,HCPCS,Outpatient,,,1033,774.75,,950.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,537.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,960.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,929.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,929.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1002.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1033,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,537.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1002.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,774.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,991.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,537.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,774.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,774.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,537.16,1033,
ANKLE DISTRACTOR STRAP,6673131,CDM,271,RC,,,Outpatient,,,226,169.5,,207.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,219.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,226,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,219.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,117.52,226,
TIBIAL INSERT APEX KNEE SYSTEM SZ 5,5300025,CDM,278,RC,C1776,HCPCS,Outpatient,,,3168,2376,,2914.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2946.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3168,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3041.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1647.36,3168,
ABLATOR ARTHROSCOPIC APOLLO RF 50 DEG,6600886,CDM,272,RC,A4649,HCPCS,Outpatient,,,6965,5223.75,,6407.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3621.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6477.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6268.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6268.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6756.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6965,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3621.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6756.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5223.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6686.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3621.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5223.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5223.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3621.8,6965,
APPLIER CLIP 12MM,42987,CDM,272,RC,A4649,HCPCS,Outpatient,,,196,147,,180.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,101.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,176.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,176.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,190.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,196,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,101.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,190.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,147,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,101.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.92,196,
APPLIER CLIP INTERNAL 360D MED LG 8.8MM,6672544,CDM,272,RC,A4649,HCPCS,Outpatient,,,198,148.5,,182.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,184.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,178.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,178.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,192.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,192.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,190.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,102.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.96,198,
APPLIER CLIP INTERNAL CLIP LIGAMAX MED LG 5MM,667265,CDM,272,RC,A4649,HCPCS,Outpatient,,,224,168,,206.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,116.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,208.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,201.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,201.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,217.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,224,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,116.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,217.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,168,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,215.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,116.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,168,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,168,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,116.48,224,
KIT CATHETER ARTERIAL 20GA 12CML,43114,CDM,272,RC,A4649,HCPCS,Outpatient,,,153,114.75,,140.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,142.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,148.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,153,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.56,153,
TUBING ARTHROSCOPY PUMP,42610,CDM,272,RC,,,Outpatient,,,235,176.25,,216.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,122.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,218.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,211.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,211.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,227.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,235,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,122.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,227.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,176.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,122.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,176.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,176.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.2,235,
CANNULA TWIST-IN NOTCHED 8.25MM X 7CM,43883,CDM,272,RC,A4649,HCPCS,Outpatient,,,97,72.75,,89.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,50.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,94.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,50.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,72.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,50.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.44,97,
BLADE EXCALIBUR 5.0MM X 13CM,41222,CDM,272,RC,A4649,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,277.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,289.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,298,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,289.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,286.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.96,298,
INTERNAL BRACE IMPLANT SYSTEM,43886,CDM,278,RC,C1713,HCPCS,Outpatient,,,5233,3924.75,,4814.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2721.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4866.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4709.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4709.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5076.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2721.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5076.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3924.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5023.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2721.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3924.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3924.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2721.16,5233,
IMPLANT DELIVERY DEVICE,43884,CDM,278,RC,C1713,HCPCS,Outpatient,,,2975,2231.25,,2737,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1547,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2766.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2677.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2677.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2885.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2975,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1547,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2885.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2231.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2856,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1547,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2231.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2231.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1547,2975,
SUTURE PASSER LOOP N TACK,6613957,CDM,278,RC,C1713,HCPCS,Outpatient,,,924,693,,850.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,480.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,859.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,831.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,831.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,896.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,924,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,480.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,896.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,693,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,887.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,480.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,693,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,693,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,480.48,924,
PICK POWER 45 DEGREE,41223,CDM,272,RC,A4649,HCPCS,Outpatient,,,389,291.75,,357.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,202.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,361.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,350.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,350.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,377.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,389,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,202.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,377.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,291.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,373.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,202.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,291.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,202.28,389,
TAPE SUTURE 1.3 MM X 26 IN,43881,CDM,272,RC,A4649,HCPCS,Outpatient,,,328,246,,301.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,295.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,295.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,318.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,328,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,246,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,314.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,246,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,246,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.56,328,
TIGER TAPE 2'X30',43882,CDM,272,RC,A4649,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.84,42,
TIGHTROPE XP IMPLANT STAINLESS STEEL,43885,CDM,278,RC,C1713,HCPCS,Outpatient,,,7476,5607,,6877.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3887.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6952.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6728.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6728.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7251.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7476,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3887.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7251.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5607,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7176.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3887.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5607,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5607,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3887.52,7476,
SCREW BONE ASNIS III TI PARTIAL THRD 42MMX14MM,41695,CDM,278,RC,C1713,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
MEDICAL SURGICAL STERILE SUPPLIES,5160008,CDM,272,RC,,,Outpatient,,,1733,1299.75,,1594.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,901.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1611.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1559.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1559.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1681.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1733,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,901.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1681.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1299.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1663.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,901.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1299.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1299.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,901.16,1733,
DILATOR BALLOON 15-18,6600889,CDM,272,RC,C1726,HCPCS,Outpatient,,,938,703.5,,862.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,487.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,872.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,844.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,844.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,909.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,938,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,487.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,909.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,703.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,900.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,487.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,703.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,703.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,487.76,938,
BASEPLATE GLENOID CEMENTLESS,5060001,CDM,278,RC,C1776,HCPCS,Outpatient,,,12600,9450,,11592,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,6552,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11718,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,11340,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,11340,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,12222,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12600,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,6552,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,12222,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,9450,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12096,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,6552,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9450,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9450,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6552,12600,
PLATE BEARING 3-HOLE LT,5200001,CDM,278,RC,C1713,HCPCS,Outpatient,,,4008,3006,,3687.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2084.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3727.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3607.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3607.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3887.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4008,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2084.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3887.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3006,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3847.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2084.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3006,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3006,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2084.16,4008,
BLADE BEAVER ARTHROSCOPY HIP,41217,CDM,272,RC,A4649,HCPCS,Outpatient,,,115,86.25,,105.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,115,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,86.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,110.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,86.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.8,115,
MEDICAL SURGICAL STERILE SUPPLIES,5160006,CDM,272,RC,,,Outpatient,,,228,171,,209.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,221.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,228,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,221.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,218.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,118.56,228,
CEMENT BONE HERAEUS,41780,CDM,278,RC,C1713,HCPCS,Outpatient,,,1586,1189.5,,1459.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,824.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1474.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1427.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1427.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1538.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1586,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,824.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1538.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1189.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1522.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,824.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1189.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1189.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,824.72,1586,
BRA POST SURGICAL LARGE,42284,CDM,271,RC,A4649,HCPCS,Outpatient,,,71,53.25,,65.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.92,71,
BRA POST SURGICAL MEDIUM,42283,CDM,271,RC,A4649,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,
BRA POST SURGICAL SMALL,42282,CDM,271,RC,A4649,HCPCS,Outpatient,,,71,53.25,,65.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.92,71,
BRA POST SURGICAL X-LARGE,42285,CDM,271,RC,A4649,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
BRA POST SURGICAL XXX-LARGE,42288,CDM,271,RC,A4649,HCPCS,Outpatient,,,71,53.25,,65.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.92,71,
BRA POST SURGICAL XX-LARGE,42287,CDM,271,RC,A4649,HCPCS,Outpatient,,,71,53.25,,65.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.92,71,
BURR AGGRESSIVE SHAVER ARTHROSCOPIC 5MM,43524,CDM,272,RC,A4649,HCPCS,Outpatient,,,169,126.75,,155.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,87.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,152.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,152.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,163.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,169,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,87.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,163.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,126.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,162.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,87.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.88,169,
BURR OVAL CARBIDE CUTTING LONG 5.5MM,41315,CDM,272,RC,A4649,HCPCS,Outpatient,,,53,39.75,,48.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.56,53,
BURR 8 FLUTE 3.0MM,6673132,CDM,272,RC,A4649,HCPCS,Outpatient,,,333,249.75,,306.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,173.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,309.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,299.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,299.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,323.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,333,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,173.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,323.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,249.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,319.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,173.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,249.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,249.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,173.16,333,
BURR AGGRESSIVE FLUTE BARREL 5.5MM X 125MM,43520,CDM,272,RC,A4649,HCPCS,Outpatient,,,130,97.5,,119.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,124.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.6,130,
BURR AGGRESSIVE OVAL 4MM X 13CML,43642,CDM,272,RC,A4649,HCPCS,Outpatient,,,228,171,,209.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,221.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,228,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,221.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,218.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,118.56,228,
BURR AGGRESSIVE ARTHROSCOPIC 5MM X 13CML,43632,CDM,272,RC,A4649,HCPCS,Outpatient,,,228,171,,209.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,221.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,228,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,221.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,218.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,118.56,228,
BIT DRILL CANNULATED 3.5MM,5160015,CDM,272,RC,,,Outpatient,,,522,391.5,,480.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,271.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,485.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,469.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,469.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,506.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,522,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,271.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,506.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,391.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,501.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,271.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,391.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,391.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,271.44,522,
CANNULA TRIPLE DAM VALVED 7MM X 7CM,41244,CDM,272,RC,A4649,HCPCS,Outpatient,,,112,84,,103.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,100.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.24,112,
SNARE CAPTIVATOR POLYPECTOMY LARGE OVAL,6211086,CDM,272,RC,A4649,HCPCS,Outpatient,,,117,87.75,,107.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,105.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.84,117,
RELEASE CARPAL TUNNEL,41285,CDM,272,RC,A4649,HCPCS,Outpatient,,,3672,2754,,3378.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3414.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3304.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3304.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3561.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3672,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3561.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3525.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.44,3672,
CAST PROTECTOR ARM ADULT,43815,CDM,271,RC,,,Outpatient,,,39,29.25,,35.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,35.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,35.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,29.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.28,39,
CAST PROTECTOR LEG ADULT,7065213,CDM,271,RC,,,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.36,43,
MEDICAL SURGICAL SUPPLIES,,,271,RC,,,Outpatient,,,45,33.75,,41.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,40.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,43.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,33.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.4,45,
MEDICAL SURGICAL SUPPLIES,,,270,RC,,,Outpatient,,,26,19.5,,23.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13.52,26,
CATHETER INTRAUTERINE PRESSURE KOALA,43152,CDM,272,RC,A4649,HCPCS,Outpatient,,,100,75,,92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52,100,
KIT CATHETER CV 3-LUMEN 7FR DIA 20CML,41391,CDM,278,RC,C1751,HCPCS,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,363,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.76,363,
CATHETER PARACENTESIS ONE-STEP 5FR DIA 10CML,43292,CDM,272,RC,C1729,HCPCS,Outpatient,,,49,36.75,,45.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,44.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.48,49,
CATHETER DRAINAGE PIGTAIL 14FR X 20CML,43450,CDM,272,RC,C1729,HCPCS,Outpatient,,,158,118.5,,145.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,82.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,146.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,142.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,142.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,153.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,158,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,82.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,153.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,118.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,151.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,82.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,118.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,118.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.16,158,
CATHETER UMBILICAL 1-LUMEN 2.5FR,431990,CDM,272,RC,A4649,HCPCS,Outpatient,,,41,30.75,,37.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,39.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.32,41,
CATHETER UMBILICAL 1-LUMEN 3.5FR,43196,CDM,272,RC,A4649,HCPCS,Outpatient,,,36,27,,33.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,32.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,32.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.72,36,
CATHETER UMBILICAL 1-LUMEN 5FR,43197,CDM,272,RC,A4649,HCPCS,Outpatient,,,36,27,,33.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,32.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,32.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.72,36,
CATHETER CRE FIXED WIRE BALLOON DILATOR 12-15MM,6600888,CDM,272,RC,C1726,HCPCS,Outpatient,,,938,703.5,,862.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,487.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,872.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,844.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,844.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,909.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,938,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,487.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,909.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,703.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,900.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,487.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,703.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,703.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,487.76,938,
CATHETER BALLOON DILATOR 8-10MM,6600887,CDM,272,RC,C1726,HCPCS,Outpatient,,,1063,797.25,,977.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,552.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,988.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,956.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,956.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1031.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1063,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,552.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1031.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,797.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1020.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,552.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,797.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,797.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,552.76,1063,
CATHETER INTRAUTERINE BALLOON 5FR,42779,CDM,272,RC,C1733,HCPCS,Outpatient,,,91,68.25,,83.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,88.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.32,91,
SET CATHETER RADIAL ARTERY .018IN X 1 3/4IN,7030334,CDM,272,RC,C1894,HCPCS,Outpatient,,,1598,1198.5,,1470.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,830.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1486.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1438.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1438.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1550.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1598,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,830.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1550.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1198.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1534.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,830.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1198.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1198.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,830.96,1598,
KIT CATHETER CV 1-LUMEN 16GA DIA 30CML,6610587,CDM,278,RC,C1751,HCPCS,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.6,80,
HEAD FEMORAL CERAMIC 28MM,5180007,CDM,278,RC,C1776,HCPCS,Outpatient,,,4200,3150,,3864,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2184,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3906,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3780,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3780,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4074,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4200,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2184,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4074,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4032,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2184,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2184,4200,
BONE VOID FILLER CERAMNET 10ML,41228,CDM,278,RC,C1889,HCPCS,Outpatient,,,11970,8977.5,,11012.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,6224.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11132.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,10773,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10773,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,11610.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11970,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,6224.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11610.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,8977.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11491.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,6224.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8977.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8977.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6224.4,11970,
BONE VOID FILLER CERAMNET 18ML,41229,CDM,278,RC,C1889,HCPCS,Outpatient,,,20916,15687,,19242.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10876.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19451.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18824.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18824.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20288.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20916,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10876.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20288.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15687,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20079.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,10876.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15687,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15687,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10876.32,20916,
DRAIN CHEST DRY SEAL SGL CHAMBER THORCIC 2000ML,6601264,CDM,272,RC,A7041,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,219.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,212.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,212.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,228.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,236,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,228.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,226.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,122.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.72,236,
SET CATHETER CHOLANGIOGRAM 4FR,6613271,CDM,272,RC,C1887,HCPCS,Outpatient,,,331,248.25,,304.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,172.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,307.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,321.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,331,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,172.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,321.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,248.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,317.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,172.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,248.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.12,331,
DEVICE CLOSURE SUTURE CARTER-THOM 5MM,6673130,CDM,272,RC,A4649,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,205.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,367.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,355.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,355.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,383.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,395,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,205.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,383.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,296.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,205.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,296.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,296.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,205.4,395,
COLLAR CERVICAL FOAM STIFNECK UNIVERSAL,42817,CDM,274,RC,L0120,HCPCS,Outpatient,,,47,35.25,,43.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.44,47,
PLATE COMPRESSION TITANIUM 16 HOLE,6610069,CDM,278,RC,C1713,HCPCS,Outpatient,,,878,658.5,,807.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,816.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,790.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,790.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,851.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,878,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,851.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,456.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,658.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.56,878,
KNEE SYSTEM CORIN APEX SIZE 5 RT,5300017,CDM,278,RC,C1776,HCPCS,Outpatient,,,15050,11287.5,,13846,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,7826,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13996.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,13545,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,13545,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,14598.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15050,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,7826,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,14598.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,11287.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14448,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,7826,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11287.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11287.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7826,15050,
KNEE SYSTEM CORIN APEX SIZE 5,5300019,CDM,278,RC,C1776,HCPCS,Outpatient,,,3168,2376,,2914.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2946.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3168,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3041.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1647.36,3168,
KIT CORIN OMNI BALANCE BOT,5300020,CDM,272,RC,,,Outpatient,,,4200,3150,,3864,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2184,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3906,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3780,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3780,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4074,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4200,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2184,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4074,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4032,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2184,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2184,4200,
BASEPLATE TIBIA CORIN PRIMARY SZ 5 RT,5300018,CDM,278,RC,C1776,HCPCS,Outpatient,,,7700,5775,,7084,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4004,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7161,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6930,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6930,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7469,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7700,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4004,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7469,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5775,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7392,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4004,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5775,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5775,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4004,7700,
SCREW CORTICAL HEX 10MM,5200005,CDM,278,RC,C1713,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182,350,
SCREW CORTICAL HEX 12MM,5200006,CDM,278,RC,C1713,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182,350,
FEMORAL COMPONENT SZ 2+ LT,5300001,CDM,278,RC,C1776,HCPCS,Outpatient,,,9800,7350,,9016,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9114,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,8820,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8820,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9506,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9800,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9506,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9408,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5096,9800,
FEMORAL COMPONENT SZ 4 RT,5300002,CDM,278,RC,C1776,HCPCS,Outpatient,,,9800,7350,,9016,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9114,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,8820,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8820,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9506,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9800,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9506,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9408,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5096,9800,
FEMORAL COMPONENT SZ 2+ RT,5300003,CDM,278,RC,C1776,HCPCS,Outpatient,,,9800,7350,,9016,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9114,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,8820,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8820,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9506,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9800,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9506,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9408,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5096,9800,
FEMORAL COMPONENT CERAMIC SZ 3 RT,5300022,CDM,278,RC,C1776,HCPCS,Outpatient,,,9800,7350,,9016,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9114,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,8820,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8820,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9506,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9800,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9506,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9408,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5096,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7350,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5096,9800,
FEMORAL COMPONENT UNCEMENTED SIZE 5 LT,5300024,CDM,278,RC,C1776,HCPCS,Outpatient,,,15050,11287.5,,13846,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,7826,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13996.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,13545,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,13545,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,14598.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15050,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,7826,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,14598.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,11287.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14448,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,7826,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11287.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11287.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7826,15050,
CONTRAST CYSTOGRAFIN 1ML INJ,40403,CDM,254,RC,Q9958,HCPCS,Outpatient,,,567,425.25,,521.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,294.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,527.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,510.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,510.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,549.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,567,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,294.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,549.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,425.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,544.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,294.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,425.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,425.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,294.84,567,
GRAFT BONE MATRIX FILLER FREEZE DRIED 2.5ML,42935,CDM,278,RC,C1713,HCPCS,Outpatient,,,2597,1947.75,,2389.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1350.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2415.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2337.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2337.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2519.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2597,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1350.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2519.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1947.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2493.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1350.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1947.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1947.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1350.44,2597,
DERMABOND ADHESIVE SKIN CLOSURE 0.7ML,42099,CDM,272,RC,A4649,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
DERMABOND DRESSING 22,42100,CDM,272,RC,A4649,HCPCS,Outpatient,,,488,366,,448.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,253.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,453.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,439.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,439.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,473.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,488,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,253.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,473.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,366,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,468.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,253.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,366,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,366,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,253.76,488,
DERMABOND ADHESIVE 42CML,42101,CDM,272,RC,A4649,HCPCS,Outpatient,,,313,234.75,,287.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,162.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,281.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,281.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,303.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,313,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,162.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,303.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,234.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,300.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,162.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,162.76,313,
SHOULDER DOUBLE TAPER +0MM,5060015,CDM,278,RC,C1776,HCPCS,Outpatient,,,1750,1312.5,,1610,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,910,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1627.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1575,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1575,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1697.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1750,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,910,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1697.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1312.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1680,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,910,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1312.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1312.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,910,1750,
DRAPE BEACH CHAIR SHOULDER,6621734,CDM,272,RC,A4649,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
MEDICAL SURGICAL STERILE SUPPLIES,6619,CDM,272,RC,,,Outpatient,,,69,51.75,,63.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.88,69,
DRESSING AQUACEL AG 3.5X10IN,43132,CDM,272,RC,A6207,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,118,
DRESSING MEPILEX 6IN X 6IN,31013,CDM,272,RC,A6207,HCPCS,Outpatient,,,285,213.75,,262.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,256.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,256.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,276.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,285,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,276.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.2,285,
DRESSING MEPITEL WOUND 4X72IN,31015,CDM,272,RC,A6208,HCPCS,Outpatient,,,73,54.75,,67.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,37.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,65.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,65.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,37.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,70.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,54.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,37.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.96,73,
DRESSING PURACOL PLUS COLLAGEN,43134,CDM,272,RC,,,Outpatient,,,69,51.75,,63.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.88,69,
DRESSING PICC/CVC,46700,CDM,272,RC,A6023,HCPCS,Outpatient,,,121,90.75,,111.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,116.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.92,121,
BIT DRILL 8/090,5200008,CDM,272,RC,,,Outpatient,,,473,354.75,,435.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,439.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,425.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,425.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,458.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,473,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,458.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,454.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.96,473,
BIT DRILL 3/080,5200009,CDM,272,RC,,,Outpatient,,,473,354.75,,435.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,245.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,439.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,425.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,425.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,458.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,473,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,245.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,458.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,354.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,454.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,245.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.96,473,
BIT DRILL 4.0MM,5160012,CDM,272,RC,,,Outpatient,,,539,404.25,,495.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,280.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,501.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,485.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,485.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,522.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,539,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,280.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,522.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,404.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,517.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,280.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,404.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,404.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,280.28,539,
BIT DRILL K-WIRE ATTACHMENT THREADED 1.5MM,42887,CDM,272,RC,A4649,HCPCS,Outpatient,,,357,267.75,,328.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,357,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.64,357,
BIT DRILL DRAW TIGHT W/STOP 1.8MM,5160011,CDM,272,RC,,,Outpatient,,,539,404.25,,495.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,280.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,501.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,485.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,485.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,522.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,539,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,280.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,522.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,404.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,517.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,280.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,404.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,404.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,280.28,539,
BIT DRILL CANNULATED TAPERED 10MM,42907,CDM,272,RC,A4649,HCPCS,Outpatient,,,2040,1530,,1876.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1060.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1897.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1836,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1836,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1978.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2040,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1060.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1978.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1530,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1958.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1060.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1530,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1530,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1060.8,2040,
BIT DRILL CANNULATED 12MM,42908,CDM,272,RC,A4649,HCPCS,Outpatient,,,4484,3363,,4125.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2331.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4170.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4035.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4035.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4349.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4484,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2331.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4349.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3363,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4304.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2331.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3363,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3363,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2331.68,4484,
BIT DRILL CANNULATED FLEXIBLE 16MM,42909,CDM,272,RC,A4649,HCPCS,Outpatient,,,3450,2587.5,,3174,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1794,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3208.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3105,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3105,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3346.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3450,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1794,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3346.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2587.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3312,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1794,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2587.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2587.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1794,3450,
BIT DRILL 2.0MM QC 110MM,42910,CDM,272,RC,A4649,HCPCS,Outpatient,,,588,441,,540.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,305.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,546.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,529.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,529.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,570.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,588,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,305.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,570.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,441,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,564.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,305.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,441,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,441,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,305.76,588,
BIT DRILL W/DEPTH MARKER 2.0MM,42911,CDM,272,RC,A4649,HCPCS,Outpatient,,,1271,953.25,,1169.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,660.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1182.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1143.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1143.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1232.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1271,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,660.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1232.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,953.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1220.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,660.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,953.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,953.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,660.92,1271,
BIT DRILL 2.0MM QC 125MM,42912,CDM,272,RC,A4649,HCPCS,Outpatient,,,1397,1047.75,,1285.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,726.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1299.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1257.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1257.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1355.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1397,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,726.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1355.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1047.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1341.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,726.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1047.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1047.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,726.44,1397,
BIT DRILL 2.5MM QC GOLD 180MM,42914,CDM,272,RC,A4649,HCPCS,Outpatient,,,699,524.25,,643.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,363.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,650.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,629.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,629.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,678.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,699,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,363.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,678.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,524.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,671.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,363.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,524.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,363.48,699,
BIT DRILL 2.5MM QC GOLD 110MM,42913,CDM,272,RC,A4649,HCPCS,Outpatient,,,4027,3020.25,,3704.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2094.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3745.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3624.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3624.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3906.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4027,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2094.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3906.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3020.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3865.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2094.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3020.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3020.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2094.04,4027,
BIT DRILL CANNULATED 2.7MM,42915,CDM,272,RC,A4649,HCPCS,Outpatient,,,5678,4258.5,,5223.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2952.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5280.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5110.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5110.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5507.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5678,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2952.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5507.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4258.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5450.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2952.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4258.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4258.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2952.56,5678,
BIT DRILL 2.7MM QC 125MM,42919,CDM,272,RC,A4649,HCPCS,Outpatient,,,460,345,,423.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,239.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,427.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,414,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,414,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,446.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,460,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,239.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,446.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,345,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,441.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,239.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,345,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,345,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.2,460,
BIT DRILL THREE FLUTED 2.7MM,42921,CDM,272,RC,A4649,HCPCS,Outpatient,,,987,740.25,,908.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,513.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,917.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,888.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,888.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,957.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,987,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,513.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,957.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,740.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,947.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,513.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,740.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,740.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,513.24,987,
BIT DRILL SOLID CORE 2.8MM,51350010,CDM,272,RC,,,Outpatient,,,753,564.75,,692.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,391.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,700.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,677.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,677.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,730.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,753,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,391.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,730.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,564.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,722.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,391.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,564.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,564.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,391.56,753,
BIT DRILL 2.8MM QC 165MM,42925,CDM,272,RC,A4649,HCPCS,Outpatient,,,1087,815.25,,1000.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,565.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1010.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,978.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,978.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1054.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1087,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,565.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1054.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,815.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1043.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,565.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,815.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,815.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,565.24,1087,
BIT DRILL 3.2MM QC 330MM,42926,CDM,272,RC,A4649,HCPCS,Outpatient,,,1014,760.5,,932.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,527.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,943.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,912.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,912.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,983.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1014,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,527.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,983.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,760.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,973.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,527.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,760.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,760.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,527.28,1014,
BIT DRILL 3.2MM QC 145MM,42927,CDM,272,RC,A4649,HCPCS,Outpatient,,,722,541.5,,664.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,375.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,671.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,649.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,649.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,700.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,722,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,375.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,700.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,541.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,693.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,375.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,541.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,541.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,375.44,722,
BIT DRILL 3.2MM,5060008,CDM,272,RC,,,Outpatient,,,872,654,,802.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,453.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,810.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,784.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,784.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,845.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,872,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,453.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,845.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,654,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,837.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,453.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,654,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,654,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,453.44,872,
BIT DRILL 3.5MM QC 110MM,46161,CDM,272,RC,A4649,HCPCS,Outpatient,,,331,248.25,,304.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,172.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,307.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,321.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,331,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,172.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,321.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,248.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,317.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,172.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,248.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.12,331,
BIT DRILL 4.2MM QC 330MM,42928,CDM,272,RC,A4649,HCPCS,Outpatient,,,2027,1520.25,,1864.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1054.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1885.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1824.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1824.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1966.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2027,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1054.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1966.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1520.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1945.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1054.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1520.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1520.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1054.04,2027,
BIT DRILL FLUTED 4.2MM,42929,CDM,272,RC,A4649,HCPCS,Outpatient,,,722,541.5,,664.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,375.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,671.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,649.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,649.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,700.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,722,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,375.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,700.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,541.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,693.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,375.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,541.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,541.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,375.44,722,
BIT DRILL CANNULATED STEPPED 6MM/9MM,42930,CDM,272,RC,A4649,HCPCS,Outpatient,,,2313,1734.75,,2127.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1202.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2151.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2081.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2081.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2243.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2313,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1202.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2243.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1734.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2220.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1202.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1734.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1734.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1202.76,2313,
BIT DRILL CANNULATED 2.6MM,5135009,CDM,272,RC,,,Outpatient,,,525,393.75,,483,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,488.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,525,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,504,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273,525,
PIN DRILL DRAW TIGHT W/STOP 1.8MM,5160019,CDM,272,RC,,,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,283.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,315,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,163.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,163.8,315,
KIT DROP STOP SECURING,6672191,CDM,272,RC,,,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,35,
LINER DYNASTY DUAL GROUP G 46MM,5180004,CDM,278,RC,C1776,HCPCS,Outpatient,,,7000,5250,,6440,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6510,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6300,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6300,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6790,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7000,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6790,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6720,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3640,7000,
GLENOSPHERE HUMELOCK REVERSED 36MM,5060002,CDM,278,RC,C1776,HCPCS,Outpatient,,,13125,9843.75,,12075,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,6825,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,12206.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,11812.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,11812.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,12731.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13125,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,6825,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,12731.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,9843.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12600,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,6825,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9843.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9843.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6825,13125,
ELECTRODE BIPOLAR WIRE CUTTING 7X0.3MM,6634911,CDM,272,RC,A4649,HCPCS,Outpatient,,,3815,2861.25,,3509.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1983.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3547.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3433.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3433.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3700.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3815,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1983.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3700.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2861.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3662.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1983.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2861.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2861.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1983.8,3815,
SPATULA ELECTRODE MEGADYN 5MM,41828,CDM,272,RC,A4649,HCPCS,Outpatient,,,147,110.25,,135.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,76.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,136.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,132.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,132.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,142.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,147,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,76.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,142.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,110.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,76.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,110.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.44,147,
ELECTRODE DEFIBRILLATOR L5.95IN X W5.24IN,41775,CDM,272,RC,A4649,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,77.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,83.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.72,86,
ELECTRODE DEFIBRILLATOR L4IN X W3.5IN,41826,CDM,272,RC,A4649,HCPCS,Outpatient,,,91,68.25,,83.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,88.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.32,91,
ENDO BABCOCK 5MM,6672620,CDM,272,RC,,,Outpatient,,,150,112.5,,138,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,150,
TIP SCISSORS ENDOCUT 19.3MM,40279,CDM,272,RC,A4649,HCPCS,Outpatient,,,132,99,,121.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,132,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.64,132,
GRASPER ENDOPATH INSULATED/ROTATING 5MM,6672612,CDM,272,RC,A4649,HCPCS,Outpatient,,,133,99.75,,122.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,127.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.16,133,
LIGATOR ENDOLOOP MONOFILAMEN 18IN VIOLET,6672653,CDM,272,RC,A4649,HCPCS,Outpatient,,,107,80.25,,98.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,103.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,80.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,55.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.64,107,
MARKER ENDO SPOT,41050,CDM,272,RC,A4649,HCPCS,Outpatient,,,133,99.75,,122.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,127.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.16,133,
PACK ENT PROCEDURE,41215,CDM,272,RC,A4649,HCPCS,Outpatient,,,109,81.75,,100.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.68,109,
DILATOR ENDO ESOPHAGEAL BALLOON 18-19-20MM,41131,CDM,272,RC,C1726,HCPCS,Outpatient,,,938,703.5,,862.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,487.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,872.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,844.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,844.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,909.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,938,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,487.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,909.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,703.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,900.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,487.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,703.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,703.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,487.76,938,
BLADE SHAVER ARTHROSCOPIC EXCALIBUR 4MM,41616,CDM,272,RC,A4649,HCPCS,Outpatient,,,228,171,,209.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,221.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,228,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,221.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,218.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,118.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,118.56,228,
BLADE SAW 25X90MM,5300004,CDM,272,RC,,,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,277.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,289.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,298,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,289.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,286.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.96,298,
STABILIZER IO-EZ NEEDLE 5.75INX5.25INX1.25IN,40506,CDM,272,RC,A4649,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
RETRACTOR LAPAROSCOPIC ENDO 31CM,6619449,CDM,272,RC,A4649,HCPCS,Outpatient,,,1047,785.25,,963.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,973.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,942.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,942.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1015.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1047,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1015.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1005.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,544.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,785.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,544.44,1047,
CUTTER / PUSHER FAST FIX,6629136,CDM,272,RC,A4649,HCPCS,Outpatient,,,477,357.75,,438.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,248.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,443.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,429.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,429.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,462.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,477,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,248.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,462.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,357.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,457.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,248.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,357.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,248.04,477,
TUBE GASTROSTOMY 14FR DIA 10CML,41140,CDM,278,RC,C1889,HCPCS,Outpatient,,,197,147.75,,181.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,102.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,177.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,177.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,191.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,197,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,102.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,147.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,189.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,102.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.44,197,
TUBE GASTROSTOMY 18FR DIA 10CML,41141,CDM,278,RC,C1889,HCPCS,Outpatient,,,197,147.75,,181.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,102.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,177.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,177.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,191.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,197,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,102.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,147.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,189.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,102.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.44,197,
TUBE GASTROSTOMY 20FR DIA 10CML,41142,CDM,278,RC,C1889,HCPCS,Outpatient,,,197,147.75,,181.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,102.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,177.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,177.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,191.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,197,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,102.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,147.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,189.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,102.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.44,197,
KIT FEMORAL ARTERIAL LINE,43113,CDM,278,RC,C1751,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.2,135,
WICK FEMORAL CANAL BONE-DRI 10IN,6677020,CDM,272,RC,A4649,HCPCS,Outpatient,,,154,115.5,,141.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,143.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.08,154,
CLIP FILSHIE INTERNAL FALLOPIAN TUBE LIGATION,43696,CDM,272,RC,A4649,HCPCS,Outpatient,,,385,288.75,,354.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,200.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,358.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,346.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,346.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,373.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,385,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,200.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,373.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,288.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,369.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,200.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,288.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,200.2,385,
FORCEPS ENDOSCOPIC BIOPSY 7.2MM,43904,CDM,272,RC,A4649,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
FORCEP BIOPSY ALLIGATOR,43905,CDM,272,RC,A4649,HCPCS,Outpatient,,,21,15.75,,19.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,10.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.92,21,
FORCEP SPECIMEN RETRIEVAL 230CM,42213,CDM,272,RC,A4649,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,104,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104,200,
KIT GASTROSTOMY TUBE PEG 20FR,43021,CDM,272,RC,A4649,HCPCS,Outpatient,,,361,270.75,,332.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,335.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,324.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,324.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,350.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,361,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,350.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,346.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,187.72,361,
KIT GASTROSTOMY TUBE PEG 24FR,6673172,CDM,272,RC,A4649,HCPCS,Outpatient,,,595,446.25,,547.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,309.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,553.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,535.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,535.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,577.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,595,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,309.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,577.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,446.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,571.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,309.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,446.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,446.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,309.4,595,
GAUGE DEPTH FOR 2.7MM SCREW,42966,CDM,272,RC,A4649,HCPCS,Outpatient,,,1730,1297.5,,1591.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,899.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1608.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1557,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1557,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1678.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1730,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,899.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1678.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1297.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1660.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,899.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1297.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1297.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,899.6,1730,
ANCHOR SUTURE GFS ULTIMATE MINI,5160004,CDM,278,RC,C1713,HCPCS,Outpatient,,,963,722.25,,885.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,500.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,895.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,866.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,866.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,934.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,963,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,500.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,934.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,722.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,924.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,500.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,722.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,722.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,500.76,963,
GLENOID PE CEMENTED 3-4 PEGS SIZE M,5060018,CDM,278,RC,C1776,HCPCS,Outpatient,,,8750,6562.5,,8050,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4550,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8137.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,7875,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7875,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8487.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8750,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4550,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8487.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,6562.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8400,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4550,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6562.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6562.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4550,8750,
GRASPER LAPAROSCOPIC 5MM,42217,CDM,272,RC,A4649,HCPCS,Outpatient,,,396,297,,364.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,368.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,356.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,356.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,384.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,396,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,384.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,380.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,205.92,396,
TRAY CATHETER CENTRAL VENOUS 2-LUMEN 9.5FR,6672877,CDM,278,RC,C1751,HCPCS,Outpatient,,,609,456.75,,560.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,316.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,566.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,548.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,548.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,590.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,609,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,316.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,590.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,456.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,584.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,316.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,456.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.68,609,
CATHETER CENTRAL VENOUS GROSHONG 1-LUMEN 8FR,6672851,CDM,278,RC,C1751,HCPCS,Outpatient,,,609,456.75,,560.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,316.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,566.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,548.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,548.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,590.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,609,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,316.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,590.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,456.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,584.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,316.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,456.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.68,609,
KIT CATHETER REPAIR LUMEN 8FR DIA 90CML,42802,CDM,278,RC,C1751,HCPCS,Outpatient,,,921,690.75,,847.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,478.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,856.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,828.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,828.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,893.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,921,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,478.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,893.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,690.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,884.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,478.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,690.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,690.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,478.92,921,
GUIDEWIRE 3.2MM 400MM,42891,CDM,272,RC,C1769,HCPCS,Outpatient,,,2061,1545.75,,1896.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1071.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1916.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1854.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1854.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1999.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2061,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1071.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1999.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1545.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1978.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1071.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1545.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1545.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1071.72,2061,
GUIDEWIRE ASNIS III 3.2X300MM,5150003,CDM,272,RC,C1769,HCPCS,Outpatient,,,203,152.25,,186.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,188.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,203,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.56,203,
"GUIDEWIRE THREADED, 1.4 X 150MM",5135008,CDM,272,RC,C1769,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.76,88,
GUIDEWIRE SPRING TIP 210CM,41820,CDM,272,RC,C1769,HCPCS,Outpatient,,,175,131.25,,161,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,162.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,157.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,175,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,169.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,131.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,168,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,131.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,131.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91,175,
DRAIN CHEST HEIMLICH VALVE,6643043,CDM,272,RC,A7040,HCPCS,Outpatient,,,266,199.5,,244.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,138.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,239.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,266,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,138.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,199.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,255.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,138.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,199.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.32,266,
CLIP INTERNAL HEMOCLIP MEDIUM,42430,CDM,272,RC,A4649,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.32,66,
BAND HEMORRHOID LIGATION,41375,CDM,272,RC,A4649,HCPCS,Outpatient,,,140,105,,128.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,140,
DRAIN HEMOVAC LARGE,6622955,CDM,272,RC,C1729,HCPCS,Outpatient,,,48,36,,44.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,24.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,43.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,43.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,46.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,24.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,46.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,24.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.96,48,
HERAEUS PULSE LAVAGE KIT,43390,CDM,272,RC,A4649,HCPCS,Outpatient,,,630,472.5,,579.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,327.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,585.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,567,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,567,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,611.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,630,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,327.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,611.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,472.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,604.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,327.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,472.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,472.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,327.6,630,
MESH HERNIA VENTRALEX 3-1/5IN DIA,41593,CDM,278,RC,C1781,HCPCS,Outpatient,,,2099,1574.25,,1931.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1091.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1952.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1889.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1889.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2036.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2099,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1091.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2036.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1574.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2015.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1091.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1574.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1574.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1091.48,2099,
SUTURE RETREIVER HEWSTON,6673578,CDM,272,RC,,,Outpatient,,,735,551.25,,676.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,382.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,683.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,661.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,661.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,712.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,735,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,382.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,712.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,705.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,382.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,382.2,735,
HOOD T5 W/ PEEL AWAY FACE,30093,CDM,272,RC,A4649,HCPCS,Outpatient,,,119,89.25,,109.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,107.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,107.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,115.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,119,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,89.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,114.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,61.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,89.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.88,119,
CUP HUMERAL STANDARD +3,5060003,CDM,278,RC,C1776,HCPCS,Outpatient,,,7000,5250,,6440,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6510,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6300,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6300,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6790,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7000,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6790,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6720,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3640,7000,
HUMERIS STEM TA6V SIZE 08 CEMENTLESS Ti/HA,5060009,CDM,278,RC,C1776,HCPCS,Outpatient,,,17500,13125,,16100,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16275,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,15750,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,15750,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,16975,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16975,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16800,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9100,17500,
HUMERIS STEM TA6V SIZE 09 CEMENTLESS Ti/HA,5060004,CDM,278,RC,C1776,HCPCS,Outpatient,,,17500,13125,,16100,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16275,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,15750,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,15750,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,16975,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16975,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16800,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9100,17500,
HUMERIS STEM TA6V SIZE 12 CEMENTLESS Ti/HA,5060013,CDM,278,RC,C1776,HCPCS,Outpatient,,,17500,13125,,16100,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16275,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,15750,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,15750,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,16975,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16975,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16800,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9100,17500,
HUMERIS STEM TA6V SIZE 16 CEMENTLESS Ti/HA,5060016,CDM,278,RC,C1776,HCPCS,Outpatient,,,17500,13125,,16100,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16275,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,15750,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,15750,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,16975,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17500,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16975,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16800,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,9100,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13125,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9100,17500,
IMPLANT BEAR,42539,CDM,278,RC,C1889,HCPCS,Outpatient,,,18288,13716,,16824.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,9509.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17007.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,16459.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,16459.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,17739.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18288,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,9509.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17739.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,13716,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17556.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,9509.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13716,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13716,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9509.76,18288,
IMPLANT FAST-FIX 360 CURVED,6629134,CDM,278,RC,C1713,HCPCS,Outpatient,,,1646,1234.5,,1514.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,855.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1530.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1481.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1481.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1596.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1646,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,855.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1596.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1234.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1580.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,855.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1234.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1234.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,855.92,1646,
IMPLANT FAST-FIX 360 STRAIGHT,6629135,CDM,278,RC,C1713,HCPCS,Outpatient,,,1646,1234.5,,1514.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,855.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1530.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1481.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1481.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1596.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1646,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,855.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1596.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1234.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1580.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,855.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1234.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1234.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,855.92,1646,
ANCHOR SPEEDBRIDGE W/PEEK SWIVELOCK,42533,CDM,278,RC,C1713,HCPCS,Outpatient,,,6090,4567.5,,5602.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3166.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5663.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5481,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5481,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5907.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6090,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3166.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5907.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4567.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5846.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3166.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4567.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4567.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3166.8,6090,
IMPLANT SYSTEM TENODESIS 4.75 BC LOOP N TACK,42530,CDM,278,RC,C1713,HCPCS,Outpatient,,,2800,2100,,2576,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1456,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2604,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2520,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2520,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2716,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2800,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1456,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2716,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2100,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2688,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1456,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2100,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2100,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1456,2800,
SUTURE INFINITY LOOP,5160007,CDM,272,RC,,,Outpatient,,,182,136.5,,167.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,94.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,169.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,163.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,163.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,176.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,94.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,176.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,136.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,94.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,136.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.64,182,
SUTURE INFINITY LOOP #5,5160002,CDM,272,RC,,,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,87.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,156.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,151.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,151.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,168,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,87.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,162.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,126,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,161.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,87.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.36,168,
INSERT DRILL SLEEVE 3.5MM / 2.5MM,41868,CDM,272,RC,A4649,HCPCS,Outpatient,,,481,360.75,,442.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,250.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,447.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,432.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,432.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,466.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,481,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,250.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,466.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,360.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,461.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,250.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,360.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,360.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,250.12,481,
LENS IRRIGATION MORGAN EYE FLOW,6623946,CDM,272,RC,A4649,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
IRRIGATION SOLUTION 350ML,46701,CDM,270,RC,A6260,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,277.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,289.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,298,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,289.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,286.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,154.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.96,298,
XPERIENCE SURGICAL SOLUTION,45500,CDM,250,RC,A6260,HCPCS,Outpatient,,,525,393.75,,483,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,488.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,525,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,504,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273,525,
CONTRAST ISOVUE 300 100ML VIAL,43387,CDM,254,RC,Q9967,HCPCS,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.8,40,
CONTRAST ISOVUE 370 100ML BOTTLE,41517,CDM,254,RC,Q9967,HCPCS,Outpatient,,,46,34.5,,42.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.92,46,
CONTRAST ISOVUE 370 125ML BOTTLE,41518,CDM,254,RC,Q9967,HCPCS,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.8,40,
CONTRAST ISOVUE 370 150ML BOTTLE,41519,CDM,254,RC,Q9967,HCPCS,Outpatient,,,49,36.75,,45.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,44.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.48,49,
CONTRAST ISOVUE 370 75ML BOTTLE,41516,CDM,254,RC,Q9967,HCPCS,Outpatient,,,25,18.75,,23,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,23.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,24.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,18.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13,25,
SOLUTION IV 5% DEXTROSE LR 1000ML,42206,CDM,258,RC,J7121,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.32,66,
KIT JUGULAR PUNCTURE INTERNAL,6627878,CDM,278,RC,C1751,HCPCS,Outpatient,,,45,33.75,,41.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,40.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,43.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,33.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.4,45,
JURGAN PIN BALLS .045MM,43682,CDM,272,RC,A4649,HCPCS,Outpatient,,,23,17.25,,21.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.96,23,
JURGAN PIN BALLS 054MM TO .062MM,43683,CDM,272,RC,A4649,HCPCS,Outpatient,,,23,17.25,,21.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.96,23,
WIRE KIRSCHNER 1.0MM,42885,CDM,278,RC,C1713,HCPCS,Outpatient,,,381,285.75,,350.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,342.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,342.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,381,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,369.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,365.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,198.12,381,
WIRE KIRSCHNER 1.25MM,42886,CDM,278,RC,C1713,HCPCS,Outpatient,,,1523,1142.25,,1401.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,791.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1416.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1370.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1370.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1477.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1523,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,791.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1477.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1142.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1462.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,791.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1142.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1142.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,791.96,1523,
WIRE KIRSCHNER 1.6MM,42888,CDM,278,RC,C1713,HCPCS,Outpatient,,,709,531.75,,652.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,368.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,659.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,638.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,638.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,687.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,709,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,368.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,687.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,531.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,680.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,368.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,531.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,531.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,368.68,709,
WIRE KIRSCHNER 2.0MM,42889,CDM,278,RC,C1713,HCPCS,Outpatient,,,381,285.75,,350.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,342.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,342.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,381,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,369.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,365.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,198.12,381,
WIRE KIRSCHNER 150MM LG,5060019,CDM,278,RC,C1713,HCPCS,Outpatient,,,140,105,,128.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,140,
WIRE KIRSCHNER 1/100,5200007,CDM,278,RC,C1713,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,
BLADE KING VISION CHANNELED,42807,CDM,272,RC,A4649,HCPCS,Outpatient,,,186,139.5,,171.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,96.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,180.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,186,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,96.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,180.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,139.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,178.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,96.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.72,186,
KIT INSTRUMENT 2.4 VA LCP,42960,CDM,272,RC,,,Outpatient,,,9933,7449.75,,9138.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5165.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9237.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,8939.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8939.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9635.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9933,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5165.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9635.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,7449.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9535.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5165.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7449.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7449.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5165.16,9933,
KIT INSTRUMENT 2.4MM VA LCP,42962,CDM,272,RC,,,Outpatient,,,3010,2257.5,,2769.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1565.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2799.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2709,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2709,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2919.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3010,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1565.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2919.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2257.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2889.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1565.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2257.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2257.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1565.2,3010,
KIT RFA THREE PROBE 17GA X 100MM X 4MM,44072,CDM,272,RC,A4649,HCPCS,Outpatient,,,5678,4258.5,,5223.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2952.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5280.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5110.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5110.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5507.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5678,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2952.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5507.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4258.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5450.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2952.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4258.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4258.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2952.56,5678,
KIT RFA THREE PROBE 17GA X 150MM X 4MM,44070,CDM,272,RC,A4649,HCPCS,Outpatient,,,5688,4266,,5232.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2957.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5289.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5119.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5119.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5517.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5688,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2957.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5517.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4266,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5460.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2957.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4266,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4266,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2957.76,5688,
KIT RFA THREE PROBE 17GA X 50MM X 2MM,44074,CDM,272,RC,A4649,HCPCS,Outpatient,,,5678,4258.5,,5223.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2952.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5280.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5110.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5110.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5507.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5678,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2952.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5507.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4258.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5450.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2952.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4258.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4258.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2952.56,5678,
KIT RFA THREE PROBE 17GA X 75MM X 4MM,44073,CDM,272,RC,A4649,HCPCS,Outpatient,,,5600,4200,,5152,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2912,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5208,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5040,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5040,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5432,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5600,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2912,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5432,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4200,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5376,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2912,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4200,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4200,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2912,5600,
KIT RFA TWO PROBE 17GA X 100MM X 4MM,44065,CDM,272,RC,A4649,HCPCS,Outpatient,,,4507,3380.25,,4146.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4191.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4056.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4056.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4371.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4371.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4326.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2343.64,4507,
KIT RFA TWO PROBE 17GA X 150MM X 4MM,44066,CDM,272,RC,A4649,HCPCS,Outpatient,,,4507,3380.25,,4146.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4191.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4056.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4056.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4371.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4371.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4326.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2343.64,4507,
KIT RFA TWO PROBE 17GA X 75MM X 2MM,44069,CDM,272,RC,A4649,HCPCS,Outpatient,,,4507,3380.25,,4146.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4191.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4056.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4056.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4371.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4371.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4326.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2343.64,4507,
KIT RFA TWO PROBE 17GA X 75MM X 5.5MM,44071,CDM,272,RC,A4649,HCPCS,Outpatient,,,4507,3380.25,,4146.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4191.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4056.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4056.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4371.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4371.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4326.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2343.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2343.64,4507,
EXTRACTOR FETAL KIWI CUP,42987,CDM,272,RC,A4649,HCPCS,Outpatient,,,105,78.75,,96.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,54.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,94.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,94.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,54.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,78.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,54.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,78.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,105,
EXTRACTOR CUP VACUUM ASSIST MEDIUM,6618714,CDM,272,RC,A4649,HCPCS,Outpatient,,,89,66.75,,81.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.28,89,
CUFF CRYO KNEE LARGE,42421,CDM,271,RC,,,Outpatient,,,567,425.25,,521.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,294.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,527.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,510.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,510.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,549.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,567,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,294.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,549.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,425.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,544.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,294.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,425.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,425.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,294.84,567,
CUFF CRYO KNEE MEDIUM,42420,CDM,271,RC,,,Outpatient,,,550,412.5,,506,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,286,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,511.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,495,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,495,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,533.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,550,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,286,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,533.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,412.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,528,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,286,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,412.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,412.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,286,550,
CUFF CRYO KNEE SMALL,42423,CDM,271,RC,,,Outpatient,,,550,412.5,,506,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,286,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,511.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,495,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,495,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,533.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,550,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,286,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,533.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,412.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,528,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,286,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,412.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,412.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,286,550,
SEALER ENDOSCOPIC BIPOLAR LIGASURE IMPACT 36CM,6612218,CDM,272,RC,A4649,HCPCS,Outpatient,,,3714,2785.5,,3416.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1931.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3454.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3342.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3342.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3602.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3714,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1931.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3602.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2785.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3565.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1931.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2785.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2785.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1931.28,3714,
LIGASURE CURVED SMALL,41224,CDM,272,RC,A4649,HCPCS,Outpatient,,,1434,1075.5,,1319.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,745.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1333.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1290.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1290.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1390.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1434,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,745.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1390.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1075.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1376.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,745.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1075.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1075.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,745.68,1434,
LIGATOR ENDOC SHORTSHOT TRIVIEW L5IN X 0.6IN,41590,CDM,272,RC,A4649,HCPCS,Outpatient,,,140,105,,128.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,140,
LIGATOR SPEEDBAND SUPERVIEW SUPER 7,41591,CDM,272,RC,A4649,HCPCS,Outpatient,,,1167,875.25,,1073.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,606.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1085.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1050.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1050.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1131.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1167,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,606.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1131.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,875.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1120.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,606.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,875.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,875.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606.84,1167,
SCREW LOCKING TA6V 4.5X20MM,5060010,CDM,278,RC,C1713,HCPCS,Outpatient,,,438,328.5,,402.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,407.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,438,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,420.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.76,438,
SCREW LOCKING TA6V 4.5X25MM,5060005,CDM,278,RC,C1713,HCPCS,Outpatient,,,438,328.5,,402.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,407.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,438,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,420.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.76,438,
CATHETER MALECOT DRAINAGE,6607924,CDM,272,RC,C1729,HCPCS,Outpatient,,,249,186.75,,229.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,249,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,249,
MESH MARLEX SURGICAL PLUG LARGE 4.1CMW X 4.8CML,6629158,CDM,278,RC,C1781,HCPCS,Outpatient,,,896,672,,824.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,465.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,833.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,806.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,806.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,869.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,896,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,465.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,869.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,672,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,860.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,465.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,672,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,672,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,465.92,896,
MASK CPAP BIPAP FULL FACE VENTED LARGE,46654,CDM,272,RC,,,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.6,80,
MASK CPAP BIPAP FULL FACE VENTED MEDIUM,46652,CDM,272,RC,,,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.6,80,
MASK CPAP BIPAP FULL FACE VENTED SMALL,46653,CDM,271,RC,,,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.6,80,
MASK CPAP/BIPAP FULL FACE SZ XL,46651,CDM,272,RC,,,Outpatient,,,83,62.25,,76.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,74.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,74.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,
MASK LARYNGEAL SIZE 1,31191,CDM,272,RC,,,Outpatient,,,32,24,,29.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,28.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,28.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,31.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.64,32,
IMPLANT MENISCAL ROOT SYSTEM,660023,CDM,278,RC,C1713,HCPCS,Outpatient,,,3831,2873.25,,3524.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1992.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3447.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3447.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3716.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3831,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1992.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3716.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2873.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3677.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1992.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2873.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2873.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1992.12,3831,
MESH BARD 1IN X 4IN,43274,CDM,278,RC,C1781,HCPCS,Outpatient,,,737,552.75,,678.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,383.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,685.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,663.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,663.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,714.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,737,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,383.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,714.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,552.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,707.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,383.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,552.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,552.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,383.24,737,
MESH BARD 3 IN X 6 IN $,43275,CDM,278,RC,C1781,HCPCS,Outpatient,,,188,141,,172.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,97.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.76,188,
MESH BARD PRE-SHAPED 10X4.5CM,43276,CDM,278,RC,C1781,HCPCS,Outpatient,,,259,194.25,,238.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,233.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,233.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,251.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,259,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,248.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.68,259,
MESH BARD PRE-SHAPED WITH KEYHOLE 10 CM X 4.5 CM $,43277,CDM,278,RC,C1781,HCPCS,Outpatient,,,1029,771.75,,946.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,535.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,956.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,926.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,926.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,998.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1029,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,535.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,998.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,771.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,987.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,535.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,771.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,771.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,535.08,1029,
CARRIER MESH 16 IN,43539,CDM,272,RC,,,Outpatient,,,203,152.25,,186.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,188.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,203,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.56,203,
CARRIER MESH 8 IN,43538,CDM,272,RC,,,Outpatient,,,123,92.25,,113.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,63.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,110.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,119.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,123,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,63.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,92.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,118.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,63.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,92.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.96,123,
MESH MONOFILAMENT SURGICAL 10CM X 15CM,43310,CDM,278,RC,C1781,HCPCS,Outpatient,,,1340,1005,,1232.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,696.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1246.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1206,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1206,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1299.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1340,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,696.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1299.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1005,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1286.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,696.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1005,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1005,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,696.8,1340,
MESH COMPOSIX SURGICAL 6IN X 8IN,43259,CDM,278,RC,C1781,HCPCS,Outpatient,,,2963,2222.25,,2725.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1540.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2755.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2666.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2666.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2874.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2963,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1540.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2874.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2222.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2844.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1540.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2222.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2222.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1540.76,2963,
MESH VENTRAL MONOFILAMENT COMPOSIX 8IN X 10IN,6629132,CDM,278,RC,C1781,HCPCS,Outpatient,,,6606,4954.5,,6077.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3435.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6143.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5945.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5945.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6407.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6606,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3435.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6407.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4954.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6341.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3435.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4954.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4954.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3435.12,6606,
MESH GORE DUAL 15CMX19CMX1.0MM,41225,CDM,278,RC,C1781,HCPCS,Outpatient,,,5005,3753.75,,4604.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2602.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4654.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4504.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4504.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4854.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5005,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2602.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4854.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3753.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4804.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2602.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3753.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3753.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2602.6,5005,
MESH SURGICAL SHEET 2.54CM X 10CM,42619,CDM,278,RC,C1781,HCPCS,Outpatient,,,180,135,,165.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,180,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.6,180,
MESH PROLENE 6IN X 6IN,41219,CDM,278,RC,C1781,HCPCS,Outpatient,,,250,187.5,,230,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,130,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,232.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,225,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,242.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,130,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,242.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,130,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130,250,
SHELL PRIMARY MICROPORT DYNASTY,5180003,CDM,278,RC,C1776,HCPCS,Outpatient,,,8400,6300,,7728,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4368,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7812,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,7560,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7560,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8148,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8400,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4368,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8148,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,6300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8064,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4368,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4368,8400,
INSERT DUAL MOBILITY 25MM,5180005,CDM,278,RC,C1776,HCPCS,Outpatient,,,7000,5250,,6440,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6510,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6300,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6300,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6790,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7000,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6790,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6720,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3640,7000,
FEMUR STRAIGHT NECK GLADIATOR SIZE 4,5180006,CDM,278,RC,C1776,HCPCS,Outpatient,,,12250,9187.5,,11270,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,6370,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11392.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,11025,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,11025,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,11882.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12250,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,6370,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11882.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,9187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11760,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,6370,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6370,12250,
MODULE COOLIEF MULTI-COOLED RADIOFREQUENCY,40465,CDM,272,RC,A4649,HCPCS,Outpatient,,,20940,15705,,19264.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10888.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19474.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18846,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18846,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20311.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20940,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10888.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20311.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15705,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20102.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,10888.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15705,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15705,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10888.8,20940,
MODULE MULTI-RADIOFREQUENCY,40464,CDM,272,RC,A4649,HCPCS,Outpatient,,,19005,14253.75,,17484.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,9882.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17674.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,17104.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,17104.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18434.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19005,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,9882.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18434.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,14253.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18244.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,9882.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,14253.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14253.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9882.6,19005,
KIT CATHETER CENTRAL VENOUS 7FR,47213,CDM,278,RC,C1751,HCPCS,Outpatient,,,361,270.75,,332.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,335.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,324.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,324.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,350.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,361,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,350.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,346.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,187.72,361,
TRAY CATHETER CENTRAL VENOUS MULTI LUMEN 7FR,6610470,CDM,278,RC,C1751,HCPCS,Outpatient,,,289,216.75,,265.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,277.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,150.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,150.28,289,
NAIL ELASTIC 2.5MM TI ELASTIC NAIL 440MM $,42894,CDM,278,RC,C1713,HCPCS,Outpatient,,,2505,1878.75,,2304.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1302.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2329.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2254.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2254.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2429.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1302.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2429.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1878.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2404.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1302.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1878.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1878.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302.6,2505,
NAIL ELASTIC 3.0MM TI ELASTIC NAIL 440MM,42895,CDM,278,RC,C1713,HCPCS,Outpatient,,,1323,992.25,,1217.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,687.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1230.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1190.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1190.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1283.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1323,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,687.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1283.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,992.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1270.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,687.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,992.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,992.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,687.96,1323,
NAIL TIBIAL 10 TI CANNULATED TIBIAL NAIL-EX/360-SILE,42893,CDM,278,RC,C1713,HCPCS,Outpatient,,,6012,4509,,5531.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3126.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5591.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5410.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5410.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5831.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6012,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3126.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5831.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4509,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5771.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3126.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4509,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4509,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3126.24,6012,
NAIL TIBIAL 9 TI CANNULATED TIBIAL NAIL-EX 330MM,42905,CDM,278,RC,C1713,HCPCS,Outpatient,,,6012,4509,,5531.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3126.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5591.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5410.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5410.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5831.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6012,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3126.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5831.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4509,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5771.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3126.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4509,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4509,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3126.24,6012,
CAP END FOR NAIL TIBIAL TI,42906,CDM,278,RC,C1889,HCPCS,Outpatient,,,680,510,,625.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,353.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,632.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,612,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,612,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,659.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,680,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,353.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,659.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,510,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,652.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,353.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,510,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,510,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,353.6,680,
DRESSING NASAL TAMPONADE 4.5CML,6600043,CDM,272,RC,,,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,149,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.48,149,
DRESSING NASAL TAMPONADE 5.5CML,6600053,CDM,272,RC,,,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,149,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.48,149,
DRESSING NASAL TAMPONADE 7.5CML,42945,CDM,272,RC,,,Outpatient,,,154,115.5,,141.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,143.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.08,154,
NEEDLE TORPEDO CURVED 4MM,43634,CDM,272,RC,A4215,HCPCS,Outpatient,,,389,291.75,,357.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,202.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,361.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,350.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,350.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,377.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,389,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,202.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,377.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,291.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,373.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,202.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,291.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,202.28,389,
NEEDLE CANNULA RADIOPAQUE 18GA X 100MM,44055,CDM,272,RC,A4215,HCPCS,Outpatient,,,230,172.5,,211.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,119.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,213.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,207,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,207,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,223.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,230,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,119.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,223.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,172.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,220.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,119.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.6,230,
NEEDLE CANNULA RADIOPAQUE 20GA X 100MM,44053,CDM,272,RC,A4215,HCPCS,Outpatient,,,230,172.5,,211.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,119.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,213.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,207,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,207,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,223.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,230,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,119.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,223.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,172.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,220.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,119.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.6,230,
NEEDLE ECHOSTIM FACET TIP 21GA X 2IN,44049,CDM,272,RC,A4215,HCPCS,Outpatient,,,53,39.75,,48.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.56,53,
NEEDLE ECHOGENIC INSULATED 21GA,44048,CDM,272,RC,A4215,HCPCS,Outpatient,,,79,59.25,,72.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,71.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,71.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,76.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,59.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.08,79,
NEEDLE ECHOSTIM FACET TIP 21GA X 6IN,44050,CDM,272,RC,A4215,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.76,88,
NEEDLE EPIDURAL TUOHY 20GA X 3.5IN,32312,CDM,272,RC,A4215,HCPCS,Outpatient,,,403,302.25,,370.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,374.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,362.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,362.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,390.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,403,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,390.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,386.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,209.56,403,
NEEDLE EPIDURAL TUOHY 18GA X 6IN,44044,CDM,272,RC,A4215,HCPCS,Outpatient,,,756,567,,695.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,393.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,703.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,680.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,680.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,733.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,756,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,393.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,733.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,567,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,725.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,393.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,567,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,567,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.12,756,
NEEDLE EPIDURAL TUOHY 20GA X 3.5IN,44151,CDM,272,RC,A4215,HCPCS,Outpatient,,,27,20.25,,24.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,14.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,24.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,24.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,26.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,14.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,20.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,14.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14.04,27,
NEEDLE EPIDURAL TUOHY 20GA X 5IN,44152,CDM,272,RC,A4215,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.84,42,
NEEDLE I  and  O EZ-CONNECT L15MM 15GA,40500,CDM,272,RC,A4215,HCPCS,Outpatient,,,479,359.25,,440.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,445.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,464.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,479,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,464.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,459.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,249.08,479,
NEEDLE I  and  O EZ-CONNECT 25MM,40501,CDM,272,RC,A4215,HCPCS,Outpatient,,,479,359.25,,440.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,445.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,464.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,479,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,464.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,459.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,249.08,479,
NEEDLE I  and  O EZ-CONNECT 45MM,40502,CDM,272,RC,A4215,HCPCS,Outpatient,,,479,359.25,,440.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,445.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,464.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,479,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,464.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,459.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,249.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,359.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,249.08,479,
NEEDLE I  and  O ILLINOIS 16GA,6600738,CDM,272,RC,A4215,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.36,43,
NEEDLE INJECTION SHORT 25GA 2.8MM,40527,CDM,272,RC,A4215,HCPCS,Outpatient,,,429,321.75,,394.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,223.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,398.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,386.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,386.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,416.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,429,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,223.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,416.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,321.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,411.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,223.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,321.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,321.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.08,429,
NEEDLE INSULATED 20GA X 4IN,44006,CDM,272,RC,A4215,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.36,43,
NEEDLE INSUFFLATION QUICK CONNECT 14GAX120MM,6622991,CDM,272,RC,A4215,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,
NEEDLE SCLEROTHERAPY 25GA,41184,CDM,272,RC,A4215,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,101.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,181.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,175.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,175.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,189.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,101.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,189.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,146.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,187.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,101.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,146.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.4,195,
NEEDLE SCORPION MULTIFIRE,42532,CDM,272,RC,A4215,HCPCS,Outpatient,,,655,491.25,,602.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,340.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,609.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,589.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,589.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,635.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,655,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,340.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,635.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,491.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,628.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,340.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,491.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,491.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,340.6,655,
NEEDLE SPINAL 18GAX6IN,44043,CDM,272,RC,A4215,HCPCS,Outpatient,,,32,24,,29.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,28.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,28.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,31.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,16.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.64,32,
NEEDLE SPINAL 22GAX5IN,42340,CDM,272,RC,A4215,HCPCS,Outpatient,,,22,16.5,,20.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,19.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,16.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,11.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.44,22,
NEEDLE SPINAL QUINCKE 22GA 4.75IN,41797,CDM,272,RC,A4215,HCPCS,Outpatient,,,68,51,,62.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,65.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.36,68,
NEEDLE SPINAL ACCUTARG CURVED TIP 22G X 7IN,44056,CDM,272,RC,A4215,HCPCS,Outpatient,,,49,36.75,,45.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,44.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,25.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.48,49,
NEEDLE SPINAL ACCUTARG CURVED TIP 22 GA X 3.5IN,44153,CDM,272,RC,A4215,HCPCS,Outpatient,,,34,25.5,,31.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,32.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,17.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.68,34,
NEEDLE SPINAL ACCUTARG 22G,44059,CDM,272,RC,A4215,HCPCS,Outpatient,,,39,29.25,,35.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,35.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,35.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,29.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.28,39,
NEEDLE SPINAL PTC ECHOBLOCK 22GA X 4IN,44068,CDM,272,RC,A4215,HCPCS,Outpatient,,,800,600,,736,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,416,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,744,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,720,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,720,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,776,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,800,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,416,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,776,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,600,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,768,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,416,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,600,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,600,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,416,800,
NEEDLE SPINAL SPROUT 24 X 4.5,43020,CDM,272,RC,A4215,HCPCS,Outpatient,,,51,38.25,,46.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.52,51,
NEEDLE BIOPSY TRU-CUT THIN 14GA,42859,CDM,272,RC,A4215,HCPCS,Outpatient,,,74,55.5,,68.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.48,74,
NEEDLE TUOHY EPIDURAL 20 GA X 4.5 IN,44158,CDM,272,RC,A4215,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,77.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,83.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.72,86,
NEEDLE TUOHY EPIDURAL 22 X 3.5,42343,CDM,272,RC,A4215,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.32,66,
MANIFOLD NEPTUNE 4-PORT STANDARD,6622154,CDM,272,RC,A4649,HCPCS,Outpatient,,,52,39,,47.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,27.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,46.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,46.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,27.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,27.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.04,52,
CLIP OLYMPUS REPOSITIONABLE,42210,CDM,272,RC,A4649,HCPCS,Outpatient,,,455,341.25,,418.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,236.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,423.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,409.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,409.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,441.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,455,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,236.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,441.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,341.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,436.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,236.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,341.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,341.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.6,455,
KIT OMNIBOTICS TRACKER,5300005,CDM,272,RC,,,Outpatient,,,4200,3150,,3864,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2184,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3906,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3780,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3780,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4074,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4200,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2184,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4074,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4032,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2184,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3150,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2184,4200,
PACK ORTHOMAX SHOULDER SPLIT DRAPE WITH POUCH,41781,CDM,272,RC,A4649,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,37.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,64.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,69.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,37.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,69.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,37.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.44,72,
PACK LAPAROTOMY EXPLORATORY,6618623,CDM,272,RC,A4649,HCPCS,Outpatient,,,321,240.75,,295.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,166.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,298.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,288.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,288.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,311.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,321,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,166.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,311.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,240.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,308.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,166.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.92,321,
TRAY/PACK PLASTIC PROCEDURE,42294,CDM,272,RC,,,Outpatient,,,306,229.5,,281.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,159.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,284.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,275.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,275.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,296.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,306,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,159.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,296.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,229.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,293.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,159.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,229.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,159.12,306,
TRAY/PACK MAJOR SURGERY,42295,CDM,272,RC,,,Outpatient,,,255,191.25,,234.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,237.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,255,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.6,255,
SCREW PARCUS 9X20MM,5180002,CDM,278,RC,C1713,HCPCS,Outpatient,,,476,357,,437.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,247.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,442.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,428.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,461.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,476,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,247.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,461.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,357,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,247.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,357,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.52,476,
CANNULA ARTHROSCOPIC 8MM,41603,CDM,272,RC,A4649,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
CANNULA ARTHROSCOPIC 10MM,41803,CDM,272,RC,A4649,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
PATELLA 35MMX8MM,5300006,CDM,278,RC,C1776,HCPCS,Outpatient,,,2450,1837.5,,2254,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1274,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2278.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2205,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2205,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2376.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2450,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1274,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2376.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1837.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2352,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1274,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1837.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1837.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1274,2450,
PATELLA 41X10MM,5300007,CDM,278,RC,C1776,HCPCS,Outpatient,,,2450,1837.5,,2254,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1274,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2278.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2205,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2205,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2376.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2450,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1274,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2376.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1837.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2352,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1274,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1837.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1837.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1274,2450,
PATELLA 32X8MM,5300008,CDM,278,RC,C1776,HCPCS,Outpatient,,,2450,1837.5,,2254,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1274,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2278.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2205,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2205,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2376.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2450,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1274,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2376.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1837.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2352,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1274,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1837.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1837.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1274,2450,
SLING PELVIC SAM LARGE,41090,CDM,271,RC,A4565,HCPCS,Outpatient,,,273,204.75,,251.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,141.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,253.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,245.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,245.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,264.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,273,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,141.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,264.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,204.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,141.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,204.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,204.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.96,273,
SLING PELVIC SAM SMALL,41091,CDM,271,RC,A4565,HCPCS,Outpatient,,,273,204.75,,251.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,141.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,253.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,245.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,245.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,264.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,273,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,141.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,264.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,204.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,141.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,204.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,204.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.96,273,
WIRE KIRSCHNER 2.0X180MM,5060007,CDM,278,RC,C1713,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
PACK PIN 1.1MM,5160005,CDM,272,RC,,,Outpatient,,,476,357,,437.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,247.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,442.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,428.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,461.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,476,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,247.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,461.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,357,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,247.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,357,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.52,476,
PLATE FIB STRAIGHT 10 HOLE,5135004,CDM,278,RC,C1713,HCPCS,Outpatient,,,4900,3675,,4508,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4557,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4410,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4410,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4753,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4900,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4753,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4704,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2548,4900,
PLATE 2.0MM VAL STRAIGHT 6 HOLES,42883,CDM,278,RC,C1713,HCPCS,Outpatient,,,2032,1524,,1869.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1056.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1889.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1828.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1828.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1971.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2032,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1056.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1971.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1524,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1950.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1056.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1524,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1524,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1056.64,2032,
PLATE 2.4 VA LCP 2-COL DSTL RAD PLATE TEMPLATES -S,42937,CDM,278,RC,C1713,HCPCS,Outpatient,,,602,451.5,,553.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,313.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,559.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,541.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,541.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,583.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,602,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,313.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,583.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,451.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,577.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,313.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,451.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,451.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.04,602,
PLATE 2.7 VA LCP CLAVICLE PLATE SHAFT/ CS2/ LEFT,42941,CDM,278,RC,C1713,HCPCS,Outpatient,,,4305,3228.75,,3960.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2238.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4003.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3874.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3874.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4175.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4305,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2238.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4175.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3228.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4132.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2238.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3228.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3228.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2238.6,4305,
PLATE 2.7/3.5 LCP LAT DSTL FIB PLATE 7H/LT/125-S,42943,CDM,278,RC,C1713,HCPCS,Outpatient,,,2893,2169.75,,2661.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1504.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2690.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2603.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2603.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2806.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2893,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1504.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2806.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2169.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2777.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1504.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2169.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2169.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1504.36,2893,
PLATE 2.7/3.5 LCP LAT DSTL FIB PLATE 5H/LFT/99,42942,CDM,278,RC,C1713,HCPCS,Outpatient,,,7820,5865,,7194.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4066.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7272.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,7038,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7038,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7585.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7820,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4066.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7585.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5865,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7507.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4066.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5865,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5865,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4066.4,7820,
PLATE 2.7/3.5 LCP LATERAL DSTL FIB PLATE 4H/RT/86,42944,CDM,278,RC,C1713,HCPCS,Outpatient,,,2573,1929.75,,2367.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1337.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2392.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2315.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2315.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2495.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2573,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1337.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2495.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1929.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2470.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1337.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1929.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1929.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1337.96,2573,
PLATE 3.5MM LCP 111MM 8 HOLES,42884,CDM,278,RC,C1713,HCPCS,Outpatient,,,1413,1059.75,,1299.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,734.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1314.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1271.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1271.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1370.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1413,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,734.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1370.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1059.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1356.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,734.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1059.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1059.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,734.76,1413,
PLATE LCP ONE-THIRD TUBULAR PLATE COLLAR 5 H/57,42946,CDM,278,RC,C1713,HCPCS,Outpatient,,,701,525.75,,644.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,364.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,651.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,630.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,630.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,679.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,701,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,364.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,679.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,525.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,672.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,364.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,525.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,525.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,364.52,701,
PLATE LCP ONE-THIRD TUBULAR PLATE COLLAR 6 H/69,42947,CDM,278,RC,C1713,HCPCS,Outpatient,,,1402,1051.5,,1289.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,729.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1303.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1261.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1261.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1359.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1402,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,729.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1359.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1051.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1345.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,729.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1051.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1051.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,729.04,1402,
PLATE LCP ONE-THIRD TUBULAR PLATE COLLAR 7 H/81,42948,CDM,278,RC,C1713,HCPCS,Outpatient,,,1428,1071,,1313.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,742.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1328.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1285.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1285.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1385.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1428,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,742.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1385.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1071,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1370.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,742.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1071,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1071,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,742.56,1428,
PLATE LCP ONE-THIRD TUBULAR PLATE COLLAR 8 H/93,42949,CDM,278,RC,C1713,HCPCS,Outpatient,,,1507,1130.25,,1386.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,783.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1401.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1356.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1356.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1461.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,783.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1461.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1130.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1446.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,783.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1130.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1130.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,783.64,1507,
KIT CATHETER PNEUMOTHORAX DRAINAGE 8FR,6609150,CDM,272,RC,C1729,HCPCS,Outpatient,,,465,348.75,,427.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,241.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,432.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,418.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,418.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,451.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,465,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,241.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,451.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,348.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,446.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,241.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,348.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,241.8,465,
SET PNEUMOTHORAX 8.5FR,42006,CDM,272,RC,C1729,HCPCS,Outpatient,,,525,393.75,,483,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,488.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,525,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,504,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273,525,
TRAP POLYPECTOMY SPECIMEN COLLECTION,41381,CDM,272,RC,A4649,HCPCS,Outpatient,,,21,15.75,,19.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,10.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.92,21,
PORT-A-CATH 20G X .75IN,43489,CDM,272,RC,,,Outpatient,,,227,170.25,,208.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,118.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,211.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,204.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,204.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,220.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,227,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,118.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,220.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,170.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,217.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,118.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,170.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,118.04,227,
PORT A CATH 22 GA X 5/8 IN,43488,CDM,278,RC,C1788,HCPCS,Outpatient,,,47,35.25,,43.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.44,47,
TRAY PORT INFUSION PORT-A-CATH 8FR,41722,CDM,278,RC,C1788,HCPCS,Outpatient,,,875,656.25,,805,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,455,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,813.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,787.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,787.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,848.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,875,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,455,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,848.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,656.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,840,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,455,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,656.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,656.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,455,875,
TRAY PORT INFUSION PORT-A-CATH 8.5FR,44003,CDM,278,RC,C1788,HCPCS,Outpatient,,,1105,828.75,,1016.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,574.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1027.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,994.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,994.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1071.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1105,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,574.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1071.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,828.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1060.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,574.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,828.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,828.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,574.6,1105,
TRAY PORT INFUSION PORT-A-CATH 6FR,44001,CDM,278,RC,C1788,HCPCS,Outpatient,,,1165,873.75,,1071.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,605.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1083.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1048.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1048.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1130.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1165,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,605.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1130.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,873.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1118.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,605.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,873.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,873.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,605.8,1165,
TRAY PORT INFUSION PORT-A-CATH 5.8FR,6600654,CDM,278,RC,C1788,HCPCS,Outpatient,,,1121,840.75,,1031.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,582.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1042.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1008.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1008.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1087.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1121,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,582.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1087.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,840.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1076.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,582.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,840.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,840.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,582.92,1121,
BASEPLATE TIBIA UNCEMENTED SIZE 4 LT,5300026,CDM,278,RC,C1776,HCPCS,Outpatient,,,7700,5775,,7084,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4004,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7161,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6930,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6930,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7469,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7700,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4004,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7469,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5775,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7392,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4004,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5775,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5775,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4004,7700,
PROBE RADIOFREQUENCY 18 GA X 100MM,44057,CDM,272,RC,A4649,HCPCS,Outpatient,,,6738,5053.5,,6198.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3503.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6266.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6064.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6064.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6535.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6738,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3503.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6535.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5053.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6468.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3503.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5053.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5053.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3503.76,6738,
PROTACK FIXATION DEVICE 5MM,42534,CDM,272,RC,A4649,HCPCS,Outpatient,,,1399,1049.25,,1287.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,727.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1301.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1259.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1259.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1357.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1399,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,727.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1357.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1049.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1343.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,727.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1049.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1049.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,727.48,1399,
KIT INTRODUCER CATHETER 8.5FR,6634117,CDM,272,RC,C1894,HCPCS,Outpatient,,,211,158.25,,194.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,109.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,196.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,189.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,189.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,204.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,211,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,109.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,204.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,158.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,109.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,158.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,211,
STAPLER INTERNAL PURSTRING SURGIDAC 45MM,43051,CDM,272,RC,A4649,HCPCS,Outpatient,,,845,633.75,,777.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,439.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,785.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,760.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,760.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,819.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,845,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,439.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,819.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,633.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,811.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,439.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,633.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,633.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,439.4,845,
STAPLER INTERNAL PURSTRING SURGIDAC 65MM,6672117,CDM,272,RC,A4649,HCPCS,Outpatient,,,733,549.75,,674.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,381.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,681.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,659.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,659.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,711.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,733,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,381.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,711.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,549.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,703.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,381.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,549.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,549.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,381.16,733,
REAMER HEAD MEDULLARY 10.0MM,42950,CDM,272,RC,A4649,HCPCS,Outpatient,,,2578,1933.5,,2371.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1340.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2397.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2320.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2320.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2500.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2578,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1340.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2500.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1933.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2474.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1340.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1933.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1933.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1340.56,2578,
REAMER HEAD MEDULLARY 10.5MM,42952,CDM,272,RC,A4649,HCPCS,Outpatient,,,1289,966.75,,1185.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1198.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1237.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,670.28,1289,
REAMER HEAD MEDULLARY 11.0MM,42953,CDM,272,RC,A4649,HCPCS,Outpatient,,,1289,966.75,,1185.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1198.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1237.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,670.28,1289,
REAMER HEAD MEDULLARY 11.5MM,42954,CDM,272,RC,A4649,HCPCS,Outpatient,,,1289,966.75,,1185.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1198.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1237.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,670.28,1289,
REAMER HEAD MEDULLARY 8.5MM,42955,CDM,272,RC,A4649,HCPCS,Outpatient,,,2578,1933.5,,2371.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1340.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2397.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2320.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2320.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2500.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2578,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1340.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2500.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1933.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2474.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1340.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1933.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1933.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1340.56,2578,
REAMER HEAD MEDULLARY 9.0MM,42956,CDM,272,RC,A4649,HCPCS,Outpatient,,,1289,966.75,,1185.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1198.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1237.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,670.28,1289,
REAMER HEAD MEDULLARY 9.5MM,42957,CDM,272,RC,A4649,HCPCS,Outpatient,,,1289,966.75,,1185.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1198.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1160.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1289,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1250.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1237.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,670.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,966.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,670.28,1289,
REAMER RETROGRADE 6-12MM,42972,CDM,272,RC,A4649,HCPCS,Outpatient,,,1771,1328.25,,1629.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,920.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1647.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1593.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1593.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1717.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1771,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,920.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1717.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1328.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1700.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,920.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1328.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1328.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,920.92,1771,
ROD REAMING BALL TIP 2.5MM,42963,CDM,272,RC,A4649,HCPCS,Outpatient,,,982,736.5,,903.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,913.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,883.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,883.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,952.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,982,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,952.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,942.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,510.64,982,
CLIP HEMOSTATIC RESOLUTION 2.8 MM 11MM,41573,CDM,272,RC,A4649,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182,350,
NET ROTH 360,660891,CDM,272,RC,A4649,HCPCS,Outpatient,,,359,269.25,,330.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,186.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,333.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,323.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,323.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,348.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,359,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,186.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,348.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,269.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,344.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,186.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,269.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.68,359,
BLADE SAW SAGITTAL 3.5 X 98 IN,41455,CDM,272,RC,A4649,HCPCS,Outpatient,,,173,129.75,,159.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,173,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.96,173,
BLADE SAW SAGITTAL L90MM X W25MM,41456,CDM,272,RC,A4649,HCPCS,Outpatient,,,173,129.75,,159.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,173,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,89.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.96,173,
SCISSORS LAPAROSCOPIC ENDOPATH 360D CURVE 21CM,6634935,CDM,272,RC,A4649,HCPCS,Outpatient,,,139,104.25,,127.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.28,139,
SCISSORS MONOPOLAR METZENBAUM 5MM DIA 31CML,48424,CDM,272,RC,A4649,HCPCS,Outpatient,,,158,118.5,,145.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,82.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,146.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,142.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,142.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,153.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,158,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,82.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,153.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,118.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,151.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,82.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,118.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,118.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.16,158,
NEEDLE SCORPION,6672621,CDM,272,RC,,,Outpatient,,,751,563.25,,690.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,390.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,698.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,675.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,675.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,728.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,751,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,390.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,728.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,563.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,720.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,390.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,563.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,563.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,390.52,751,
SCREW CORTEX SELF-TAPPING 2.0X12MM,42841,CDM,278,RC,C1713,HCPCS,Outpatient,,,150,112.5,,138,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,150,
SCREW CORTEX SELF-TAPPING SD RECESS 2.0X10MM,42848,CDM,278,RC,C1713,HCPCS,Outpatient,,,299,224.25,,275.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,278.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,269.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,269.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,290.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,299,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,287.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.48,299,
SCREW CORTEX SELF-TAPPING 2.0MM,42842,CDM,278,RC,C1713,HCPCS,Outpatient,,,154,115.5,,141.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,143.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.08,154,
SCREW CORTEX SELF-TAPPING T8 SD 2.4X22MM,42876,CDM,278,RC,C1713,HCPCS,Outpatient,,,1674,1255.5,,1540.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1556.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1674,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1607.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,870.48,1674,
SCREW CORTEX SELF-TAPPING T8 SD 2.4X20MM,42875,CDM,278,RC,C1713,HCPCS,Outpatient,,,1674,1255.5,,1540.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1556.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1506.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1674,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1623.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1607.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,870.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1255.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,870.48,1674,
SCREW CORTEX SELF-TAPPING T8 SD 2.4X26MM,42855,CDM,278,RC,C1713,HCPCS,Outpatient,,,419,314.25,,385.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,217.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,389.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,377.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,377.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,406.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,419,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,217.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,406.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,314.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,402.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,217.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,314.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,314.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,217.88,419,
SCREW 2.4 VA LOCKING SD 12 STERILE $,42869,CDM,278,RC,C1713,HCPCS,Outpatient,,,891,668.25,,819.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,463.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,828.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,801.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,801.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,864.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,891,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,463.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,864.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,668.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,855.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,463.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,668.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,668.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,463.32,891,
SCREW VA LOCKING 2.4X14MM,42877,CDM,278,RC,C1713,HCPCS,Outpatient,,,1782,1336.5,,1639.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,926.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1657.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1603.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1603.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1728.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1782,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,926.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1728.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1336.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1710.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,926.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1336.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1336.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,926.64,1782,
SCREW VA LOCKING 2.4X16MM,42878,CDM,278,RC,C1713,HCPCS,Outpatient,,,1782,1336.5,,1639.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,926.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1657.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1603.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1603.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1728.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1782,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,926.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1728.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1336.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1710.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,926.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1336.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1336.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,926.64,1782,
SCREW VA LOCKING 2.4X22MM,42879,CDM,278,RC,C1713,HCPCS,Outpatient,,,1782,1336.5,,1639.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,926.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1657.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1603.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1603.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1728.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1782,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,926.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1728.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1336.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1710.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,926.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1336.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1336.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,926.64,1782,
SCREW VA LOCKING 2.4X24MM,42880,CDM,278,RC,C1713,HCPCS,Outpatient,,,3564,2673,,3278.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1853.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3314.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3207.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3207.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3457.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3564,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1853.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3457.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2673,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3421.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1853.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2673,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2673,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1853.28,3564,
SCREW CORTEX SELF-TAPPING T8 SD REC 2.7X22MM,42850,CDM,278,RC,C1713,HCPCS,Outpatient,,,321,240.75,,295.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,166.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,298.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,288.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,288.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,311.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,321,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,166.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,311.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,240.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,308.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,166.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.92,321,
SCREW CORTEX SELF-TAPPING T8 SD REC 2.7X16MM,42931,CDM,278,RC,C1713,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,296.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,531.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,513.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,513.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,553.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,571,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,296.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,553.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,428.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,548.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,296.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,428.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,428.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,296.92,571,
SCREW CORTEX SELF-TAPPING T8 SD REC 2.7X18MM,42932,CDM,278,RC,C1713,HCPCS,Outpatient,,,381,285.75,,350.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,342.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,342.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,381,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,369.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,365.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,198.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,285.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,198.12,381,
SCREW CORTEX SELF-TAPPING T8 SD REC 2.7X14MM,42933,CDM,278,RC,C1713,HCPCS,Outpatient,,,1182,886.5,,1087.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,614.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1099.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1063.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1063.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1146.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1182,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,614.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1146.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,886.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1134.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,614.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,886.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,886.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,614.64,1182,
SCREW LOCKING SELF-TAPPING T8 SD REC 2.7X16MM,42934,CDM,278,RC,C1713,HCPCS,Outpatient,,,1772,1329,,1630.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,921.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1647.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1594.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1594.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1718.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1772,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,921.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1718.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1329,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1701.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,921.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1329,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1329,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,921.44,1772,
SCREW CORTEX SELF-TAPPING 2.7MM X 12MM,42843,CDM,278,RC,C1713,HCPCS,Outpatient,,,161,120.75,,148.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,83.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,144.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,156.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,161,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,83.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,156.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,120.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,83.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.72,161,
SCREW CORTEX SELF-TAPPING 2.7X18MM,42849,CDM,278,RC,C1713,HCPCS,Outpatient,,,321,240.75,,295.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,166.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,298.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,288.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,288.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,311.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,321,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,166.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,311.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,240.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,308.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,166.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.92,321,
SCREW CORTEX SELF-TAPPING 2.7X16MM,42856,CDM,278,RC,C1713,HCPCS,Outpatient,,,481,360.75,,442.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,250.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,447.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,432.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,432.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,466.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,481,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,250.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,466.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,360.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,461.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,250.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,360.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,360.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,250.12,481,
SCREW 3.5 LCKNG SLF-TPNG W/SD(TM) REC 14 $,42871,CDM,278,RC,C1713,HCPCS,Outpatient,,,1050,787.5,,966,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,546,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,976.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,945,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,945,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1018.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1050,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,546,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1018.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,787.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1008,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,546,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,787.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,787.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,546,1050,
SCREW LOCKING SELF-TAPPING W/SD REC 3.5X10MM,42857,CDM,278,RC,C1713,HCPCS,Outpatient,,,525,393.75,,483,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,488.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,525,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,504,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273,525,
SCREW LOCKING SELF-TAPPING W/SD REC 3.5X12MM,42858,CDM,278,RC,C1713,HCPCS,Outpatient,,,525,393.75,,483,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,488.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,525,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,504,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273,525,
SCREW NON-LOCING 3.5MM,5135006,CDM,278,RC,C1713,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,
SCREW 3.5MM CORTEX SELF-TAPPING 32MM $,42835,CDM,278,RC,C1713,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.12,106,
SCREW 3.5 SD CORTEX SELF-TAPPING 20 $,42836,CDM,278,RC,C1713,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.12,106,
SCREW CORTEX SELF-TAPPING 3.5X46MM,42837,CDM,278,RC,C1713,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,55.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.12,106,
SCREW LOCKING SELF-TAPPING W/SD REC 3.5X18MM,42861,CDM,278,RC,C1713,HCPCS,Outpatient,,,634,475.5,,583.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,329.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,589.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,570.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,570.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,614.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,634,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,329.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,614.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,475.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,608.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,329.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,475.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,475.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,329.68,634,
SCREW CORTEX SELF-TAPPING 3.5X22MM,42833,CDM,278,RC,C1713,HCPCS,Outpatient,,,89,66.75,,81.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.28,89,
SCREW 3.5MM CORTEX SELF-TAPPING 32MM $,42834,CDM,278,RC,C1713,HCPCS,Outpatient,,,89,66.75,,81.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,86.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.28,89,
SCREW CORTEX SELF-TAPPING 3.5MM X 26MM,42845,CDM,278,RC,C1713,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,178,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.56,178,
SCREW CORTEX SELF-TAPPING 3.5MM X 24MM,42844,CDM,278,RC,C1713,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,178,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.56,178,
SCREW CORTEX SELF-TAPPING 3.5MM X 45MM,42846,CDM,278,RC,C1713,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,178,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.56,178,
SCREW CORTEX SELF-TAPPING 3.5MM X 40MM,42847,CDM,278,RC,C1713,HCPCS,Outpatient,,,266,199.5,,244.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,138.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,239.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,266,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,138.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,199.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,255.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,138.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,199.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.32,266,
SCREW CORTEX SELF-TAPPING 3.5X16MM,42851,CDM,278,RC,C1713,HCPCS,Outpatient,,,355,266.25,,326.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,184.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,330.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,319.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,319.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,344.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,355,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,184.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,344.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,266.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,340.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,184.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,266.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,266.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.6,355,
SCREW CORTEX SELF-TAPPING 3.5X14MM,42862,CDM,278,RC,C1713,HCPCS,Outpatient,,,709,531.75,,652.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,368.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,659.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,638.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,638.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,687.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,709,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,368.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,687.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,531.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,680.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,368.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,531.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,531.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,368.68,709,
SCREW CORTEX SELF-TAPPING 3.5X12MM,42863,CDM,278,RC,C1713,HCPCS,Outpatient,,,798,598.5,,734.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,414.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,742.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,718.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,718.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,774.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,798,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,414.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,774.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,598.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,766.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,414.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,598.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,598.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,414.96,798,
SCREW CORTEX SELF-TAPPING 3.5X20MM,42853,CDM,278,RC,C1713,HCPCS,Outpatient,,,355,266.25,,326.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,184.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,330.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,319.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,319.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,344.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,355,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,184.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,344.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,266.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,340.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,184.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,266.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,266.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.6,355,
SCREW CORTEX SELF-TAPPING 3.5X10MM,42860,CDM,278,RC,C1713,HCPCS,Outpatient,,,532,399,,489.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,276.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,478.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,478.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,516.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,532,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,276.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,516.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,399,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,510.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,276.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,399,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,399,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.64,532,
SCREW CANN HEADED 4.0X36MM,5135007,CDM,278,RC,C1713,HCPCS,Outpatient,,,525,393.75,,483,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,488.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,472.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,525,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,509.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,504,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,273,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273,525,
SCREW CORTEX SELF-TAPPING 4.0X16MM,42832,CDM,278,RC,C1713,HCPCS,Outpatient,,,73,54.75,,67.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,37.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,65.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,65.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,37.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,70.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,54.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,37.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.96,73,
SCREW CORTEX SELF-TAPPING 4.0X14MM,42840,CDM,278,RC,C1713,HCPCS,Outpatient,,,146,109.5,,134.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,75.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,131.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,131.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,141.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,146,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,75.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,109.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,140.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,75.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75.92,146,
SCREW 4.0 CANCELLOUS PARTIALLY THRD/10 $,42831,CDM,278,RC,C1713,HCPCS,Outpatient,,,69,51.75,,63.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.88,69,
SCREW CORTEX SELF-TAPPING 4.0X40MM,42839,CDM,278,RC,C1713,HCPCS,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.76,138,
SCREW CORTEX SELF-TAPPING 4.0X28MM,42838,CDM,278,RC,C1713,HCPCS,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.76,138,
SCREW CORTEX SELF-TAPPING 4.0X50MM,42874,CDM,278,RC,C1713,HCPCS,Outpatient,,,1628,1221,,1497.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,846.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1514.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1465.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1465.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1579.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1628,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,846.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1579.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1221,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1562.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,846.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1221,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1221,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,846.56,1628,
SCREW CORTEX SELF-TAPPING 4.0X52MM,42864,CDM,278,RC,C1713,HCPCS,Outpatient,,,814,610.5,,748.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,423.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,757.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,732.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,732.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,789.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,423.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,789.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,610.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,781.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,423.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,610.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,610.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,423.28,814,
SCREW CORTEX SELF-TAPPING 4.0X64MM,42866,CDM,278,RC,C1713,HCPCS,Outpatient,,,814,610.5,,748.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,423.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,757.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,732.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,732.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,789.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,423.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,789.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,610.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,781.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,423.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,610.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,610.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,423.28,814,
SCREW CORTEX SELF-TAPPING 4.0X54MM,42865,CDM,278,RC,C1713,HCPCS,Outpatient,,,814,610.5,,748.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,423.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,757.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,732.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,732.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,789.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,423.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,789.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,610.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,781.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,423.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,610.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,610.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,423.28,814,
SCREW CORTEX SELF-TAPPING 4.0X36MM,42873,CDM,278,RC,C1713,HCPCS,Outpatient,,,1628,1221,,1497.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,846.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1514.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1465.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1465.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1579.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1628,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,846.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1579.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1221,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1562.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,846.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1221,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1221,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,846.56,1628,
SCREW CANN 6.5X70MM,5150001,CDM,278,RC,C1713,HCPCS,Outpatient,,,1145,858.75,,1053.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,595.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1064.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1030.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1030.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1110.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,595.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1110.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,858.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1099.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,595.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,858.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,858.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,595.4,1145,
SCREW CANNULATED TI 6.5X75MM,5150002,CDM,278,RC,C1713,HCPCS,Outpatient,,,1145,858.75,,1053.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,595.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1064.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1030.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1030.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1110.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,595.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1110.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,858.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1099.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,595.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,858.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,858.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,595.4,1145,
SCREW BONE CANCELLOUS TI 4MM X 12MM,41866,CDM,278,RC,C1713,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.76,88,
SCREW CANN 10X30MM,5160009,CDM,278,RC,C1713,HCPCS,Outpatient,,,506,379.5,,465.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,263.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,470.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,455.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,455.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,490.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,506,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,263.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,490.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,379.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,485.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,263.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,379.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,263.12,506,
SCREW LOCKING TI LCKNG SCR T25 SD FOR IM NAILS 4.0X34MM,42897,CDM,278,RC,C1713,HCPCS,Outpatient,,,730,547.5,,671.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,678.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,730,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,700.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.6,730,
SCREW CORTEX SELF-TAPPING 4.0X30MM,42896,CDM,278,RC,C1713,HCPCS,Outpatient,,,730,547.5,,671.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,678.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,730,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,700.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.6,730,
SCREW LOCKING TI LCKNG SCR T25 SD FOR IM NAILS 4.0X36MM,42898,CDM,278,RC,C1713,HCPCS,Outpatient,,,730,547.5,,671.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,678.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,730,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,700.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.6,730,
SCREW LOCKING TI LCKNG SCR T25 SD FOR IM NAILS 4.0X40MM,42899,CDM,278,RC,C1713,HCPCS,Outpatient,,,1460,1095,,1343.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,759.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1357.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1314,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1314,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1416.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1460,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,759.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1416.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1095,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1401.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,759.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1095,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1095,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,759.2,1460,
SCREW LOCKING TI LCKNG SCR T25 SD FOR IM NAILS 5.0X40MM,42903,CDM,278,RC,C1713,HCPCS,Outpatient,,,1460,1095,,1343.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,759.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1357.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1314,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1314,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1416.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1460,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,759.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1416.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1095,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1401.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,759.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1095,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1095,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,759.2,1460,
SCREW LOCKING TI LCKNG SCR T25 SD FOR IM NAILS 5.0X30MM,42900,CDM,278,RC,C1713,HCPCS,Outpatient,,,730,547.5,,671.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,678.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,730,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,700.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.6,730,
SCREW LOCKING TI LCKNG SCR T25 SD FOR IM NAILS 5.0X34MM,42901,CDM,278,RC,C1713,HCPCS,Outpatient,,,730,547.5,,671.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,678.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,730,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,700.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.6,730,
SCREW LOCKING TI LCKNG SCR T25 SD FOR IM NAILS 5.0X36MM,42902,CDM,278,RC,C1713,HCPCS,Outpatient,,,730,547.5,,671.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,678.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,730,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,700.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.6,730,
SCREW LOCKING TI LCKNG SCR T25 SD FOR IM NAILS 5.0X42MM,42904,CDM,278,RC,C1713,HCPCS,Outpatient,,,730,547.5,,671.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,678.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,730,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,700.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.6,730,
SCREW LOCKING TA6V 4.5X30MM,5060012,CDM,278,RC,C1713,HCPCS,Outpatient,,,438,328.5,,402.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,407.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,438,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,420.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.76,438,
SCREW LOCKING TA6V 4.5X35MM,5060014,CDM,278,RC,C1713,HCPCS,Outpatient,,,438,328.5,,402.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,407.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,438,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,420.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.76,438,
SHAFT SCREWDRIVER STARDRIVE T6 SELF-RET 50MM,42936,CDM,272,RC,A4649,HCPCS,Outpatient,,,2072,1554,,1906.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1077.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1926.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1864.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1864.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2009.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2072,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1077.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2009.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1554,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1989.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1077.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1554,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1554,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1077.44,2072,
SCREW CANN 9.0X30MM,5160014,CDM,278,RC,C1713,HCPCS,Outpatient,,,476,357,,437.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,247.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,442.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,428.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,428.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,461.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,476,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,247.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,461.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,357,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,247.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,357,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.52,476,
SCREW PEEK TENO 7.0X15MM,5135001,CDM,278,RC,C1713,HCPCS,Outpatient,,,613,459.75,,563.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,318.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,570.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,551.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,551.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,594.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,613,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,318.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,594.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,459.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,588.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,318.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,459.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,459.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318.76,613,
SCREWDRIVER CANNULATED HEXAGONAL 2.5MM,42965,CDM,272,RC,A4649,HCPCS,Outpatient,,,1617,1212.75,,1487.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,840.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1503.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1455.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1455.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1568.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1617,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,840.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1568.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1212.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1552.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,840.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1212.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1212.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,840.84,1617,
SCREWDRIVER SD DRIVE SHAFT QC/T15 $,42872,CDM,272,RC,A4649,HCPCS,Outpatient,,,1250,937.5,,1150,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,650,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1162.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1125,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1125,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1212.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1250,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,650,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1212.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,937.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1200,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,650,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,937.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,937.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,650,1250,
REAMER SHAFT FLEXIBLE 5.0MM,42964,CDM,272,RC,A4649,HCPCS,Outpatient,,,1233,924.75,,1134.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,641.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1146.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1109.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1109.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1196.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,641.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1196.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,924.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1183.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,641.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,924.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,924.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,641.16,1233,
CUFF CRYO SHOULDER X-LARGE,42419,CDM,271,RC,,,Outpatient,,,609,456.75,,560.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,316.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,566.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,548.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,548.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,590.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,609,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,316.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,590.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,456.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,584.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,316.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,456.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,456.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.68,609,
TRAY SHOULDER SUSPENSION,42424,CDM,272,RC,A4649,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.36,43,
SLEEVE COMPRESSION CALF KNEE <21IN MEDIUM PAIR,6636732,CDM,271,RC,A4467,HCPCS,Outpatient,,,60,45,,55.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.2,60,
SLEEVE COMPRESSION CALF KNEE <21IN MEDIUM PAIR,6636732,CDM,271,RC,A4467,HCPCS,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.8,40,
SLEEVE COMPRESSION CALF KNEE SMALL PAIR,6636715,CDM,271,RC,A4467,HCPCS,Outpatient,,,47,35.25,,43.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,24.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.44,47,
SLEEVE COMPRESSION KNEE LARGE PAIR,6636734,CDM,271,RC,A4467,HCPCS,Outpatient,,,48,36,,44.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,24.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,43.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,43.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,46.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,24.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,46.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,24.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.96,48,
SUTURE PASSER SMITH  and  NEPHEW,6673575,CDM,272,RC,A4649,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.64,82,
SNARE COLD EXACTO 2.4MM X 230CM,41380,CDM,272,RC,A4649,HCPCS,Outpatient,,,53,39.75,,48.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.56,53,
SNARE ENDOSCOPIC EXACTO 9MM X 2.4MM,42109,CDM,272,RC,A4649,HCPCS,Outpatient,,,875,656.25,,805,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,455,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,813.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,787.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,787.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,848.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,875,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,455,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,848.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,656.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,840,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,455,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,656.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,656.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,455,875,
BAG SPECIMEN RETRIEVAL,6672503,CDM,272,RC,A4649,HCPCS,Outpatient,,,131,98.25,,120.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.12,131,
SWIVELOCK INTERNAL FIXATION 4.75MM DIA 19.1MML,6629133,CDM,278,RC,C1713,HCPCS,Outpatient,,,6090,4567.5,,5602.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3166.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5663.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5481,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5481,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5907.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6090,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3166.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5907.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4567.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5846.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3166.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4567.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4567.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3166.8,6090,
SCREW STANDARD TA6V 4.5X20MM,5060006,CDM,278,RC,C1713,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,244.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,236.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,236.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,255.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,263,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,255.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,252.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.76,263,
SCREW STANDARD TA6V 4.5X30MM,5060011,CDM,278,RC,C1713,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,244.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,236.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,236.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,255.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,263,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,255.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,252.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,136.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.76,263,
STAPLER RELOAD ECHELON CURVED 40MM,6671937,CDM,272,RC,A4649,HCPCS,Outpatient,,,1027,770.25,,944.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,534.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,955.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,924.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,924.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,996.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1027,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,534.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,996.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,770.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,985.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,534.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,770.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,770.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,534.04,1027,
STAPLER INTERNAL PROXIMATE TI 55MM X 3.81MM,6672034,CDM,272,RC,A4649,HCPCS,Outpatient,,,241,180.75,,221.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,125.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,224.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,216.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,216.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,233.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,241,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,125.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,233.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,180.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,231.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,125.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,180.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,180.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.32,241,
STAPLER LINEAR PROXIMATE THICK 55MM,6671839,CDM,272,RC,A4649,HCPCS,Outpatient,,,256,192,,235.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,133.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,230.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,230.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,248.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,256,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,133.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,192,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,133.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,192,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.12,256,
STAPLER LINEAR PROXIMATE THICK 75MM,6671853,CDM,272,RC,A4649,HCPCS,Outpatient,,,431,323.25,,396.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,400.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,387.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,387.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,418.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,431,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,418.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,413.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,224.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,323.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.12,431,
STAPLER CTR LINEAR REG 75MM,6671841,CDM,272,RC,A4649,HCPCS,Outpatient,,,364,273,,334.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,189.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,338.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,327.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,327.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,353.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,364,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,189.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,353.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,273,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,349.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,189.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,273,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,189.28,364,
STAPLER LINEAR INTERNAL ENDO TI 75MM,6672174,CDM,272,RC,A4649,HCPCS,Outpatient,,,154,115.5,,141.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,143.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.08,154,
STAPLER INTERNAL PROXIMATE TI 29MM,6610147,CDM,272,RC,A4649,HCPCS,Outpatient,,,708,531,,651.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,368.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,658.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,637.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,637.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,686.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,708,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,368.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,686.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,531,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,679.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,368.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,531,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,531,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,368.16,708,
STAPLER INTERNAL PROXIMATE TI 33MM,6610148,CDM,272,RC,A4649,HCPCS,Outpatient,,,642,481.5,,590.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,333.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,597.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,577.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,577.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,622.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,642,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,333.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,622.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,481.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,616.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,333.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,481.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,481.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,333.84,642,
STAPLER CIRCULAR CURVED ENDO 25MM,6671978,CDM,272,RC,A4649,HCPCS,Outpatient,,,5256,3942,,4835.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2733.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4888.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4730.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4730.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5098.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5256,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2733.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5098.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3942,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5045.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2733.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3942,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3942,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2733.12,5256,
STAPLER CIRCULAR CURVED ENDO 29MM,6671879,CDM,272,RC,A4649,HCPCS,Outpatient,,,735,551.25,,676.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,382.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,683.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,661.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,661.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,712.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,735,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,382.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,712.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,705.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,382.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,382.2,735,
STAPLER CIRCULAR CURVED ENDO 33MM,6671895,CDM,272,RC,A4649,HCPCS,Outpatient,,,735,551.25,,676.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,382.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,683.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,661.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,661.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,712.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,735,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,382.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,712.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,705.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,382.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,551.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,382.2,735,
STAPLER ENDOPATH ETHICON FLEX 45MM,42992,CDM,272,RC,A4649,HCPCS,Outpatient,,,697,522.75,,641.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,362.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,648.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,627.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,627.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,676.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,697,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,362.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,676.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,522.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,669.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,362.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,522.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,522.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,362.44,697,
STAPLER RELOAD PROXIMATE TI 60MM X 4.4MM,6610150,CDM,272,RC,A4649,HCPCS,Outpatient,,,550,412.5,,506,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,286,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,511.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,495,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,495,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,533.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,550,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,286,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,533.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,412.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,528,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,286,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,412.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,412.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,286,550,
STAPLER LINEAR CTR 60 3.5MM,6672059,CDM,272,RC,A4649,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
STAPLER INTERNAL PROXIMATE TI L60MM X 4.8MM,6672067,CDM,272,RC,A4649,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
STAPLER INTERNAL PROXIMATE TI 3.9MM X 6.9MM,6672075,CDM,272,RC,A4649,HCPCS,Outpatient,,,2387,1790.25,,2196.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1241.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2219.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2148.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2148.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2315.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2387,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1241.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2315.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1790.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2291.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1241.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1790.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1790.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1241.24,2387,
STAPLER LINEAR CUTTER FLEX ARTIC 45MM,6672562,CDM,272,RC,A4649,HCPCS,Outpatient,,,673,504.75,,619.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,349.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,625.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,605.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,605.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,652.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,349.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,652.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,504.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,646.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,349.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,504.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,504.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,349.96,673,
STAPLER ECHELON ARTICULATING 45MM X 340MM,6617955,CDM,272,RC,A4649,HCPCS,Outpatient,,,921,690.75,,847.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,478.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,856.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,828.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,828.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,893.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,921,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,478.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,893.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,690.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,884.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,478.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,690.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,690.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,478.92,921,
STAPLER RELOAD ENDOPATH 45X2.5MM,42993,CDM,272,RC,A4649,HCPCS,Outpatient,,,335,251.25,,308.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,174.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,311.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,301.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,301.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,324.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,335,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,174.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,251.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,321.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,174.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,251.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.2,335,
STAPLER RELOAD VASCULAR REGULAR 45MM,6634927,CDM,272,RC,A4649,HCPCS,Outpatient,,,342,256.5,,314.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,177.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,307.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,307.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,331.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,342,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,177.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,256.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,328.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,177.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,256.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,256.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.84,342,
STAPLER RELOAD VASCULAR THIN 45MM,41447,CDM,272,RC,A4649,HCPCS,Outpatient,,,343,257.25,,315.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,178.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,308.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,308.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,332.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,343,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,178.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,257.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,329.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,178.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,257.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,257.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,178.36,343,
STAPLER RELOAD ECHELON ENDO REGULAR 3.5MMX45MM,42916,CDM,272,RC,A4649,HCPCS,Outpatient,,,443,332.25,,407.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,411.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,398.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,398.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,429.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,443,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,429.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,425.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,230.36,443,
STAPLER RELOAD PROXIMATE TI REGULAR 55MMX3.81MM,6671770,CDM,272,RC,A4649,HCPCS,Outpatient,,,132,99,,121.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,132,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.64,132,
STAPLER RELOAD LINEAR THICK 55MM,6621601,CDM,272,RC,A4649,HCPCS,Outpatient,,,132,99,,121.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,132,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,68.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.64,132,
STAPLER RELOAD PROXIMATE TI REGULAR 75MM,6671842,CDM,272,RC,A4649,HCPCS,Outpatient,,,196,147,,180.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,101.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,176.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,176.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,190.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,196,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,101.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,190.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,147,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,101.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.92,196,
STAPLER RELOAD PROXIMATE TI 60MM X 3.5MM,43515,CDM,272,RC,A4649,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65,125,
STAPLER RLD LNR CTR 60 4.8 GREEN,6610414,CDM,272,RC,A4649,HCPCS,Outpatient,,,140,105,,128.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,140,
STAPLER RELOAD PROXIMATE TI 90MM,6621107,CDM,272,RC,A4649,HCPCS,Outpatient,,,679,509.25,,624.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,353.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,631.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,611.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,611.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,658.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,679,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,353.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,658.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,509.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,651.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,353.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,509.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,509.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,353.08,679,
STAPLER RELOAD ENDO ECHELON TI 35MM,42991,CDM,272,RC,A4649,HCPCS,Outpatient,,,492,369,,452.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,255.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,457.56,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,442.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,442.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,477.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,492,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,255.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,477.24,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,369,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,472.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,255.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,369,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,369,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,255.84,492,
STAPLER RELOAD ENDO ECHELON TI 75MM,6671838,CDM,272,RC,A4649,HCPCS,Outpatient,,,232,174,,213.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.64,232,
SYSTEM STOOL MANAGEMENT DIGNISHIELD,41596,CDM,270,RC,,,Outpatient,,,394,295.5,,362.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,204.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,366.42,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,354.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,354.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,382.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,394,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,204.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,382.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,295.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,378.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,204.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,295.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,295.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,204.88,394,
TIP ENDOSCOPIC SUCTION/IRRIGATION COAG PROBE,6623300,CDM,272,RC,A4649,HCPCS,Outpatient,,,172,129,,158.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,89.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,159.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,154.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,154.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,166.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,172,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,89.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,166.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,129,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,165.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,89.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,89.44,172,
SET HANDPIECE INTERPULSE SUCTION HIGH FLOW TIP,43393,CDM,272,RC,A4649,HCPCS,Outpatient,,,96,72,,88.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,49.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,89.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,86.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,86.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,96,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,49.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,49.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.92,96,
DRESSING HEMOSTAT SURGICEL 4IN X 8IN,6673354,CDM,272,RC,A6022,HCPCS,Outpatient,,,365,273.75,,335.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,189.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,328.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,328.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,354.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,365,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,189.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,273.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,350.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,189.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,273.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,189.8,365,
SURGIFOAM SPONGE ABSORBABLE 100C 12.5CMX8CM,6621601,CDM,272,RC,A6023,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
SUTURE FIBERWIRE 5,42173,CDM,272,RC,,,Outpatient,,,154,115.5,,141.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,143.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.08,154,
SUTURE ANCHOR DRAW TIGHT 1.8MM,CDM,CDM,278,RC,C1713,HCPCS,Outpatient,,,450,337.5,,414,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,234,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,418.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,405,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,405,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,436.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,450,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,234,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,436.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,337.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,432,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,234,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,337.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234,450,
ANCHOR SUTURE 4.75X15MM,44510,CDM,278,RC,C1713,HCPCS,Outpatient,,,788,591,,724.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,409.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,732.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,709.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,709.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,764.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,788,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,409.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,764.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,591,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,756.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,409.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,591,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,591,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,409.76,788,
ANCHOR SUTURE PEEK SWIVELOCK,42531,CDM,278,RC,C1713,HCPCS,Outpatient,,,1313,984.75,,1207.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,682.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1221.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1181.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1181.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1273.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1313,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,682.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1273.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,984.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1260.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,682.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,984.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,984.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,682.76,1313,
SUTURE CHROMIC GUT TIES,42106,CDM,272,RC,,,Outpatient,,,37,27.75,,34.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.24,37,
SUTURE CHROMIC TIES 2-0,42102,CDM,272,RC,,,Outpatient,,,38,28.5,,34.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.76,38,
SUTURE ETHIBOND EXCEL V-37,41960,CDM,272,RC,,,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.84,42,
SUTURE ETHIBOND V-37 5-0,42117,CDM,272,RC,,,Outpatient,,,41,30.75,,37.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,39.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.32,41,
SUTURE GORE-TEX CV-0 THX-26 36IN UNDYED,41575,CDM,272,RC,,,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.6,80,
SUTURE MONOCRYL PLUS KNOTLESS,42175,CDM,272,RC,,,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.6,80,
SUTURE MONODEK #0 48IN VIOLET,41778,CDM,272,RC,,,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,71.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,103.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.76,138,
SUTURE PLAIN GUT TIES 3-0,42135,CDM,272,RC,,,Outpatient,,,37,27.75,,34.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.24,37,
SUTURE PROLENE 1 XLH DA 30 IN BLUE,41679,CDM,272,RC,,,Outpatient,,,23,17.25,,21.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.96,23,
SUTURE PROLENE 4-0 V-5 L36IN MONOFILAMENT BLUE,41893,CDM,272,RC,,,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
SUTURE SHUTTLE LEFT 45 DEGREE,42426,CDM,272,RC,,,Outpatient,,,998,748.5,,918.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,518.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,928.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,898.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,898.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,968.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,998,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,518.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,968.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,748.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,958.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,518.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,748.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,748.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,518.96,998,
SHUTTLE SUTURE 45 DEGREE RIGHT,42425,CDM,272,RC,,,Outpatient,,,998,748.5,,918.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,518.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,928.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,898.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,898.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,968.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,998,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,518.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,968.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,748.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,958.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,518.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,748.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,748.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,518.96,998,
SUTURE STRATAFIX PDO 1 CTX L36CM VIOLET,41614,CDM,272,RC,,,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.56,78,
SUTURE TAPE 1.6MM,44511,CDM,272,RC,,,Outpatient,,,175,131.25,,161,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,162.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,157.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,169.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,175,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,169.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,131.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,168,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,91,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,131.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,131.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91,175,
SUTURE TAPE WHITE/BLUE 40IN,5135003,CDM,272,RC,,,Outpatient,,,193,144.75,,177.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,100.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,179.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,173.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,173.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,187.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,193,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,100.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,187.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,144.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,100.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.36,193,
SUTURE VICRYL 3-0 TAPERPOINT SH,42291,CDM,272,RC,,,Outpatient,,,33,24.75,,30.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,17.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,29.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,29.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,32.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,17.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,24.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,17.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.16,33,
SUTURE VICRYL 3-0 TIES 18IN UNDYED,43309,CDM,272,RC,,,Outpatient,,,25,18.75,,23,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,23.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,24.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,18.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13,25,
SUTURE VICRYL CT-1 #0 27IN UNDYED,43267,CDM,272,RC,,,Outpatient,,,406,304.5,,373.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,211.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,377.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,365.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,365.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,393.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,406,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,211.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,304.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,389.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,211.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,304.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,211.12,406,
SUTURE LOOP HI-FI 20 IN,42418,CDM,272,RC,,,Outpatient,,,122,91.5,,112.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,118.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,122,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,118.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,117.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,63.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.44,122,
KIT SYNDESMOSIS REPAIR,5135011,CDM,278,RC,C1713,HCPCS,Outpatient,,,4988,3741,,4588.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2593.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4638.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4489.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4489.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4838.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4988,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2593.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4838.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3741,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4788.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2593.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3741,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3741,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2593.76,4988,
HEAD OFFSET HUMELOCK CEMENTED 46X18,5060017,CDM,278,RC,C1776,HCPCS,Outpatient,,,7000,5250,,6440,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6510,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6300,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6300,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6790,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7000,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6790,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6720,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3640,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5250,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3640,7000,
NAIL TFA TI CANNULATED 11/130 DEG 170MM,42958,CDM,278,RC,C1713,HCPCS,Outpatient,,,6705,5028.75,,6168.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3486.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6235.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6034.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6034.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6503.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6705,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3486.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6503.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5028.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6436.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3486.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5028.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5028.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3486.6,6705,
BLADE HELICAL TFNA FENSTRATED 100MM,42959,CDM,278,RC,C1713,HCPCS,Outpatient,,,3364,2523,,3094.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1749.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3128.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3027.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3027.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3263.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3364,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1749.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3263.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2523,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3229.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1749.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2523,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2523,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1749.28,3364,
TIBIAL INSERT SIZE 2 10MM,5300009,CDM,278,RC,C1776,HCPCS,Outpatient,,,3168,2376,,2914.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2946.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3168,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3041.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1647.36,3168,
TIBIAL INSERT SIZE 2 11MM,5300010,CDM,278,RC,C1776,HCPCS,Outpatient,,,3168,2376,,2914.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2946.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3168,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3041.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1647.36,3168,
TIBIAL INSERT SIZE 2 12MM,5300011,CDM,278,RC,C1776,HCPCS,Outpatient,,,3168,2376,,2914.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2946.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3168,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3041.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1647.36,3168,
TIBIAL INSERT SIZE 3 11MM,5300023,CDM,278,RC,C1776,HCPCS,Outpatient,,,3168,2376,,2914.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2946.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3168,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3041.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1647.36,3168,
TIBIAL INSERT SIZE 4 10MM,5300012,CDM,278,RC,C1776,HCPCS,Outpatient,,,3168,2376,,2914.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2946.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2851.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3168,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3072.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3041.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1647.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2376,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1647.36,3168,
BOLT TIBIAL LOCKING,5300013,CDM,278,RC,C1713,HCPCS,Outpatient,,,459,344.25,,422.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,238.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,426.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,413.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,413.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,445.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,459,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,238.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,445.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,344.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,440.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,238.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,344.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,344.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.68,459,
TIBIAL TRAY NON-ROUS SIZE 1 LT,5300014,CDM,278,RC,C1776,HCPCS,Outpatient,,,4900,3675,,4508,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4557,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4410,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4410,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4753,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4900,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4753,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4704,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2548,4900,
TRAY TIBIAL NON-ROUS DT SIZE 2 RT,5300015,CDM,278,RC,C1776,HCPCS,Outpatient,,,4900,3675,,4508,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4557,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4410,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4410,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4753,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4900,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4753,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4704,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2548,4900,
TRAY TIBIAL NON-ROUS DT SIZE 4 RT,5300016,CDM,278,RC,C1776,HCPCS,Outpatient,,,4900,3675,,4508,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4557,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4410,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4410,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4753,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4900,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4753,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4704,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2548,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3675,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2548,4900,
TENDON TIBIALIS POSTERIOR ALLOGRAFT,5180001,CDM,278,RC,C1889,HCPCS,Outpatient,,,8225,6168.75,,7567,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4277,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7649.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,7402.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7402.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7978.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8225,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4277,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7978.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,6168.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7896,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4277,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6168.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6168.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4277,8225,
SYNDESMOSIS TIGHTROPE IMPLANT,6612220,CDM,278,RC,C1713,HCPCS,Outpatient,,,5756,4317,,5295.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2993.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5353.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5180.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5180.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5583.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5756,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2993.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5583.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4317,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5525.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2993.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4317,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4317,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2993.12,5756,
TORPEDO 3.5MMX7CM,43631,CDM,272,RC,,,Outpatient,,,508,381,,467.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,264.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,472.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,457.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,457.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,492.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,508,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,264.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,492.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,381,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,487.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,264.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,381,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,381,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,264.16,508,
KIT CATHETER SUCTION CLOSED 14FR DIA 21.3INL,41245,CDM,272,RC,,,Outpatient,,,911,683.25,,838.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,473.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,847.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,819.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,819.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,883.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,911,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,473.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,883.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,683.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,874.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,473.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,683.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,683.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,473.72,911,
TUBE TRACHEOSTOMY ADULT 6.0MM,42412,CDM,278,RC,A7520,HCPCS,Outpatient,,,232,174,,213.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.64,232,
TUBE TRACHEOSTOMY ADULT 8.0MM,42413,CDM,278,RC,A7520,HCPCS,Outpatient,,,232,174,,213.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.64,232,
TUBE TRACHEOSTOMY NEONATE 3.0MM,42414,CDM,278,RC,A7520,HCPCS,Outpatient,,,926,694.5,,851.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,481.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,861.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,833.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,833.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,898.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,926,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,481.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,898.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,694.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,888.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,481.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,694.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,694.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,481.52,926,
TUBE TRACHEOSTOMY NEONATE 3.5MM,43240,CDM,278,RC,A7520,HCPCS,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.56,78,
TUBE TRACHEOSTOMY NEONATE 4.0MM,43455,CDM,278,RC,A7520,HCPCS,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.56,78,
TUBE TRACHEOSTOMY NEONATE 4.5MM,43456,CDM,278,RC,A7520,HCPCS,Outpatient,,,74,55.5,,68.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.48,74,
TUBE TRACHEOSTOMY PEDIATRIC 3.0MM,43462,CDM,278,RC,A7520,HCPCS,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.56,78,
TUBE TRACHEOSTOMY PEDIATRIC 4.0MM,42411,CDM,278,RC,A7520,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.28,114,
TUBE TRACHEOSTOMY PEDIATRIC 4.5MM,42409,CDM,278,RC,A7520,HCPCS,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,40.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.56,78,
TUBE TRACHEOSTOMY PEDIATRIC 5.0MM,42410,CDM,278,RC,A7520,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.28,114,
TUBE TRACHEOSTOMY PEDIATRIC 5.5MM,43461,CDM,278,RC,A7520,HCPCS,Outpatient,,,74,55.5,,68.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,38.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.48,74,
TRAY ARTHROGRAM COAG ELECTROSUR SUCTION 12FR,7041025,CDM,272,RC,A4649,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.6,30,
TRAY CATHETER UMBILICAL NEONATE W/MICRO FORCEPS,6608525,CDM,272,RC,A4649,HCPCS,Outpatient,,,167,125.25,,153.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,86.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,155.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,150.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,150.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,161.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,167,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,86.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,161.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,125.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,160.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,86.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.84,167,
KIT CATHETER CENTRAL VENOUS 7FR,6618359,CDM,278,RC,C1755,HCPCS,Outpatient,,,128,96,,117.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,66.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,115.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,115.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,124.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,128,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,66.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,96,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,66.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.56,128,
TRAY  LUMBAR PUNCTURE ADULT,6627707,CDM,272,RC,,,Outpatient,,,31,23.25,,28.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,16.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,30.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,16.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,23.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,16.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,23.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.12,31,
TRAY MIDLINE DUAL LUMEN 20 CM,41594,CDM,278,RC,C1751,HCPCS,Outpatient,,,498,373.5,,458.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,258.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,463.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,448.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,448.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,483.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,498,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,258.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,483.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,373.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,478.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,258.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,373.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,373.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,258.96,498,
TRAY MIDLINE SINGLE LUMEN 18GA,41598,CDM,278,RC,C1751,HCPCS,Outpatient,,,388,291,,356.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,360.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,388,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,372.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.76,388,
TRAY MIDLINE SINGLE LUMEN 10 CM,41597,CDM,278,RC,C1751,HCPCS,Outpatient,,,368,276,,338.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,191.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,342.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,331.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,331.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,356.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,368,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,191.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,356.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,276,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,353.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,191.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,276,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,191.36,368,
TRAY CATHETER PICC 2-LUMEN 5FR DIA 55CML,40610,CDM,278,RC,C1751,HCPCS,Outpatient,,,388,291,,356.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,360.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,388,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,376.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,372.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,201.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,291,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.76,388,
TRAY CATHETER THORACENTESIS 8FR X 16CML,6610414,CDM,272,RC,C1729,HCPCS,Outpatient,,,187,140.25,,172.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,97.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,173.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,168.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,168.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,181.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,97.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,181.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,140.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,179.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,97.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,140.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.24,187,
TRAY NEEDLE SPINAL WHITACRE 25GA 3.5IN,6637011,CDM,272,RC,A4649,HCPCS,Outpatient,,,46,34.5,,42.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,44.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,23.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.92,46,
TRAY CATHETER THORACENTESIS 8FR,6600357,CDM,272,RC,C1729,HCPCS,Outpatient,,,294,220.5,,270.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,152.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,273.42,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,264.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,264.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,285.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,294,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,152.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,285.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,220.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,282.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,152.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,220.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,220.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.88,294,
TROCAR BLUNT TIP 12MM,6608772,CDM,272,RC,A4649,HCPCS,Outpatient,,,91,68.25,,83.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,88.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.32,91,
TROCAR BLADELESS 15MM,41218,CDM,272,RC,A4649,HCPCS,Outpatient,,,161,120.75,,148.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,83.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,144.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,156.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,161,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,83.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,156.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,120.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,83.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.72,161,
TROCAR BLADELESS LONG 150MM,41212,CDM,272,RC,A4649,HCPCS,Outpatient,,,102,76.5,,93.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,53.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,91.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,91.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,98.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,102,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,53.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,98.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,76.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,53.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.04,102,
TROCAR BLADELESS 8MM,41214,CDM,272,RC,A4649,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.56,103,
TROCAR BLADELESS OBTURATOR 5X100MM,6643755,CDM,272,RC,A4649,HCPCS,Outpatient,,,91,68.25,,83.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,88.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,47.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.32,91,
TROCAR ENDOSCOPIC DILATING 11X100MML,42961,CDM,272,RC,A4649,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
TROCAR ENDOSCOPIC DILATING 12X100MML,6673495,CDM,272,RC,A4649,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
TROCAR ENDOSCOPIC DILATING 12X150MML,42338,CDM,272,RC,A4649,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,125.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,70.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,70.2,135,
TROCAR ENDOSCOPIC DILATING 5X100MML,6673511,CDM,272,RC,A4649,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
TUBULAR PLATE 1/3,41869,CDM,278,RC,C1713,HCPCS,Outpatient,,,701,525.75,,644.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,364.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,651.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,630.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,630.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,679.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,701,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,364.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,679.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,525.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,672.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,364.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,525.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,525.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,364.52,701,
PEG TORX UNTHREADED 16MM,5200002,CDM,278,RC,C1713,HCPCS,Outpatient,,,1208,906,,1111.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,628.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1123.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1087.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1087.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1171.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1208,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,628.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1171.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,906,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1159.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,628.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,906,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,906,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,628.16,1208,
PEG THREADED LOCKING 18MM,5200003,CDM,278,RC,C1713,HCPCS,Outpatient,,,403,302.25,,370.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,374.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,362.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,362.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,390.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,403,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,390.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,386.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,209.56,403,
PEG TORX UNTHREADED 20MM,5200004,CDM,278,RC,C1713,HCPCS,Outpatient,,,403,302.25,,370.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,374.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,362.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,362.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,390.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,403,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,390.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,386.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,209.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,209.56,403,
VACURETTE CURVED 10MM,41723,CDM,272,RC,A4649,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
CANNULA CURETTE CURVED 12MM,41701,CDM,272,RC,A4649,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
LIGATOR BAND VARICEAL,6634912,CDM,272,RC,,,Outpatient,,,769,576.75,,707.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,399.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,715.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,692.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,692.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,745.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,769,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,399.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,745.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,576.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,738.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,399.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,576.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,576.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,399.88,769,
PACK HERNIA VENTRALEX MEDIUM,41484,CDM,278,RC,C1781,HCPCS,Outpatient,,,1759,1319.25,,1618.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,914.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1635.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1583.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1583.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1706.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1759,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,914.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1706.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1319.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1688.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,914.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1319.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1319.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,914.68,1759,
PACK HERNIA VENTRALEX SMALL,42027,CDM,278,RC,C1781,HCPCS,Outpatient,,,1466,1099.5,,1348.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,762.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1363.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1319.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1319.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1422.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1466,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,762.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1422.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1099.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1407.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,762.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1099.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1099.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,762.32,1466,
VISERA RETAINER,41211,CDM,272,RC,A4649,HCPCS,Outpatient,,,68,51,,62.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,65.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.36,68,
WASHER 7.0MM,42968,CDM,278,RC,C1889,HCPCS,Outpatient,,,212,159,,195.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,110.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,197.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,190.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,190.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,205.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,212,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,110.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,205.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,159,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,203.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,110.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,159,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,159,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,110.24,212,
DRESSING WOUND PICO 7 - 4 X12CM,41577,CDM,272,RC,,,Outpatient,,,1103,827.25,,1014.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,573.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1025.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,992.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,992.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1069.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1103,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,573.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1069.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,827.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1058.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,573.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,827.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,827.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,573.56,1103,
DRESSING WOUND PICO 14 - 10X30CM,41574,CDM,272,RC,,,Outpatient,,,1201,900.75,,1104.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,624.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1116.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1080.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1080.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1164.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1201,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,624.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1164.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,900.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1152.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,624.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,900.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,900.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,624.52,1201,
ANCHOR SUTURE X-TWIST 4.75MM,5160003,CDM,278,RC,C1713,HCPCS,Outpatient,,,910,682.5,,837.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,473.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,846.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,819,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,819,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,882.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,910,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,473.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,882.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,682.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,873.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,473.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,682.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,682.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,473.2,910,
ANCHOR SUTURE X-TWIST 4.75MM,5160001,CDM,278,RC,C1713,HCPCS,Outpatient,,,910,682.5,,837.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,473.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,846.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,819,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,819,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,882.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,910,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,473.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,882.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,682.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,873.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,473.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,682.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,682.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,473.2,910,
KIT PAD POSITIONING XL 20X40IN,43000,CDM,272,RC,A4649,HCPCS,Outpatient,,,406,304.5,,373.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,211.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,377.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,365.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,365.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,393.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,406,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,211.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,304.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,389.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,211.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,304.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,211.12,406,
EGD TRANSORAL BIOPSY SINGLE/MULTIPLE,78001409,CDM,750,RC,43239,HCPCS,Outpatient,,,2789,2091.75,,2565.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1450.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2593.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2510.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2510.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2705.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2789,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1450.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2705.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2091.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2677.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1450.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2091.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2091.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1450.28,2789,
CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK,78001546,CDM,361,RC,54150,HCPCS,Outpatient,,,371,278.25,,341.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,192.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,345.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,359.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,371,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,192.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,359.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,278.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,356.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,192.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,278.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,278.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192.92,371,
CIRCUMCISION AGE >28 DAYS,78001548,CDM,361,RC,54161,HCPCS,Outpatient,,,2782,2086.5,,2559.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1446.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2587.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2503.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2503.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2698.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2782,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1446.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2698.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2086.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2670.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1446.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2086.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2086.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1446.64,2782,
INJECTION ANES and /STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL,78001748,CDM,361,RC,64483,HCPCS,Outpatient,,,1761,1320.75,,1620.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,915.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1637.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1584.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1584.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1708.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1761,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,915.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1708.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1320.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1690.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,915.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1320.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1320.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,915.72,1761,
NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNEL,78001790,CDM,361,RC,64721,HCPCS,Outpatient,,,3679,2759.25,,3384.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1913.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3421.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3311.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3311.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3568.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3679,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1913.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3568.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2759.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3531.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1913.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2759.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2759.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1913.08,3679,
COLORECTAL CANCER SCREEN FLEXIBLE SIGMOIDOSCOPY,66100001,CDM,360,RC,G0104,HCPCS,Outpatient,,,2896,2172,,2664.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1505.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2693.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2606.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2606.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2809.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2896,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1505.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2809.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2172,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2780.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1505.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2172,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2172,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1505.92,2896,
OR LEVEL 1 ADDITIONAL 15 MINUTES,66100003,CDM,360,RC,,,Outpatient,,,1048,786,,964.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,544.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,974.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,943.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,943.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1016.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1048,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,544.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1016.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,786,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1006.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,544.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,786,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,786,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,544.96,1048,
OR LEVEL 1 ADDITIONAL PROCEDURE,66100065,CDM,360,RC,,,Outpatient,,,1955,1466.25,,1798.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1016.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1818.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1759.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1759.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1896.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1955,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1016.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1896.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1466.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1876.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1016.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1466.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1466.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1016.6,1955,
OR LEVEL 2 ADDITIONAL PROCEDURE,66100066,CDM,360,RC,,,Outpatient,,,3058,2293.5,,2813.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1590.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2843.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2752.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2752.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2966.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3058,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1590.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2966.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2293.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2935.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1590.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2293.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2293.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1590.16,3058,
OR LEVEL 3 ADDITIONAL PROCEDURE,66100067,CDM,360,RC,,,Outpatient,,,4260,3195,,3919.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2215.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3961.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3834,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3834,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4132.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4260,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2215.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4132.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3195,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4089.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2215.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3195,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3195,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2215.2,4260,
OR LEVEL 4 ADDITIONAL PROCEDURE,66100068,CDM,360,RC,,,Outpatient,,,5570,4177.5,,5124.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2896.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5180.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5013,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5013,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5402.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5570,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2896.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5402.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4177.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5347.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2896.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4177.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4177.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2896.4,5570,
OR LEVEL 5 ADDITIONAL PROCEDURE,66100069,CDM,360,RC,,,Outpatient,,,6720,5040,,6182.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3494.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6249.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6048,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6048,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6518.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6720,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3494.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6518.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5040,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6451.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3494.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5040,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5040,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3494.4,6720,
OR LEVEL 6 ADDITIONAL PROCEDURE,66100070,CDM,360,RC,,,Outpatient,,,8475,6356.25,,7797,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4407,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,7881.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,7627.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,7627.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8220.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8475,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4407,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8220.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,6356.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8136,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4407,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6356.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6356.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4407,8475,
MEAS POST-VOIDING RESIDUAL URINE/BLADDER CAP,78001540,CDM,361,RC,51798,HCPCS,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.13,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,149,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.13,149,
CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL,68500005,CDM,361,RC,92960,HCPCS,Outpatient,,,1205,903.75,,1108.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,626.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1120.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1084.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1084.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1168.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1205,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,626.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1168.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,903.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1156.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,626.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,903.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,903.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,626.6,1205,
REMOVE TUNNELED CTR VAD W/SUBQ PORT/PUMP,78001332,CDM,361,RC,36590,HCPCS,Outpatient,,,2318,1738.5,,2132.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1205.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2155.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2086.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2086.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2248.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2318,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1205.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2248.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1738.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2225.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1205.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1738.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1738.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1205.36,2318,
TUBE THORACOSTOMY INCLUDES WATER SEAL,78001276,CDM,361,RC,32551,HCPCS,Outpatient,,,1182,886.5,,1087.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,614.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1099.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1063.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1063.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1146.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1182,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,614.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1146.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,886.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1134.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,614.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,886.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,886.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,614.64,1182,
ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,78001340,CDM,410,RC,36600,HCPCS,Outpatient,,,349,261.75,,321.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,349,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,338.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,335.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,181.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.48,349,
ECG ROUTINE W/LEAST 12 LDS TRCG ONLY W/O IR,78001840,CDM,730,RC,93005,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,354,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,339.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.08,354,
BLOOD OCCULT FECES,70200202,CDM,300,RC,82270,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
HOLTER MONITOR <= 48 HR RECORDING,74000001,CDM,731,RC,93225,HCPCS,Outpatient,,,620,465,,570.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,322.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,576.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,558,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,558,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,601.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,620,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,322.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,601.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,465,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,595.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,322.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,465,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,465,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,322.4,620,
SCREENING TEST PURE TONE AIR ONLY,65000005,CDM,470,RC,92551,HCPCS,Outpatient,,,357,267.75,,328.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,357,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.64,357,
REMOVE TUNNELED CTR VAD W/SUBQ PORT/PUMP,78001332,CDM,361,RC,36590,HCPCS,Outpatient,,,2318,1738.5,,2132.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1205.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2155.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2086.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2086.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2248.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2318,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1205.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2248.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1738.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2225.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1205.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1738.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1738.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1205.36,2318,
BRONCH DILAT RESPONSE SPIROMETRY PRE  POST,78001846,CDM,410,RC,94060,HCPCS,Outpatient,,,576,432,,529.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,535.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,518.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,518.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,558.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,576,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,558.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,552.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,299.52,576,
BILIRUBIN TOTAL TRANSCUTANEOUS,70201066,CDM,300,RC,88720,HCPCS,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
TRANSFUSION BLOOD/BLOOD COMPONENTS,78001304,CDM,391,RC,36430,HCPCS,Outpatient,,,982,736.5,,903.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,913.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,883.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,883.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,952.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,982,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,952.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,942.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,510.64,982,
TRANSFUSION BLOOD/BLOOD COMPONENTS,78001304,CDM,391,RC,36430,HCPCS,Outpatient,,,982,736.5,,903.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,913.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,883.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,883.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,952.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,982,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,952.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,942.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,510.64,982,
TRANSFUSION BLOOD/BLOOD COMPONENTS,78001304,CDM,391,RC,36430,HCPCS,Outpatient,,,982,736.5,,903.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,913.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,883.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,883.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,952.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,982,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,952.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,942.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,510.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,736.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,510.64,982,
URINALYSIS COMPONENT W/O MICROSCOPY,70200121,CDM,300,RC,81003,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.36,43,
URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS,70200125,CDM,300,RC,81025,HCPCS,Outpatient,,,85,63.75,,78.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,44.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,76.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,76.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,82.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,44.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,63.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,44.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.2,85,
WOUND CARE INCISION AND DRAINAGE ABSCESS SIMPLE/SINGLE,96000005,CDM,361,RC,10060,HCPCS,Outpatient,,,415,311.25,,381.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,385.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,373.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,373.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,402.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,415,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,402.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,398.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,215.8,415,
WOUND CARE INCISION AND DRAINAGE ABSCESS SIMPLE/SINGLE,96000005G,CDM,361,RC,10060,HCPCS,Outpatient,,,415,311.25,,381.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,385.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,373.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,373.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,402.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,415,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,402.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,398.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,215.8,415,
WOUND CARE INCISION AND DRAINAGE ABSCESS COMP/MULT,96000007,CDM,361,RC,10061,HCPCS,Outpatient,,,519,389.25,,477.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,269.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,482.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,467.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,467.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,503.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,519,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,269.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,503.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,389.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,498.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,269.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,389.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,389.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.88,519,
WOUND CARE INCISION AND DRAINAGE ABSCESS COMP/MULT,96000007G,CDM,361,RC,10061,HCPCS,Outpatient,,,519,389.25,,477.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,269.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,482.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,467.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,467.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,503.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,519,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,269.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,503.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,389.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,498.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,269.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,389.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,389.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.88,519,
WOUND CARE DEBRIDE SUBCUTANEOUS TISSUE 20 SQ CM/<,96000032,CDM,361,RC,11042,HCPCS,Outpatient,,,856,642,,787.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,445.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,796.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,770.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,770.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,830.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,445.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,830.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,642,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,821.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,445.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,642,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,642,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,445.12,856,
WOUND CARE DEBRIDE SUBCUTANEOUS TISSUE 20 SQ CM/<,96000032G,CDM,361,RC,11042,HCPCS,Outpatient,,,856,642,,787.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,445.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,796.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,770.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,770.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,830.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,445.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,830.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,642,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,821.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,445.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,642,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,642,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,445.12,856,
WOUND CARE DEBRIDE MUSCLE AND/OR FASCIA FIRST 20 SQCM OR <,96000034,CDM,361,RC,11043,HCPCS,Outpatient,,,1223,917.25,,1125.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,635.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1137.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1100.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1100.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1186.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1223,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,635.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1186.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,917.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1174.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,635.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,917.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,917.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,635.96,1223,
WOUND CARE DEBRIDE MUSCLE AND/OR FASCIA FIRST 20 SQCM OR,96000034G,CDM,361,RC,11043,HCPCS,Outpatient,,,1223,917.25,,1125.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,635.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1137.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1100.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1100.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1186.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1223,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,635.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1186.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,917.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1174.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,635.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,917.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,917.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,635.96,1223,
WOUND CARE DEBRIDE BONE FIRST 20 SQ CM OR LESS,96000036,CDM,361,RC,11044,HCPCS,Outpatient,,,2388,1791,,2196.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1241.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2220.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2149.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2149.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2316.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2388,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1241.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2316.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1791,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2292.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1241.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1791,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1791,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1241.76,2388,
WOUND CARE DEBRIDE BONE FIRST 20 SQ CM OR LESS,96000036G,CDM,361,RC,11044,HCPCS,Outpatient,,,2388,1791,,2196.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1241.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2220.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2149.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2149.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2316.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2388,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1241.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2316.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1791,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2292.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1241.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1791,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1791,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1241.76,2388,
WOUND CARE DEBRIDE SUBCUT TISSUE EACH ADDL 20 SQ CM,96000038,CDM,361,RC,11045,HCPCS,Outpatient,,,607,455.25,,558.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,315.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,564.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,546.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,546.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,588.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,607,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,315.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,588.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,455.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,582.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,315.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,455.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,455.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,315.64,607,
WOUND CARE DEBRIDE SUBCUT TISSUE EACH ADDL 20 SQ CM,96000038G,CDM,361,RC,11045,HCPCS,Outpatient,,,607,455.25,,558.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,315.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,564.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,546.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,546.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,588.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,607,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,315.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,588.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,455.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,582.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,315.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,455.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,455.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,315.64,607,
WOUND CARE DEBRIDE MUSCLE AND/OR FASCIA EACH ADDL 20 SQ CM,96000040,CDM,361,RC,11046,HCPCS,Outpatient,,,503,377.25,,462.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,467.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,452.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,452.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,487.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,503,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,487.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,482.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.56,503,
WOUND CARE DEBRIDE MUSCLE AND/OR FASCIA EACH ADDL 20 SQ C,96000040G,CDM,361,RC,11046,HCPCS,Outpatient,,,503,377.25,,462.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,467.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,452.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,452.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,487.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,503,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,487.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,482.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.56,503,
WOUND CARE DEBRIDE BONE EACH ADDL 20 SQ CM,96000042,CDM,361,RC,11047,HCPCS,Outpatient,,,1404,1053,,1291.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,730.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1305.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1263.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1263.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1361.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1404,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,730.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1361.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1053,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1347.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,730.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1053,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1053,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,730.08,1404,
WOUND CARE DEBRIDE BONE EACH ADD'L 20 SQ CM,96000042G,CDM,361,RC,11047,HCPCS,Outpatient,,,1404,1053,,1291.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,730.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1305.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1263.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1263.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1361.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1404,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,730.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1361.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1053,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1347.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,730.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1053,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1053,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,730.08,1404,
WOUND CARE PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,96000044,CDM,361,RC,11055,HCPCS,Outpatient,,,296,222,,272.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,275.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,266.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,266.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,287.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,287.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,284.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.92,296,
WOUND CARE PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,96000044G,CDM,361,RC,11055,HCPCS,Outpatient,,,296,222,,272.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,275.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,266.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,266.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,287.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,287.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,284.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.92,296,
WOUND CARE PARING/CUTTING BENIGN HYPERKERATOTC LESIONS 2-4,96000046,CDM,361,RC,11056,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,286,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,274.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.72,286,
WOUND CARE PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,96000044G,CDM,361,RC,11056,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,286,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,274.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.72,286,
WOUND CARE PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,96000048,CDM,361,RC,11057,HCPCS,Outpatient,,,248,186,,228.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,230.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,240.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,248,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.96,248,
WOUND CARE PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,96000048G,CDM,361,RC,11057,HCPCS,Outpatient,,,248,186,,228.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,230.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,240.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,248,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.96,248,
WOUND CARE TANGENTIAL BIOPSY SKIN SINGLE LESION,96000050G,CDM,361,RC,11102,HCPCS,Outpatient,,,232,174,,213.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.64,232,
WOUND CARE TANGENTIAL BIOPSY SKIN SINGLE LESION,96000050,CDM,361,RC,11102,HCPCS,Outpatient,,,232,174,,213.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.64,232,
WOUND CARE TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESION,96000052G,CDM,361,RC,11103,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
WOUND CARE TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESION,96000052,CDM,361,RC,11103,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
WOUND CARE PUNCH BIOPSY SKIN SINGLE LESION,96000054,CDM,361,RC,11104,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,288,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.76,288,
WOUND CARE PUNCH BIOPSY SKIN SINGLE LESION,96000054G,CDM,361,RC,11104,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,288,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.76,288,
WOUND CARE PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION TECH,96000056,CDM,361,RC,11105,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
WOUND CARE PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION,96000056G,CDM,361,RC,11105,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
WOUND CARE INCISIONAL BIOPSY SKIN SINGLE LESION,96000058G,CDM,361,RC,11106,HCPCS,Outpatient,,,357,267.75,,328.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,357,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.64,357,
WOUND CARE INCISIONAL BIOPSY SKIN SINGLE LESION,96000058,CDM,361,RC,11106,HCPCS,Outpatient,,,357,267.75,,328.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,357,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.64,357,
WOUND CARE INCISIONAL BIOPSY SKIN EA SEP/ADD'L LESION,96000060G,CDM,361,RC,11107,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,162,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.24,162,
WOUND CARE INCISIONAL BIOPSY SKIN EA SEP/ADD'L LESION,96000060,CDM,361,RC,11107,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,162,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.24,162,
WOUND CARE EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100CM,96000274,CDM,361,RC,15116,HCPCS,Outpatient,,,1019,764.25,,937.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,947.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,917.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,917.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,988.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1019,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,988.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,978.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,529.88,1019,
WOUND CARE EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100CM,96000274G,CDM,361,RC,15116,HCPCS,Outpatient,,,1019,764.25,,937.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,947.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,917.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,917.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,988.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1019,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,988.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,978.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,529.88,1019,
WOUND CARE SKIN GRAFT TRUNK ARM LEG UP TO 100SQCM 1ST 25SQCM,96000282,CDM,361,RC,15271,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3415.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3526.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.96,3673,
WOUND CARE SKIN GRAFT TRUNK ARM LEG UP TO 100SQCM 1ST 25S,96000282G,CDM,361,RC,15271,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3415.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3526.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.96,3673,
APPLY SKIN GRFT FACE NCK GENIT HAND FT TO 100SQCM 1ST 25SQCM,78000290,CDM,361,RC,15275,HCPCS,Outpatient,,,1838,1378.5,,1690.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,955.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1709.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1654.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1654.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1782.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1838,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,955.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1782.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1378.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1764.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,955.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1378.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1378.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,955.76,1838,
WOUND CARE DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE < 5,96000304,CDM,361,RC,16020,HCPCS,Outpatient,,,340,255,,312.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,176.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,316.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,306,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,306,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,329.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,340,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,176.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,255,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,176.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,255,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,255,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,176.8,340,
WOUND CARE DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE,96000304G,CDM,361,RC,16020,HCPCS,Outpatient,,,340,255,,312.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,176.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,316.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,306,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,306,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,329.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,340,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,176.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,255,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,176.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,255,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,255,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,176.8,340,
WOUND CARE DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/SBSQ,96000306,CDM,361,RC,16025,HCPCS,Outpatient,,,443,332.25,,407.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,411.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,398.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,398.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,429.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,443,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,429.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,425.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,230.36,443,
WOUND CARE DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/S,96000306G,CDM,361,RC,16025,HCPCS,Outpatient,,,443,332.25,,407.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,411.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,398.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,398.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,429.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,443,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,429.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,425.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,230.36,443,
WOUND CARE DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/SBSQ,96000308,CDM,361,RC,16030,HCPCS,Outpatient,,,507,380.25,,466.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,263.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,471.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,456.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,456.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,491.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,263.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,491.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,486.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,263.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,263.64,507,
WOUND CARE DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/S,96000308G,CDM,361,RC,16030,HCPCS,Outpatient,,,507,380.25,,466.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,263.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,471.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,456.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,456.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,491.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,263.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,491.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,486.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,263.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,263.64,507,
WOUND CARE APPLICATION RIGID TOTAL CONTACT LEG CAST,96001182,CDM,361,RC,29445,HCPCS,Outpatient,,,285,213.75,,262.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,256.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,256.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,276.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,285,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,276.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.2,285,
WOUND CARE APPLICATION RIGID TOTAL CONTACT LEG CAST,96001182G,CDM,361,RC,29445,HCPCS,Outpatient,,,285,213.75,,262.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,256.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,256.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,276.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,285,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,276.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.2,285,
WOUND CARE STRAPPING UNNA BOOT,96001196,CDM,361,RC,29580,HCPCS,Outpatient,,,309,231.75,,284.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,287.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,278.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,278.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,299.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,309,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,299.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,296.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,160.68,309,
WOUND CARE STRAPPING UNNA BOOT,96001196G,CDM,361,RC,29580,HCPCS,Outpatient,,,309,231.75,,284.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,287.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,278.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,278.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,299.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,309,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,299.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,296.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,160.68,309,
WOUND CARE STRAPPING UNNA BOOT BILATERAL,96002804,CDM,361,RC,29580,HCPCS,Outpatient,,,463.5,347.63,,426.42,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,241.02,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,431.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,417.15,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,417.15,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,449.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,463.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,241.02,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,449.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,347.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,444.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,241.02,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,347.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,347.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,241.02,463.5,
WOUND CARE STRAPPING UNNA BOOT BIL,96002804G,CDM,361,RC,29580,HCPCS,Outpatient,,,463.5,347.63,,426.42,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,241.02,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,431.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,417.15,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,417.15,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,449.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,463.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,241.02,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,449.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,347.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,444.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,241.02,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,347.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,347.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,241.02,463.5,
WOUND CARE INJECT NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN,96001305,CDM,361,RC,36465,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3415.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3526.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.96,3673,
WOUND CARE INJECT NONCMPND SCLEROSANT SINGLE INCMPTNT VEI,96001305G,CDM,361,RC,36465,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3415.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3526.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.96,3673,
WOUND CARE INJECT NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEIN,96001307,CDM,361,RC,36466,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3415.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3526.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.96,3673,
WOUND CARE INJECT NONCMPND SCLEROSANT MULTIPLE INCMPTNT V,96001307G,CDM,361,RC,36466,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3415.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3526.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.96,3673,
WOUND CARE ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,96001326,CDM,361,RC,36478,HCPCS,Outpatient,,,4486,3364.5,,4127.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2332.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4171.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4037.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4037.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4351.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4486,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2332.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4351.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4306.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2332.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2332.72,4486,
WOUND CARE ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,96001326G,CDM,361,RC,36478,HCPCS,Outpatient,,,4486,3364.5,,4127.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2332.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4171.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4037.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4037.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4351.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4486,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2332.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4351.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4306.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2332.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2332.72,4486,
WOUND CARE ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VNS,96001328,CDM,361,RC,36479,HCPCS,Outpatient,,,1814,1360.5,,1668.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,943.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1687.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1632.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1632.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1759.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,943.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1759.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1360.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1741.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,943.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1360.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1360.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,943.28,1814,
WOUND CARE ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VNS,96001328G,CDM,361,RC,36479,HCPCS,Outpatient,,,1814,1360.5,,1668.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,943.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1687.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1632.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1632.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1759.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,943.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1759.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1360.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1741.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,943.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1360.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1360.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,943.28,1814,
I&D PERIANAL ABSCESS SUPERFICIAL,78001459G,CDM,361,RC,46050,HCPCS,Outpatient,,,954,715.5,,877.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,496.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,887.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,858.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,858.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,925.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,954,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,496.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,925.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,715.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,915.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,496.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,715.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,715.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,496.08,954,
WOUND CARE REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE UNI,96001819,CDM,361,RC,69209,HCPCS,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,149,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.48,149,
WOUND CRE REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,96001820G,CDM,361,RC,69210,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
WOUND CRE REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,96001820,CDM,361,RC,69210,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
GLUCOSE BLOOD GLUCOSCAN/METER FINGER STICK,96000322,CDM,300,RC,82962,HCPCS,Outpatient,,,68,51,,62.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,65.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.36,68,
WOUND CARE US UPPER/LWR PHYSILG STUDY OF ARTERIES 1-2 LVL,96000045G,CDM,921,RC,93922,HCPCS,Outpatient,,,242,181.5,,222.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,217.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,217.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,234.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,242,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,232.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.84,242,
WOUND CARE UPPER/LWR PHYSILGC STUDIES OF ARTERIES 1-2 LVLS,96000045,CDM,921,RC,93922,HCPCS,Outpatient,,,242,181.5,,222.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,217.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,217.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,234.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,242,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,232.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.84,242,
WOUND CARE NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVELS,96000047,CDM,921,RC,93923,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.16,233,
WOUND CARE NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEV,96000047G,CDM,921,RC,93923,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.16,233,
WOUND CARE US SCAN XTR VEINS COMPLETE BILATERAL STUDY,96000043,CDM,921,RC,93970,HCPCS,Outpatient,,,1865,1398.75,,1715.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,969.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1734.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1678.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1678.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1809.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1865,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,969.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1809.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1398.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1790.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,969.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1398.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1398.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,969.8,1865,
WOUND CARE US SCAN XTR VEINS COMPLETE BILATERAL STUDY,96000043G,CDM,921,RC,93970,HCPCS,Outpatient,,,1865,1398.75,,1715.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,969.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1734.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1678.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1678.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1809.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1865,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,969.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1809.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1398.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1790.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,969.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1398.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1398.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,969.8,1865,
WOUND CARE US SCAN XTR VEINS UNILATERAL/LIMITED STUDY,96000065,CDM,921,RC,93971,HCPCS,Outpatient,,,1350,1012.5,,1242,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,702,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1255.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1215,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1215,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1309.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,702,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1309.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1012.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1296,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,702,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1012.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1012.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,702,1350,
WOUND CARE US SCAN XTR VEINS UNIL/LIMITED STUDY,96000065G,CDM,921,RC,93971,HCPCS,Outpatient,,,1350,1012.5,,1242,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,702,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1255.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1215,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1215,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1309.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,702,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1309.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1012.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1296,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,702,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1012.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1012.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,702,1350,
WOUND CARE INJECTION SUBQ OR IM,96000025,CDM,361,RC,96372,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
WOUND CARE DEBRIDEMENT OPEN WOUND 20 SQ CM/<,96001862,CDM,361,RC,97597,HCPCS,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,363,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.76,363,
WOUND CARE DEBRIDEMENT OPEN WOUND 20 SQ CM/<,96001862G,CDM,361,RC,97597,HCPCS,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,363,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.76,363,
WOUND CARE DEBRIDEMENT OPEN WOUND EACH ADD'L 20SQCM,96001864,CDM,361,RC,97598,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182,350,
WOUND CARE DEBRIDEMENT OPEN WOUND EACH ADD'L 20SQCM,96001864G,CDM,361,RC,97598,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182,350,
WOUND CARE REMOVAL DEVITALIZD TISS N-SLCTV DBRDMT W/O ANES,96001866,CDM,361,RC,97602,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
WOUND CARE REMOVAL DEVITALIZD TISS N-SLCTV DBRDMT W/O ANE,96001866G,CDM,361,RC,97602,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
WOUND CARE NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQCM,96001867,CDM,361,RC,97605,HCPCS,Outpatient,,,269,201.75,,247.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,250.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,242.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,242.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,269,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,260.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,258.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.88,269,
WOUND CARE NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQC,96001867G,CDM,361,RC,97605,HCPCS,Outpatient,,,269,201.75,,247.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,250.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,242.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,242.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,269,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,260.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,258.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.88,269,
WOUND CARE NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM,96001869,CDM,361,RC,97606,HCPCS,Outpatient,,,420,315,,386.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,390.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,378,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,378,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,407.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,420,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,407.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,403.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,218.4,420,
WOUND CARE NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM,96001869G,CDM,361,RC,97606,HCPCS,Outpatient,,,420,315,,386.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,390.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,378,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,378,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,407.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,420,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,407.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,403.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,218.4,420,
WOUND CARE NEGATIVE PRESSURE WOUND THERAPY NON DME </= 50,96001871G,CDM,361,RC,97607,HCPCS,Outpatient,,,874,655.5,,804.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,812.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,786.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,786.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,847.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,874,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,847.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,839.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,454.48,874,
WOUND CARE NEGATIVE PRESSURE WOUND THERAPY NON DME </= 50 SQ,96001871,CDM,361,RC,97607,HCPCS,Outpatient,,,874,655.5,,804.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,812.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,786.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,786.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,847.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,874,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,847.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,839.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,454.48,874,
WOUND CARE NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM,96001873G,CDM,361,RC,97608,HCPCS,Outpatient,,,546,409.5,,502.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,507.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,546,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,283.92,546,
WOUND CARE NEG PRESSURE WOUND THERAPY NON DME >50SQCM,96001873,CDM,361,RC,97608,HCPCS,Outpatient,,,546,409.5,,502.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,507.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,546,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,283.92,546,
TECH WOUND CARE NEW PATIENT VISIT LEVEL 2,96001891,CDM,761,RC,99202,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,162,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.24,162,
WOUND CARE NEW PATIENT VISIT LEVEL 2,96001891G,CDM,761,RC,99202,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,162,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.24,162,
TECH WOUND CARE NEW PATIENT VISIT LEVEL 3,96001895,CDM,761,RC,99203,HCPCS,Outpatient,,,219,164.25,,201.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,203.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,219,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.88,219,
WOUND CARE NEW PATIENT VISIT LEVEL 3,96001895G,CDM,761,RC,99203,HCPCS,Outpatient,,,219,164.25,,201.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,203.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,219,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.88,219,
TECH WOUND CARE NEW PATIENT VISIT LEVEL 4,96001899,CDM,761,RC,99204,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.04,327,
WOUND CARE NEW PATIENT VISIT LEVEL 4,96001899G,CDM,761,RC,99204,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.04,327,
TECH WOUND CARE NEW PATIENT VISIT LEVEL 5,96001903,CDM,761,RC,99205,HCPCS,Outpatient,,,432,324,,397.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,401.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,388.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,388.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,419.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,432,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,419.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,414.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.64,432,
WOUND CARE NEW PATIENT VISIT LEVEL 5,96001903G,CDM,761,RC,99205,HCPCS,Outpatient,,,432,324,,397.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,401.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,388.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,388.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,419.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,432,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,419.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,414.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.64,432,
TECH WOUND CARE EST PATIENT VISIT LEVEL 1,96001907,CDM,761,RC,99211,HCPCS,Outpatient,,,51,38.25,,46.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.52,51,
WOUND CARE EST PATIENT VISIT LEVEL 1,96001907G,CDM,761,RC,99211,HCPCS,Outpatient,,,51,38.25,,46.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.52,51,
WOUND CARE EST PATIENT VISIT LEVEL 2,96001911G,CDM,761,RC,99212,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
TECH WOUND CARE EST PATIENT VISIT LEVEL 2,96001911,CDM,761,RC,99212,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
TECH WOUND CARE EST PATIENT VISIT LEVEL 3,96001915,CDM,761,RC,99213,HCPCS,Outpatient,,,180,135,,165.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,180,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.6,180,
WOUND CARE EST PATIENT VISIT LEVEL 3,96001915G,CDM,761,RC,99213,HCPCS,Outpatient,,,180,135,,165.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,180,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.6,180,
TECH WOUND CARE EST PATIENT VISIT LEVEL 4,96001919,CDM,761,RC,99214,HCPCS,Outpatient,,,249,186.75,,229.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,249,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,249,
WOUND CARE EST PATIENT VISIT LEVEL 4,96001919G,CDM,761,RC,99214,HCPCS,Outpatient,,,249,186.75,,229.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,249,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,249,
TECH WOUND CARE EST PATIENT VISIT LEVEL 5,96001923,CDM,761,RC,99215,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.6,330,
WOUND CARE EST PATIENT VISIT LEVEL 5,96001923G,CDM,761,RC,99215,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.6,330,
PUNCH BIOPSY SKIN EA SEPERATE OR ADDITIONAL LESION,78000056,CDM,361,RC,11105,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
WOUND CARE APPLY LOW CST SKIN SUB =<100SQCM TRUNK 1ST 25SQCM,96002050,CDM,361,RC,C5271,HCPCS,Outpatient,,,1123,842.25,,1033.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1044.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1123,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1078.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,583.96,1123,
WOUND CARE APPLY LOW COST SKIN SUB =<100SQCM TRUNK ADDL 25,96002051,CDM,361,RC,C5272,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
WOUND CARE APPLY LOW CST SKIN SUB =>100SQCM TRUNK 1ST 25SQCM,96002052,CDM,361,RC,C5273,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3415.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3526.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.96,3673,
WOUND CARE APPLY LOW COST SKIN SUB =>100SQCM TRUNK ADDL 25,96002053,CDM,361,RC,C5274,HCPCS,Outpatient,,,808,606,,743.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,420.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,751.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,727.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,727.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,783.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,808,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,420.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,783.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,775.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,420.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,606,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,420.16,808,
WOUND CARE APPLY LOW CST SKN SUB FACE <100SQCM 1ST 25SQCM =<,96002054,CDM,361,RC,C5275,HCPCS,Outpatient,,,1123,842.25,,1033.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1044.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1123,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1078.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,583.96,1123,
WOUND CARE APPLY LOW COST SKIN SUB FACE <100SQCM EA ADDL 25,96002055,CDM,361,RC,C5276,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
WOUND CARE APPLY LOW CST SKIN SUB =<100SQCM TRUNK 1ST 25SQCM,96002056,CDM,361,RC,C5277,HCPCS,Outpatient,,,1123,842.25,,1033.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1044.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1123,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1078.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,583.96,1123,
WOUND CARE APPLY LOW COST SKIN SUBS FACE EA ADDL 100 SQCM,96002057,CDM,361,RC,C5278,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
WOUND CARE HYPERBARIC OXYGEN FULL BODY CHAMBER EA 30MIN,96001889G,CDM,413,RC,G0277,HCPCS,Outpatient,,,750,562.5,,690,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,390,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,697.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,675,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,675,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,727.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,750,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,390,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,727.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,562.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,720,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,390,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,562.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,562.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,390,750,
WOUND CARE HYPERBARIC OXYGEN FULL BODY CHAMBER EACH 30 MIN,96001889,CDM,413,RC,G0277,HCPCS,Outpatient,,,750,562.5,,690,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,390,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,697.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,675,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,675,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,727.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,750,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,390,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,727.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,562.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,720,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,390,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,562.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,562.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,390,750,
WOUND CARE APLIGRAF PER SQUARE CENTIMETER,96002778,CDM,636,RC,Q4101,HCPCS,Outpatient,,,121,90.75,,111.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,116.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.92,121,
WOUND CARE OASIS WOUND MATRIX PER SQUARE CENTIMETER,96002779,CDM,636,RC,Q4102,HCPCS,Outpatient,,,36,27,,33.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,32.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,32.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.72,36,
WOUND CARE OASIS BURN MATRIX PER SQUARE CENTIMETER,96002780,CDM,636,RC,Q4103,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
WOUND CARE INTEGRA BILAYER MATRIX WOUND DRESSING PER SQUARE,96002781,CDM,636,RC,Q4104,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,166.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,166.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,179.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,185,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,179.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.2,185,
WOUND CARE INTEGRA DERMAL REGENERATION TEMPLATE PER SQUARE C,96002782,CDM,636,RC,Q4105,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,193.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,187.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,187.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,201.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,208,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,199.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.16,208,
WOUND CARE DERMAGRAFT PER SQUARE CENTIMETER,96002783,CDM,636,RC,Q4106,HCPCS,Outpatient,,,117,87.75,,107.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,105.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.84,117,
WOUND CARE GRAFTJACKET PER SQUARE CENTIMETER,96002784,CDM,636,RC,Q4107,HCPCS,Outpatient,,,365,273.75,,335.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,189.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,328.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,328.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,354.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,365,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,189.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,273.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,350.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,189.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,273.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,189.8,365,
WOUND CARE INTEGRA MATRIX PER SQUARE CENTIMETER,96002785,CDM,636,RC,Q4108,HCPCS,Outpatient,,,212,159,,195.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,110.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,197.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,190.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,190.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,205.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,212,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,110.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,205.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,159,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,203.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,110.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,159,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,159,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,110.24,212,
WOUND CARE PRIMATRIX PER SQUARE CENTIMETER,96002786,CDM,636,RC,Q4110,HCPCS,Outpatient,,,145,108.75,,133.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75.4,145,
WOUND CARE ALLODERM PER SQUARE CENTIMETER,96002787,CDM,636,RC,Q4116,HCPCS,Outpatient,,,174,130.5,,160.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,161.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,168.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,174,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,168.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,167.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90.48,174,
WOUND CARE MATRISTEM MICROMATRIX 1MG,96002788,CDM,636,RC,Q4118,HCPCS,Outpatient,,,18,13.5,,16.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,9.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,17.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,9.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,13.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,9.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9.36,18,
WOUND CARE THERASKIN PER SQUARE CENTIMETER,96002789,CDM,636,RC,Q4121,HCPCS,Outpatient,,,202,151.5,,185.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,187.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,195.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,202,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,195.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,193.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.04,202,
WOUND CARE OASIS ULTRA TRI-LAYER WOUND MATRIX PER SQUARE CM,96002790,CDM,636,RC,Q4124,HCPCS,Outpatient,,,54,40.5,,49.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,28.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,48.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,48.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,28.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,28.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.08,54,
WOUND CARE GRAFIX PRIME STRAVIX AND STRAVIXPL PER SQUARE CM,96002792,CDM,636,RC,Q4133,HCPCS,Outpatient,,,425,318.75,,391,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,395.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,382.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,382.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,412.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,425,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,412.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,408,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,221,425,
WOUND CARE EPIFIX PER SQUARE CENTIMETER,96002791,CDM,636,RC,Q4186,HCPCS,Outpatient,,,439,329.25,,403.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,228.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,408.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,395.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,395.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,425.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,439,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,228.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,425.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,329.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,421.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,228.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,329.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,228.28,439,
WOUND CARE PURAPLY PER SQUARE CENTIMETER,96002793,CDM,636,RC,Q4195,HCPCS,Outpatient,,,375,281.25,,345,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,348.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,337.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,337.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,363.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,375,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,363.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,360,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,195,375,
WOUND CARE PURAPLY AM PER SQUARE CENTIMETER,96002794,CDM,636,RC,Q4196,HCPCS,Outpatient,,,320,240,,294.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,166.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,297.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,288,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,288,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,310.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,320,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,166.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,310.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,240,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,307.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,166.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.4,320,
INJECTION SUBQ OR IM,66100025,CDM,260,RC,96372,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
INJECTION SUBQ OR IM,66100025,CDM,260,RC,96372,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
PULMONARY STRESS TESTING 6-MINUTE WALK,74000004,CDM,410,RC,94618,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
"49281-0122-65 - influenza virus vaccine, inactivated high-dose preservative-free quadrivalent Sus [MEMO]",40580020,CDM,636,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
50580-0601-21 - ibuprofen 100 mg/5 mL Oral Susp 120 mL [MEMO],40530033,CDM,250,RC,90675,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,293.79,
58160-0826-52 - hepatitis A adult vaccine preservative free  1440 units/mL Sus [MEMO],40580085,CDM,636,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
"58160-0890-52 - influenza virus vaccine, inactivated preservative-free quadrivalent Sus [MEMO]",40580017,CDM,636,RC,90675,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,293.79,
COLLECTION VENOUS BLOOD VENIPUNCTURE,78001297,CDM,300,RC,36415,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges,15.6,52,,,percent of total billed charges,52% of total billed charges,27.9,93,,,percent of total billed charges,93% of total billed charges,27,90,,,percent of total billed charges,90% of total billed charges,27,90,,,percent of total billed charges,90% of total billed charges,29.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,52,,,percent of total billed charges,52% of total billed charges,29.1,97,,,percent of total billed charges,97% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges,28.8,96,,,percent of total billed charges,96% of total billed charges,15.6,52,,,percent of total billed charges,52% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges,15.6,29.1,
CLOSED TREATMENT OF FRACTURE OF LOWER WEIGHT BEARING JOINT O,78001010G,CDM,450,RC,27825,HCPCS,Outpatient,,,1941,1455.75,,1785.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1009.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1805.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1746.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1746.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1882.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1941,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1009.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1882.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1455.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1863.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1009.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1455.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1455.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1009.32,1941,
DIPHTH/TET/ACELL PERTUSSIS TDAP VACC >7 YR IM,78002133,CDM,636,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
AMB ZOSTER VACCINE SHINGRIX IM,78002341,CDM,636,RC,90750,HCPCS,Outpatient,,,440.17,330.13,,404.96,92,,,percent of total billed charges,92% of total billed charges,228.89,52,,,percent of total billed charges,52% of total billed charges,409.36,93,,,percent of total billed charges,93% of total billed charges,396.15,90,,,percent of total billed charges,90% of total billed charges,396.15,90,,,percent of total billed charges,90% of total billed charges,426.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,228.89,52,,,percent of total billed charges,52% of total billed charges,426.96,97,,,percent of total billed charges,97% of total billed charges,330.13,75,,,percent of total billed charges,75% of total billed charges,422.56,96,,,percent of total billed charges,96% of total billed charges,228.89,52,,,percent of total billed charges,52% of total billed charges,330.13,75,,,percent of total billed charges,75% of total billed charges,330.13,75,,,percent of total billed charges,75% of total billed charges,228.89,426.96,
BOOSTRIX,78002133,CDM,636,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
IMMUNIZATION ADMINISTRATION EACH ADD'L VACCINE,78001827,CDM,771,RC,90472,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges,42.64,52,,,percent of total billed charges,52% of total billed charges,76.26,93,,,percent of total billed charges,93% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,79.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.64,52,,,percent of total billed charges,52% of total billed charges,79.54,97,,,percent of total billed charges,97% of total billed charges,61.5,75,,,percent of total billed charges,75% of total billed charges,78.72,96,,,percent of total billed charges,96% of total billed charges,42.64,52,,,percent of total billed charges,52% of total billed charges,61.5,75,,,percent of total billed charges,75% of total billed charges,61.5,75,,,percent of total billed charges,75% of total billed charges,42.64,79.54,
IMMUNIZATION ADMINISTRATION ONE VACCINE,78001826,CDM,771,RC,90471,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,293.79,
VFC DIPHTH/TET/ACELL PERT DTAP VACC <7 YR IM,78002134,CDM,636,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
AMB LEVONORGESTRE (SKYLA) 13.5MG IMPLANT,78002315,CDM,636,RC,,,Outpatient,,,3145.2,2358.9,,2893.58,92,,,percent of total billed charges,92% of total billed charges,1635.5,52,,,percent of total billed charges,52% of total billed charges,2925.04,93,,,percent of total billed charges,93% of total billed charges,2830.68,90,,,percent of total billed charges,90% of total billed charges,2830.68,90,,,percent of total billed charges,90% of total billed charges,3050.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1635.5,52,,,percent of total billed charges,52% of total billed charges,3050.84,97,,,percent of total billed charges,97% of total billed charges,2358.9,75,,,percent of total billed charges,75% of total billed charges,3019.39,96,,,percent of total billed charges,96% of total billed charges,1635.5,52,,,percent of total billed charges,52% of total billed charges,2358.9,75,,,percent of total billed charges,75% of total billed charges,2358.9,75,,,percent of total billed charges,75% of total billed charges,1635.5,3050.84,
SHVG SKIN LESN 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,78002891G,CDM,361,RC,11302,HCPCS,Outpatient,,,204,153,,187.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,106.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,189.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,183.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,183.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,197.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,204,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,106.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,197.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,153,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,195.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,106.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,153,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.08,204,
INJECTION(S) PLATELET RICH PLASMA,78002892G,CDM,510,RC,0232T,HCPCS,Outpatient,,,759,569.25,,698.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,705.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,683.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,683.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,736.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,759,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,736.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,728.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.68,759,
FINE NEEDLE ASPIRATION BIOPSY W/US GUIDE FIRST LESION,78000001G,CDM,510,RC,10005,HCPCS,Outpatient,,,1357,1017.75,,1248.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,705.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1262.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1221.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1221.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1316.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1357,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,705.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1316.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1017.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1302.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,705.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1017.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1017.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,705.64,1357,
FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESN,78000003G,CDM,510,RC,10021,HCPCS,Outpatient,,,923,692.25,,849.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,479.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,858.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,830.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,830.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,895.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,923,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,479.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,895.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,692.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,886.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,479.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,692.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,692.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,479.96,923,
INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE,78000005G,CDM,510,RC,10060,HCPCS,Outpatient,,,415,311.25,,381.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,385.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,373.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,373.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,402.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,415,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,402.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,398.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,215.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,311.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,215.8,415,
INCISION  DRAINAGE ABSCESS COMPLICATED/MULT,78000007G,CDM,510,RC,10061,HCPCS,Outpatient,,,519,389.25,,477.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,269.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,482.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,467.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,467.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,503.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,519,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,269.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,503.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,389.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,498.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,269.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,389.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,389.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.88,519,
INCISION  DRAINAGE PILONIDAL CYST SIMPLE,78000009G,CDM,510,RC,10080,HCPCS,Outpatient,,,457,342.75,,420.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,237.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,425.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,411.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,411.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,443.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,457,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,237.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,443.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,342.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,438.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,237.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,342.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.64,457,
INCISION  DRAINAGE PILONIDAL CYST COMPLICATED,78000011G,CDM,510,RC,10081,HCPCS,Outpatient,,,1335,1001.25,,1228.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,694.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1241.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1201.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1201.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1294.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1335,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,694.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1294.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1001.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1281.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,694.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1001.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1001.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,694.2,1335,
INCISION  REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,78000013G,CDM,510,RC,10120,HCPCS,Outpatient,,,494,370.5,,454.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,256.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,459.42,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,444.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,444.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,479.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,494,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,256.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,479.18,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,370.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,474.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,256.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,370.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,370.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,256.88,494,
INCISION  REMOVAL FOREIGN BODY SUBQ TISS COMPLETE,78000015G,CDM,510,RC,10121,HCPCS,Outpatient,,,2532,1899,,2329.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1316.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2354.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2278.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2278.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2456.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2532,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1316.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2456.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1899,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2430.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1316.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1899,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1899,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1316.64,2532,
ID HEMATOMA SEROMA/FLUID COLLECTION,78000017G,CDM,510,RC,10140,HCPCS,Outpatient,,,2019,1514.25,,1857.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1049.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1877.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1817.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1817.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1958.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2019,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1049.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1958.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1514.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1938.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1049.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1514.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1514.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1049.88,2019,
INCISION  DRAIN POST OP WOUND INFECTION COMPLEX,78000021G,CDM,510,RC,10180,HCPCS,Outpatient,,,3844,2883,,3536.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1998.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3574.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3459.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3459.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3728.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3844,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1998.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3728.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2883,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3690.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1998.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2883,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2883,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1998.88,3844,
DEBRIDE W/FOREIGN BODY REMOVAL SKIN & SUBC TISS,78000026G,CDM,510,RC,11010,HCPCS,Outpatient,,,1444,1083,,1328.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1342.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1299.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1299.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1400.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1444,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1400.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1386.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,750.88,1444,
DEBRIDE W/FOREIGN BODY RMVL SKIN SUBQ TISS MUSC,78000028G,CDM,510,RC,11011,HCPCS,Outpatient,,,1128,846,,1037.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,586.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1049.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1015.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1015.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1094.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1128,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,586.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1094.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,846,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1082.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,586.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,846,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,846,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,586.56,1128,
DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,78000032G,CDM,510,RC,11042,HCPCS,Outpatient,,,856,642,,787.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,445.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,796.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,770.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,770.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,830.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,856,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,445.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,830.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,642,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,821.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,445.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,642,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,642,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,445.12,856,
DEBRIDE MUSCLE AND/OR FASCIA FIRST 20 SQCM OR <,78000034G,CDM,510,RC,11043,HCPCS,Outpatient,,,1223,917.25,,1125.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,635.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1137.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1100.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1100.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1186.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1223,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,635.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1186.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,917.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1174.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,635.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,917.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,917.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,635.96,1223,
DEBRIDEMENT BONE FIRST 20 SQ CM OR LESS,78000036G,CDM,510,RC,11044,HCPCS,Outpatient,,,2388,1791,,2196.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1241.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2220.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2149.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2149.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2316.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2388,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1241.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2316.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1791,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2292.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1241.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1791,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1791,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1241.76,2388,
DEBRIDE SUBCUTANEOUS TISSUE EACH ADDL 20 SQ CM,78000038G,CDM,510,RC,11045,HCPCS,Outpatient,,,607,455.25,,558.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,315.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,564.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,546.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,546.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,588.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,607,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,315.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,588.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,455.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,582.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,315.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,455.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,455.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,315.64,607,
DEBRIDE MUSCLE AND/OR FASCIA EACH ADDL 20 SQ CM,78000040G,CDM,510,RC,11046,HCPCS,Outpatient,,,503,377.25,,462.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,467.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,452.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,452.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,487.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,503,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,487.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,482.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,261.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,377.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,261.56,503,
DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM,78000042G,CDM,510,RC,11047,HCPCS,Outpatient,,,1404,1053,,1291.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,730.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1305.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1263.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1263.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1361.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1404,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,730.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1361.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1053,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1347.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,730.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1053,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1053,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,730.08,1404,
PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,78000044G,CDM,510,RC,11055,HCPCS,Outpatient,,,296,222,,272.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,275.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,266.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,266.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,287.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,296,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,287.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,284.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,153.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.92,296,
PARING/CUTTING BENIGN HYPERKERATOTC LESIONS 2-4,78000046G,CDM,510,RC,11056,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,286,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,274.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.72,286,
PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,78000048G,CDM,510,RC,11057,HCPCS,Outpatient,,,248,186,,228.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,230.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,240.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,248,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.96,248,
"11102 Tangential biopsy of skin (eg, shave, scoop, saucerize",78000050G,CDM,510,RC,11102,HCPCS,Outpatient,,,232,174,,213.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.64,232,
TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000052G,CDM,510,RC,11103,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
PUNCH BIOPSY SKIN SINGLE LESION,78000054G,CDM,510,RC,11104,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,288,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.76,288,
PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000056G,CDM,510,RC,11105,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
INCISIONAL BIOPSY SKIN SINGLE LESION,78000058G,CDM,510,RC,11106,HCPCS,Outpatient,,,357,267.75,,328.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,321.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,357,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,346.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,185.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,267.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.64,357,
INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000060G,CDM,510,RC,11107,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,162,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.24,162,
REMOVAL OF UP TO AND INCLUDING 15 SKIN TAGS,78000062G,CDM,510,RC,11200,HCPCS,Outpatient,,,203,152.25,,186.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,188.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,203,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.56,203,
REMOVAL OF SKIN TAGS ANY AREA EACH ADD 10 LESIONS,78000064G,CDM,510,RC,11201,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,110.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,59.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.28,114,
SHAVING SKIN LESN 1 TRUNK/ARM/LEG DIAM 0.5CM/<,78000066G,CDM,510,RC,11300,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.16,233,
SHAVING SKIN LESION TRUNK/ARM/LEG DIAM 0.6-1.0 CM,78000068G,CDM,510,RC,11301,HCPCS,Outpatient,,,278,208.5,,255.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,144.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,250.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,250.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,269.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,278,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,144.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,269.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,208.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,266.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,144.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,208.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,208.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.56,278,
SHAVING OF 0.5 CENTIMETERS OR LESS SKIN GROWTH OF FACE EARS,78000072G,CDM,510,RC,11310,HCPCS,Outpatient,,,265,198.75,,243.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,137.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,246.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,238.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,238.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,257.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,265,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,137.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,257.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,198.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,254.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,137.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,198.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,198.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.8,265,
SHAVING OF 0.6 CENTIMETERS TO 1.0 CENTIMETERS SKIN GROWTH OF,78000074G,CDM,510,RC,11311,HCPCS,Outpatient,,,312,234,,287.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,312,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,299.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,162.24,312,
EXCISE BENIGN LESION MARGIN XCP SK TG T/A/L 0.5 CM/<,78000076G,CDM,510,RC,11400,HCPCS,Outpatient,,,965,723.75,,887.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,501.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,897.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,868.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,868.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,936.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,965,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,501.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,936.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,723.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,926.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,501.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,723.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,723.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,501.8,965,
REMOVAL OF GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE TRUNK ARMS,78000078G,CDM,510,RC,11401,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,354,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,343.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,339.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,184.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.08,354,
EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 1.1-2.0 CM,78000080G,CDM,510,RC,11402,HCPCS,Outpatient,,,1113,834.75,,1023.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,578.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1035.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1001.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1001.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1079.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,578.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1079.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,834.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1068.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,578.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,834.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,834.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,578.76,1113,
EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 2.1-3.0 CM,78000082G,CDM,510,RC,11403,HCPCS,Outpatient,,,858,643.5,,789.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,446.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,797.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,772.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,772.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,832.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,858,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,446.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,832.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,643.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,823.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,446.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,643.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,643.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,446.16,858,
EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 3.1-4.0 CM,78000084G,CDM,510,RC,11404,HCPCS,Outpatient,,,1474,1105.5,,1356.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,766.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1370.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1326.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1326.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1429.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1474,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,766.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1429.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1105.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1415.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,766.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1105.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1105.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,766.48,1474,
EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS >4.0 CM,78000086G,CDM,510,RC,11406,HCPCS,Outpatient,,,2167,1625.25,,1993.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1126.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2015.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1950.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1950.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2101.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2167,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1126.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2101.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1625.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2080.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1126.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1625.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1625.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1126.84,2167,
EXCISE BENIGN LESN MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM,78000092G,CDM,510,RC,11422,HCPCS,Outpatient,,,921,690.75,,847.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,478.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,856.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,828.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,828.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,893.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,921,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,478.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,893.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,690.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,884.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,478.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,690.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,690.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,478.92,921,
EXCISE BENIGN LESION MGN XCP SK TG S/N/H/F/G 2.1-3.0CM,78000094G,CDM,510,RC,11423,HCPCS,Outpatient,,,1444,1083,,1328.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1342.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1299.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1299.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1400.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1444,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1400.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1386.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,750.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1083,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,750.88,1444,
EXCISE BENIGN LESION MGN XCP SK TG S/N/H/F/G 3.1-4.0CM,78000096G,CDM,510,RC,11424,HCPCS,Outpatient,,,1621,1215.75,,1491.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,842.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1507.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1458.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1458.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1572.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1621,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,842.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1572.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1215.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1556.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,842.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1215.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1215.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.92,1621,
EXCISE BENIGN LESION SCALP NECK HANDS FEET GENITALS > 4.0CM,78000098G,CDM,510,RC,11426,HCPCS,Outpatient,,,2552,1914,,2347.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1327.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2373.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2296.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2296.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2475.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2552,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1327.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2475.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1914,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2449.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1327.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1914,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1914,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1327.04,2552,
EXCISE BENIGN LESION FACE EARS EYELIDS NOSE LIPS MOUTH 0.5CM,78000100G,CDM,510,RC,11440,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,298.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,533.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,516.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,516.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,556.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,574,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,298.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,556.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,430.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,551.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,298.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,430.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,430.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,298.48,574,
EXCISE BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM,78000102G,CDM,510,RC,11441,HCPCS,Outpatient,,,557,417.75,,512.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,289.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,518.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,501.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,501.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,540.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,557,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,289.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,540.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,417.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,534.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,289.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,417.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,417.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,289.64,557,
EXCISION MALIGNAT LESION TRUNK ARMS LEGS 0.5 CM/<,78000108G,CDM,510,RC,11600,HCPCS,Outpatient,,,799,599.25,,735.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,415.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,743.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,719.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,719.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,775.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,799,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,415.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,775.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,599.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,767.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,415.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,599.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,599.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,415.48,799,
EXCISION MALIGNANT LESION TRUNK ARMS LEGS 0.6-1.0CM,78000110G,CDM,510,RC,11601,HCPCS,Outpatient,,,517,387.75,,475.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,480.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,517,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,496.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,268.84,517,
EXCISION MALIGNANT LESION TRUNK ARMS LEGS 1.1-2.0CM,78000112G,CDM,510,RC,11602,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,286.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,512.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,495.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,495.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,534.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,551,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,286.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,534.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,413.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,528.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,286.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,413.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,413.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,286.52,551,
EXCISION MALIGNANT LESION TRUNK ARMS LEGS 2.1-3.0CM,78000114G,CDM,510,RC,11603,HCPCS,Outpatient,,,755,566.25,,694.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,392.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,702.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,679.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,679.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,732.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,755,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,392.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,732.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,566.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,724.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,392.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,566.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,566.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,392.6,755,
EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT 0.6-1.0CM,78000118G,CDM,510,RC,11621,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,612.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,659,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,342.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,494.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.68,659,
EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT 1.1-2.0CM,78000120G,CDM,510,RC,11622,HCPCS,Outpatient,,,688,516,,632.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,357.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,619.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,619.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,667.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,688,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,357.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,667.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,516,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,660.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,357.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,516,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,516,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,357.76,688,
EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM,78000122G,CDM,510,RC,11623,HCPCS,Outpatient,,,1304,978,,1199.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,678.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1212.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1173.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1173.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1264.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1304,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,678.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1264.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,978,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1251.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,678.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,978,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,978,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,678.08,1304,
EXCISE MALIGNANT LESION FACE EARS EYELIDS NOSE LIPS 0.5CM/<,78000126G,CDM,510,RC,11640,HCPCS,Outpatient,,,771,578.25,,709.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,400.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,717.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,693.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,693.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,747.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,771,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,400.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,747.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,578.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,740.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,400.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,578.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,578.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,400.92,771,
EXCISE MALIGNANT LESN FACE EARS EYELIDS NOSE LIPS 0.6-1.0CM,78000128G,CDM,510,RC,11641,HCPCS,Outpatient,,,678,508.5,,623.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,630.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,610.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,610.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,678,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,657.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,650.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,352.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,508.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,352.56,678,
EXCISE MALIGNANT LESN FACE EARS EYELIDS NOSE LIPS 1.1-2.0CM,78000130G,CDM,510,RC,11642,HCPCS,Outpatient,,,716,537,,658.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,372.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,665.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,644.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,644.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,694.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,716,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,372.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,694.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,537,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,687.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,372.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,537,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,537,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,372.32,716,
DEBRIDEMENT NAIL ANY METHOD 1-5,78000138G,CDM,510,RC,11720,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,53.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.56,103,
AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE,78000142G,CDM,510,RC,11730,HCPCS,Outpatient,,,261,195.75,,240.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,135.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,242.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,234.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,234.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,253.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,261,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,135.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,253.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,195.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,250.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,135.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,195.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,195.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135.72,261,
AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL,78000144G,CDM,510,RC,11732,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,103.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.16,108,
EVACUATION SUBUNGUAL HEMATOMA,78000146G,CDM,510,RC,11740,HCPCS,Outpatient,,,152,114,,139.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,79.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,136.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,136.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,147.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,152,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,79.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,114,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,145.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,79.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,114,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.04,152,
WEDGE EXCISION SKIN NAIL FOLD,78000152G,CDM,510,RC,11765,HCPCS,Outpatient,,,377,282.75,,346.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,196.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,350.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,339.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,365.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,377,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,196.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,365.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,282.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,361.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,196.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,282.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,282.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,196.04,377,
INJECTION INTRALESIONAL UP TO  and  INCLUD 7 LESION,78000156G,CDM,510,RC,11900,HCPCS,Outpatient,,,165,123.75,,151.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,153.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,148.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,148.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,165,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,158.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,85.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,85.8,165,
SUBCUTANEOUS HORMONE PELLET IMPLANTATION,78002110G,CDM,510,RC,11980,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,193.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,187.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,187.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,201.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,208,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,199.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.16,208,
INSERT NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,78000160G,CDM,510,RC,11981,HCPCS,Outpatient,,,243,182.25,,223.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,126.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,218.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,218.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,235.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,243,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,126.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,235.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,182.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,233.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,126.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.36,243,
REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,78000162G,CDM,510,RC,11982,HCPCS,Outpatient,,,316,237,,290.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,164.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,293.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,284.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,284.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,306.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,316,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,164.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,237,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,303.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,164.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,237,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.32,316,
REMOVAL W/REINSERT NON-BIODEGRADABLE DRUG DELIVERY IMPLT,78000164G,CDM,510,RC,11983,HCPCS,Outpatient,,,319,239.25,,293.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,165.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,296.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,287.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,287.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,309.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,319,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,165.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,309.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,239.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,306.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,165.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,165.88,319,
SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 2.5CM/<,78000166G,CDM,510,RC,12001,HCPCS,Outpatient,,,360,270,,331.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,187.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,334.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,324,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,324,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,349.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,360,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,187.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,349.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,270,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,345.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,187.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,270,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,270,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,187.2,360,
SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 2.6-7.5CM,78000168G,CDM,510,RC,12002,HCPCS,Outpatient,,,387,290.25,,356.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,359.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,348.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,348.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,375.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,387,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,375.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,371.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,201.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,290.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.24,387,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 2.5CM/<,78000178G,CDM,510,RC,12011,HCPCS,Outpatient,,,377,282.75,,346.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,196.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,350.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,339.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,365.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,377,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,196.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,365.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,282.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,361.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,196.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,282.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,282.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,196.04,377,
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM,78000180G,CDM,510,RC,12013,HCPCS,Outpatient,,,400,300,,368,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,208,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,372,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,360,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,360,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,388,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,208,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,388,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,384,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,208,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,208,400,
REPAIR INTERMEDIATE SCALP UNDERARMS TRUNK ARM LEG 2.5 CM/<,78000194G,CDM,510,RC,12031,HCPCS,Outpatient,,,557,417.75,,512.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,289.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,518.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,501.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,501.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,540.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,557,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,289.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,540.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,417.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,534.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,289.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,417.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,417.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,289.64,557,
REPAIR INTERMEDIATE SCALP UNDERARMS TRUNK ARM LEG 2.6-7.5CM,78000196G,CDM,510,RC,12032,HCPCS,Outpatient,,,634,475.5,,583.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,329.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,589.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,570.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,570.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,614.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,634,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,329.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,614.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,475.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,608.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,329.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,475.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,475.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,329.68,634,
REPAIR INTERMEDIATE NECK HAND FEET GENITALS 2.5CM/<,78000206G,CDM,510,RC,12041,HCPCS,Outpatient,,,456,342,,419.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,237.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,424.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,410.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,410.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,442.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,456,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,237.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,442.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,342,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,437.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,237.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,342,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,456,
REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<,78000218G,CDM,510,RC,12051,HCPCS,Outpatient,,,536,402,,493.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,278.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,498.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,482.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,482.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,519.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,536,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,278.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,519.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,402,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,514.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,278.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,402,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,402,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,278.72,536,
REPAIR COMPLEX WOUND TRUNK 1.1-2.5 CM,78000232G,CDM,510,RC,13100,HCPCS,Outpatient,,,1006,754.5,,925.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,523.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,935.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,905.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,905.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,975.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1006,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,523.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,975.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,754.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,965.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,523.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,754.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,754.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,523.12,1006,
REPAIR COMPLEX WOUND TRUNK 2.6-7.5 CM,78000234G,CDM,510,RC,13101,HCPCS,Outpatient,,,1290,967.5,,1186.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,670.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1199.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1161,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1161,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1251.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1290,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,670.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1251.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,967.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1238.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,670.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,967.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,967.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,670.8,1290,
REPAIR COMPLEX WOUND SCALP ARM LEG 1.1-2.5 CM,78000238G,CDM,510,RC,13120,HCPCS,Outpatient,,,807,605.25,,742.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,419.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,750.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,726.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,726.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,782.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,807,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,419.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,782.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,605.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,774.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,419.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,605.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,605.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,419.64,807,
REPAIR COMPLEX WOUND SCALP ARM LEG 2.6-7.5 CM,78000240G,CDM,510,RC,13121,HCPCS,Outpatient,,,965,723.75,,887.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,501.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,897.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,868.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,868.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,936.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,965,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,501.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,936.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,723.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,926.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,501.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,723.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,723.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,501.8,965,
REPAIR COMPLEX WOUND SCALP ARM LEG EACH ADDL 5 CM/<,78000242G,CDM,510,RC,13122,HCPCS,Outpatient,,,448,336,,412.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,232.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,416.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,403.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,403.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,434.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,448,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,232.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,434.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,336,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,430.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,232.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,336,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,232.96,448,
REPAIR COMP FOREHEAD CHEEK CHIN MOUTH NECK HAND 2.6-7.5CM,78000246G,CDM,510,RC,13132,HCPCS,Outpatient,,,1067,800.25,,981.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,554.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,992.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,960.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,960.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1034.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1067,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,554.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1034.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,800.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1024.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,554.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,800.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,800.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,554.84,1067,
EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM,78000274G,CDM,510,RC,15116,HCPCS,Outpatient,,,1019,764.25,,937.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,947.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,917.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,917.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,988.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1019,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,988.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,978.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,529.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,764.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,529.88,1019,
SKIN GRAFT TRUNK ARM LEG UP TO 100SQCM 1ST 25 SQ CM,78000282G,CDM,510,RC,15271,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3415.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3526.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.96,3673,
DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE (LESS THAN 5%,78000304G,CDM,510,RC,16020,HCPCS,Outpatient,,,340,255,,312.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,176.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,316.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,306,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,306,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,329.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,340,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,176.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,255,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,326.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,176.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,255,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,255,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,176.8,340,
DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/SBSQ MEDIUM,78000306G,CDM,510,RC,16025,HCPCS,Outpatient,,,443,332.25,,407.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,411.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,398.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,398.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,429.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,443,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,429.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,425.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,230.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,332.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,230.36,443,
DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/SBSQ LARGE,78000308G,CDM,510,RC,16030,HCPCS,Outpatient,,,507,380.25,,466.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,263.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,471.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,456.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,456.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,491.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,507,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,263.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,491.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,486.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,263.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,380.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,263.64,507,
DESTRUCTION PREMALIGNANT LESION 1ST,78000310G,CDM,510,RC,17000,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,151,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,146.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.52,151,
DESTRUCTION PREMALIGNANT LESION 2 TO 14,78000312G,CDM,510,RC,17003,HCPCS,Outpatient,,,15,11.25,,13.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,7.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,13.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,13.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,14.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,7.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,14.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,11.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,7.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,7.8,15,
DESTRUCTION PREMALIGNANT LESION 15/>,78000314G,CDM,510,RC,17004,HCPCS,Outpatient,,,380,285,,349.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,197.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,353.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,342,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,342,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,368.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,380,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,197.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,368.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,285,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,364.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,197.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,285,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,285,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.6,380,
DESTRUCTION BENIGN LESIONS 15/>,78000318G,CDM,510,RC,17111,HCPCS,Outpatient,,,299,224.25,,275.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,278.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,269.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,269.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,290.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,299,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,287.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.48,299,
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE,78000320G,CDM,510,RC,17250,HCPCS,Outpatient,,,203,152.25,,186.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,188.79,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,203,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,196.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.56,203,
PUNCTURE ASPIRATION OF CYST OF BREAST,78002193G,CDM,510,RC,19000,HCPCS,Outpatient,,,772,579,,710.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,401.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,717.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,694.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,694.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,748.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,772,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,401.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,748.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,579,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,741.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,401.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,579,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,579,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,401.44,772,
BIOPSY MUSCLE PERCUTANEOUS NEEDLE,78000336G,CDM,510,RC,20206,HCPCS,Outpatient,,,1577,1182.75,,1450.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,820.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1466.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1419.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1419.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1529.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1577,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,820.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1529.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1182.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1513.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,820.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1182.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1182.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,820.04,1577,
INJECTION SINGLE TENDON ORIGIN/INSERTION,78000350G,CDM,510,RC,20551,HCPCS,Outpatient,,,250,187.5,,230,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,130,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,232.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,225,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,242.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,130,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,242.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,130,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,187.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130,250,
INJECTIONS OF TRIGGER POINTS IN 1 OR 2 MUSCLES,78000352G,CDM,510,RC,20552,HCPCS,Outpatient,,,458,343.5,,421.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,238.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,425.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,412.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,412.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,444.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,458,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,238.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,444.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,343.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,439.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,238.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,343.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,343.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.16,458,
INJECTIONS OF TRIGGER POINTS IN 3 OR MORE MUSCLES,78000354G,CDM,510,RC,20553,HCPCS,Outpatient,,,411,308.25,,378.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,382.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,369.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,398.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,411,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,398.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.72,411,
ARTHROCNT ASPIR/INJ SML JT/BURSAW/US REC RPRT,78000360G,CDM,510,RC,20604,HCPCS,Outpatient,,,358,268.5,,329.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,186.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,332.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,322.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,322.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,347.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,358,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,186.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,347.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,268.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,343.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,186.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,268.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.16,358,
ARTHROCENTESIS ASPIR/INJ INTERM JT/BURS W/US,78000366G,CDM,510,RC,20606,HCPCS,Outpatient,,,467,350.25,,429.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,242.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,434.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,420.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,420.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,452.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,467,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,242.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,452.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,350.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,448.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,242.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,350.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,350.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,242.84,467,
ARTHROCENTESIS ASPIRATION INJECTION MAJOR JT/BURSA W/O US,78000368G,CDM,510,RC,20610,HCPCS,Outpatient,,,552,414,,507.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,513.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,496.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,496.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,535.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,552,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,535.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,529.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,287.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,414,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,287.04,552,
ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA W/US,78000372G,CDM,510,RC,20611,HCPCS,Outpatient,,,585,438.75,,538.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,304.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,544.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,526.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,526.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,567.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,585,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,304.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,567.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,438.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,561.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,304.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,438.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,304.2,585,
ASPIRATION INJECTION GANGLION CYST ANY LOCATION,78000374G,CDM,510,RC,20612,HCPCS,Outpatient,,,180,135,,165.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,180,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.6,180,
INCISION  DRAIN DEEP ABSC/HEMATOMA SOFT TISS NECK THORAX,78000394G,CDM,510,RC,21501,HCPCS,Outpatient,,,4226,3169.5,,3887.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2197.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3930.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3803.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3803.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4099.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4226,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2197.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4099.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4056.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2197.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2197.52,4226,
EXCISION TUMOR SOFT TISSUE NECK ANTERIOR THORAX SUBQ <3CM,78000396G,CDM,510,RC,21555,HCPCS,Outpatient,,,3504,2628,,3223.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1822.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3258.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3153.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3153.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3398.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3504,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1822.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3398.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2628,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3363.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1822.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2628,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2628,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1822.08,3504,
CLOSED TX VERT BODY FX W/O MANIP REQUIRES CASTING OR BRACING,78000406G,CDM,510,RC,22310,HCPCS,Outpatient,,,698,523.5,,642.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,649.14,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,628.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,628.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,677.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,698,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,677.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,670.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,362.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,523.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,362.96,698,
CLOSED TX CLAVICULAR FRACTURE W/O MANIPULATION,78000449G,CDM,510,RC,23500,HCPCS,Outpatient,,,505,378.75,,464.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,262.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,469.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,454.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,454.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,489.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,505,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,262.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,489.85,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,378.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,484.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,262.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,378.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,378.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.6,505,
CLOSED TX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION,78000466G,CDM,510,RC,23600,HCPCS,Outpatient,,,759,569.25,,698.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,705.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,683.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,683.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,736.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,759,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,736.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,728.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.68,759,
CLOSED TX GREATER HUMERAL TUBEROSITY FX W/O MANIP,78000472G,CDM,510,RC,23620,HCPCS,Outpatient,,,616,462,,566.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,320.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,572.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,554.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,554.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,597.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,616,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,320.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,597.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,462,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,591.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,320.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,462,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,462,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,320.32,616,
CLOSED TX HUMERAL SHAFT FRACTURE W/O MANIPULATION,78000516G,CDM,510,RC,24500,HCPCS,Outpatient,,,823,617.25,,757.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,427.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,765.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,740.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,740.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,798.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,823,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,427.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,798.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,617.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,790.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,427.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,617.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,617.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,427.96,823,
CLOSED TX RADIAL HEAD SUBLXTJ CHLD NURSEMAID ELBOW W/MANIP,78000548G,CDM,510,RC,24640,HCPCS,Outpatient,,,411,308.25,,378.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,382.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,369.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,398.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,411,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,398.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,213.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,308.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.72,411,
CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANIP,78000556G,CDM,510,RC,24670,HCPCS,Outpatient,,,666,499.5,,612.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,346.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,619.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,599.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,599.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,646.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,666,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,346.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,646.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,499.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,639.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,346.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,499.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,499.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,346.32,666,
CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION,78000601G,CDM,510,RC,25500,HCPCS,Outpatient,,,648,486,,596.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,336.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,602.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,583.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,583.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,628.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,648,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,336.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,628.56,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,486,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,622.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,336.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,486,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,486,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336.96,648,
CLOSED TX DISTAL RADIAL FX/EPIPHYSL SEP W/O MANIP,78000624G,CDM,510,RC,25600,HCPCS,Outpatient,,,771,578.25,,709.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,400.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,717.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,693.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,693.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,747.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,771,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,400.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,747.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,578.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,740.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,400.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,578.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,578.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,400.92,771,
CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANIP,78000635G,CDM,510,RC,25622,HCPCS,Outpatient,,,700,525,,644,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,364,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,651,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,630,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,630,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,679,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,700,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,364,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,679,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,525,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,672,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,364,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,525,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,525,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,364,700,
CLOSED TREATMENT ULNAR STYLOID FRACTURE,78000639G,CDM,510,RC,25650,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,391.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,699.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,676.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,676.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,729.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,752,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,391.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,729.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,564,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,721.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,391.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,564,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,564,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,391.04,752,
CLOSED TX METACARPAL FX W/O MANIPULATION EACH BONE,78000702G,CDM,510,RC,26600,HCPCS,Outpatient,,,685,513.75,,630.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,356.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,637.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,616.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,616.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,664.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,685,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,356.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,664.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,513.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,657.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,356.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,513.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,513.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,356.2,685,
CLOSED TX METACARPAL FX W/MANIP W/XTRNL FIXATION EACH BONE,78000706G,CDM,510,RC,26607,HCPCS,Outpatient,,,1158,868.5,,1065.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,602.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1076.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1042.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1042.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1123.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1158,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,602.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1123.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,868.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1111.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,602.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,868.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,868.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,602.16,1158,
CLOSED TX PHALANGEAL FX PROX/MIDDLE FINGER THUMB W/O MANP EA,78000726G,CDM,510,RC,26720,HCPCS,Outpatient,,,455,341.25,,418.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,236.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,423.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,409.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,409.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,441.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,455,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,236.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,441.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,341.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,436.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,236.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,341.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,341.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.6,455,
CLOSED TX DISTAL PHLNGL FX FINGR OR THUMB W/O MANIP EACH,78000736G,CDM,510,RC,26750,HCPCS,Outpatient,,,425,318.75,,391,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,395.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,382.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,382.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,412.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,425,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,412.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,408,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,221,425,
CLOSED TX DISTAL PHALANGEAL FX FINGER THUMB W/MANIP EA,78000738G,CDM,510,RC,26755,HCPCS,Outpatient,,,438,328.5,,402.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,407.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,394.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,438,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,424.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,420.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,227.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,328.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.76,438,
INJECT SACROLIAC JOINT FOR ANESTH/STEROID,78000764G,CDM,510,RC,27096,HCPCS,Outpatient,,,369,276.75,,339.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,191.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,343.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,332.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,332.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,357.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,369,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,191.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,357.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,276.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,354.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,191.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,276.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,191.88,369,
CLOSED TREATMENT COCCYGEAL FRACTURE,78000774G,CDM,510,RC,27200,HCPCS,Outpatient,,,284,213,,261.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,147.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,264.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,255.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,255.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,275.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,284,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,147.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,275.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,213,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,147.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,213,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.68,284,
CLOSED TX GREATER TROCHANTERIC FX W/O MANIP,78000791G,CDM,510,RC,27246,HCPCS,Outpatient,,,882,661.5,,811.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,458.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,820.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,793.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,793.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,855.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,882,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,458.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,855.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,661.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,846.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,458.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,661.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,661.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,458.64,882,
ClOSED TX TIBIAL FX PROXIMAL W/O MANIPULATION,78000896G,CDM,510,RC,27530,HCPCS,Outpatient,,,702,526.5,,645.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,365.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,652.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,631.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,631.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,680.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,702,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,365.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,680.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,526.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,673.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,365.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,526.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,526.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,365.04,702,
CLOSED TX TIBIAL SHAFT FX W/O MANIPULATION,78000963G,CDM,510,RC,27750,HCPCS,Outpatient,,,789,591.75,,725.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,410.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,733.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,710.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,710.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,765.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,789,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,410.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,765.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,591.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,757.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,410.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,591.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,591.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,410.28,789,
CLOSED TX MEDIAL MALLEOLUS FX W/O MANIPULATION,78000974G,CDM,510,RC,27760,HCPCS,Outpatient,,,756,567,,695.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,393.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,703.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,680.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,680.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,733.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,756,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,393.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,733.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,567,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,725.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,393.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,567,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,567,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.12,756,
CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP,78000979G,CDM,510,RC,27767,HCPCS,Outpatient,,,665,498.75,,611.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,345.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,618.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,598.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,598.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,645.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,665,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,345.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,645.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,498.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,638.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,345.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,498.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,498.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,345.8,665,
CLOSED TX DISTAL FIBULAR FX LATERAL MALLS W/O MANIP,78000989G,CDM,510,RC,27786,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,664.95,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,643.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,643.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,693.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,715,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,693.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,686.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,371.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,536.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,371.8,715,
CLOSED TX TALUS FRACTURE W/O MANIPULATION,78001099G,CDM,510,RC,28430,HCPCS,Outpatient,,,544,408,,500.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,282.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,505.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,489.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,489.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,527.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,544,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,282.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,527.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,408,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,522.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,282.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,408,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,408,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,282.88,544,
CLOSED TX METATARSAL FRACTURE W/O MANIPULATION,78001106G,CDM,510,RC,28470,HCPCS,Outpatient,,,493,369.75,,453.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,256.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,458.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,443.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,443.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,478.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,493,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,256.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,478.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,369.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,473.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,256.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,369.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,369.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,256.36,493,
CLOSED TX FX GREAT TOE PHLX/PHLG W/MANIP,78001114G,CDM,510,RC,28495,HCPCS,Outpatient,,,449,336.75,,413.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,233.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,417.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,404.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,404.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,435.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,449,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,233.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,435.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,336.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,431.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,233.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,336.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,233.48,449,
CLOSED TX FX PHALANX OR PHALANGES NOT GREAT TOE W/O MANIP,78001118G,CDM,510,RC,28510,HCPCS,Outpatient,,,297,222.75,,273.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,154.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,276.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,267.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,267.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,288.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,297,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,154.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,288.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,222.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,285.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,154.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,222.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.44,297,
APPLICATION CAST SHOULDER HAND LONG ARM,78001148G,CDM,510,RC,29065,HCPCS,Outpatient,,,243,182.25,,223.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,126.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,218.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,218.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,235.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,243,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,126.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,235.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,182.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,233.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,126.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,182.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.36,243,
APPLICATION OF CAST ELBOW TO FINGER (SHORT ARM),78001150G,CDM,510,RC,29075,HCPCS,Outpatient,,,223,167.25,,205.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,200.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,200.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,216.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,223,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.96,223,
APPLICATION CAST HAND  LOWER FOREARM GAUNTLET,78001152G,CDM,510,RC,29085,HCPCS,Outpatient,,,145,108.75,,133.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75.4,145,
APPLICATION LONG ARM SPLINT SHOULDER HAND,78001156G,CDM,510,RC,29105,HCPCS,Outpatient,,,312,234,,287.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,312,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,302.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,299.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,162.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,162.24,312,
APPLY SHORT ARM SPLINT FOREARM-HAND STATIC,78001158G,CDM,510,RC,29125,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,288,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.76,288,
APPLICATION FINGER SPLINT STATIC,78001160G,CDM,510,RC,29130,HCPCS,Outpatient,,,213,159.75,,195.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,110.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,198.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,191.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,191.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,206.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,110.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,206.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,159.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,204.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,110.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,159.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,159.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,110.76,213,
APPLICATION LONG LEG CAST THIGH-TOE,78001174G,CDM,510,RC,29345,HCPCS,Outpatient,,,302,226.5,,277.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,157.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,280.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,271.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,271.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,292.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,302,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,157.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,226.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,289.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,157.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,226.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,157.04,302,
APPLICATION SHORT LEG CAST BELOW KNEE-TOE,78001176G,CDM,510,RC,29405,HCPCS,Outpatient,,,251,188.25,,230.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,130.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,233.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,225.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,243.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,251,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,130.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,243.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,188.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,130.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,188.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130.52,251,
APPLICATION SHORT LEG CAST WALKING/AMBULATORY,78001178G,CDM,510,RC,29425,HCPCS,Outpatient,,,517,387.75,,475.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,480.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,465.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,517,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,501.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,496.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,268.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,387.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,268.84,517,
APPLICATION RIGID TOTAL CONTACT LEG CAST,78001182G,CDM,510,RC,29445,HCPCS,Outpatient,,,285,213.75,,262.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,256.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,256.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,276.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,285,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,276.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,148.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.2,285,
STRAPPING UNNA BOOT,78001196G,CDM,510,RC,29580,HCPCS,Outpatient,,,309,231.75,,284.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,287.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,278.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,278.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,299.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,309,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,299.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,296.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,160.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,231.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,160.68,309,
REMOVAL FOREIGN BODY INTRANASAL,78001249G,CDM,510,RC,30300,HCPCS,Outpatient,,,189,141.75,,173.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,175.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.28,189,
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE UNILATERAL,78001251G,CDM,510,RC,30901,HCPCS,Outpatient,,,361,270.75,,332.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,335.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,324.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,324.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,350.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,361,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,350.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,346.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,187.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,270.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,187.72,361,
PERCUTANEOUS DRAINAGE PLEURA INSERT CATH W/O IMAGING,78001282G,CDM,510,RC,32556,HCPCS,Outpatient,,,1752,1314,,1611.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1629.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1576.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1576.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1699.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1752,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1699.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1681.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,911.04,1752,
COLLECTION VENOUS BLOOD VENIPUNCTURE,78001297,CDM,300,RC,36415,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.6,30,
COLLECTION CAPILLARY BLOOD SPECIMEN,78001299,CDM,510,RC,36416,HCPCS,Outpatient,,,17,12.75,,15.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,8.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,16.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,8.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,12.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,8.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,12.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.84,17,
INJECTION NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN,78001305G,CDM,510,RC,36465,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3415.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3526.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.96,3673,
INJECTION NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS,78001307G,CDM,510,RC,36466,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3415.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3526.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.96,3673,
ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,78001326G,CDM,510,RC,36478,HCPCS,Outpatient,,,4486,3364.5,,4127.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2332.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4171.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4037.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4037.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4351.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4486,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2332.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4351.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4306.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2332.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3364.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2332.72,4486,
ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VNS,78001328G,CDM,510,RC,36479,HCPCS,Outpatient,,,1814,1360.5,,1668.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,943.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1687.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1632.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1632.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1759.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1814,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,943.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1759.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1360.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1741.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,943.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1360.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1360.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,943.28,1814,
REMOVE TUNNELED CTR VAD W/SUBQ PORT/PUMP,78001332G,CDM,510,RC,36590,HCPCS,Outpatient,,,2318,1738.5,,2132.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1205.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2155.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2086.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2086.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2248.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2318,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1205.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2248.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1738.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2225.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1205.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1738.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1738.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1205.36,2318,
BIOPSY OF LIP,78001362G,CDM,510,RC,40490,HCPCS,Outpatient,,,277,207.75,,254.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,257.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,277,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,268.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,265.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,144.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,207.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.04,277,
INCISION THROMBOSED HEMORRHOID EXTERNAL,78001462G,CDM,510,RC,46083,HCPCS,Outpatient,,,482,361.5,,443.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,250.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,448.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,433.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,433.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,467.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,482,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,250.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,467.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,361.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,462.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,250.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,361.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,361.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,250.64,482,
EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS,78001464G,CDM,510,RC,46220,HCPCS,Outpatient,,,578,433.5,,531.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,300.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,537.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,520.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,520.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,560.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,578,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,300.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,560.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,433.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,554.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,300.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,433.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,433.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,300.56,578,
INSERT NON-INDWELLING BLADDER CATHETER,78001532G,CDM,510,RC,51701,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
INSERT TEMP INDWELLING BLADDER CATHETER SIMPLE,78001534G,CDM,510,RC,51702,HCPCS,Outpatient,,,217,162.75,,199.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,112.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,195.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,195.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,210.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,217,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,112.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,162.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,208.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,112.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,162.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,162.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.84,217,
MEAS POST-VOIDING RESIDUAL URINE/BLADDER CAP,78001540,CDM,510,RC,51798,HCPCS,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.13,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,149,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.13,149,
CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK,78001546G,CDM,510,RC,54150,HCPCS,Outpatient,,,576,432,,529.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,535.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,518.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,518.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,558.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,576,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,558.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,552.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,299.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,432,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,299.52,576,
CIRCUMCISION AGE >28 DAYS,78001548G,CDM,510,RC,54161,HCPCS,Outpatient,,,2782,2086.5,,2559.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1446.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2587.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2503.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2503.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2698.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2782,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1446.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2698.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2086.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2670.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1446.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2086.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2086.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1446.64,2782,
VASECTOMY W/POSTOP SEMEN EXAMS,78001556G,CDM,510,RC,55250,HCPCS,Outpatient,,,759,569.25,,698.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,705.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,683.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,683.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,736.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,759,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,736.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,728.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,394.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,569.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,394.68,759,
DESTRUCTION LESIONS VULVA SIMPLE,78001563G,CDM,510,RC,56501,HCPCS,Outpatient,,,737,552.75,,678.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,383.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,685.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,663.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,663.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,714.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,737,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,383.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,714.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,552.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,707.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,383.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,552.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,552.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,383.24,737,
BIOPSY VULVA/PERINEUM 1 LESION,78001567G,CDM,510,RC,56605,HCPCS,Outpatient,,,219,164.25,,201.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,203.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,219,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.88,219,
BIOPSY VULVA/PERINEUM EACH ADDL LESION,78001569G,CDM,510,RC,56606,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,77.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,83.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,44.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.72,86,
FIT AND INSERTION OF VAGINAL SUPPORT DEVICE,78001578G,CDM,510,RC,57160,HCPCS,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,87.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,156.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,151.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,151.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,168,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,87.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,162.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,126,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,161.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,87.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.36,168,
DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS,78001580G,CDM,510,RC,57170,HCPCS,Outpatient,,,177,132.75,,162.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,92.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,164.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,159.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,159.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,171.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,177,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,92.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,171.69,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,132.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,169.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,92.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.04,177,
COMBINED ANTEROPOSTERIOR COLPORRHAPHY,78001585G,CDM,510,RC,57260,HCPCS,Outpatient,,,1744,1308,,1604.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,906.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1621.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1569.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1569.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1691.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1744,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,906.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1691.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1308,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1674.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,906.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1308,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1308,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,906.88,1744,
COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX,78001588G,CDM,510,RC,57421,HCPCS,Outpatient,,,400,300,,368,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,208,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,372,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,360,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,360,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,388,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,208,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,388,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,384,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,208,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,300,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,208,400,
COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA,78001590G,CDM,510,RC,57452,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,265.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,286,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,277.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,274.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,148.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.72,286,
COLPOSCOPY CERVIX BX CERVIX  and  ENDO CURRETAGE,78001592G,CDM,510,RC,57454,HCPCS,Outpatient,,,382,286.5,,351.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,198.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,355.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,343.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,343.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,370.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,382,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,198.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,370.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,286.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,366.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,198.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,286.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,286.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,198.64,382,
COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX,78001594G,CDM,510,RC,57460,HCPCS,Outpatient,,,725,543.75,,667,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,377,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,674.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,652.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,652.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,703.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,725,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,377,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,703.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,543.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,696,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,377,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,543.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,543.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,377,725,
BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESN SPX,78001596G,CDM,510,RC,57500,HCPCS,Outpatient,,,356,267,,327.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,185.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,345.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,356,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,185.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,345.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,267,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,341.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,185.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,267,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.12,356,
CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT,78001598G,CDM,510,RC,57511,HCPCS,Outpatient,,,459,344.25,,422.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,238.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,426.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,413.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,413.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,445.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,459,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,238.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,445.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,344.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,440.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,238.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,344.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,344.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.68,459,
CONIZATION CERVIX W/WO D and C REPAIR ELTRD EXC,78001601G,CDM,510,RC,57522,HCPCS,Outpatient,,,689,516.75,,633.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,358.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,640.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,620.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,620.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,668.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,689,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,358.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,668.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,516.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,661.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,358.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,516.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,516.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,358.28,689,
ENDOMETRIAL SAMPLING W/O CERVICAL DILATION,78001604G,CDM,510,RC,58100,HCPCS,Outpatient,,,232,174,,213.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,222.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,120.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.64,232,
ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY,78001606G,CDM,510,RC,58110,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.72,111,
INSERTION INTRAUTERINE DEVICE IUD,78001619G,CDM,510,RC,58300,HCPCS,Outpatient,,,255,191.25,,234.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,237.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,255,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.6,255,
REMOVAL INTRAUTERINE DEVICE IUD,78001621G,CDM,510,RC,58301,HCPCS,Outpatient,,,251,188.25,,230.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,130.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,233.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,225.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,243.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,251,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,130.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,243.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,188.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,130.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,188.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130.52,251,
FETAL CONTRACTION STRESS TEST,78001658G,CDM,510,RC,59020,HCPCS,Outpatient,,,457,342.75,,420.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,237.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,425.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,411.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,411.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,443.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,457,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,237.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,443.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,342.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,438.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,237.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,342.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.64,457,
FETAL NONSTRESS TEST,78001660G,CDM,510,RC,59025,HCPCS,Outpatient,,,371,278.25,,341.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,192.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,345.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,359.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,371,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,192.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,359.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,278.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,356.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,192.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,278.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,278.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192.92,371,
ANTEPARTUM CARE ONLY 4-6 VISITS,78001680G,CDM,510,RC,59425,HCPCS,Outpatient,,,1244,933,,1144.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,646.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1156.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1119.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1119.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1206.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1244,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,646.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1206.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,933,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1194.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,646.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,933,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,933,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,646.88,1244,
ANTEPARTUM CARE ONLY 7/> VISITS,78001682G,CDM,510,RC,59426,HCPCS,Outpatient,,,2273,1704.75,,2091.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1181.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2113.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2045.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2045.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2204.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2273,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1181.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2204.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1704.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2182.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1181.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1704.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1704.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1181.96,2273,
INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE,78001722G,CDM,510,RC,64405,HCPCS,Outpatient,,,656,492,,603.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,341.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,610.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,590.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,590.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,636.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,656,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,341.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,636.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,492,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,629.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,341.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,492,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,492,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,341.12,656,
INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE,78001736G,CDM,510,RC,64445,HCPCS,Outpatient,,,1299,974.25,,1195.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,675.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1208.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1169.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1169.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1260.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1299,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,675.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1260.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,974.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1247.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,675.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,974.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,974.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,675.48,1299,
INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,78001738G,CDM,510,RC,64450,HCPCS,Outpatient,,,853,639.75,,784.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,793.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,767.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,767.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,827.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,853,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,827.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,818.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,443.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,639.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,443.56,853,
INCISIONAL BIOPSY EYELID SKIN  and  LID MARGIN,78001809G,CDM,510,RC,67810,HCPCS,Outpatient,,,422,316.5,,388.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,219.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,392.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,379.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,379.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,409.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,422,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,219.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.34,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,316.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,405.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,219.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,316.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,219.44,422,
DRAINAGE EXTERNAL EAR ABSCESS SIMPLE,78002850G,CDM,510,RC,69000,HCPCS,Outpatient,,,1947,1460.25,,1791.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1012.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1810.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1752.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1752.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1888.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1947,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1012.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1888.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1460.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1869.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1012.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1460.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1460.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1012.44,1947,
REMOVAL FB EXTERNAL AUDITORY CANAL W/O ANES,78001817G,CDM,510,RC,69200,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE UNI,78001819,CDM,510,RC,69209,HCPCS,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,149,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.48,149,
REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,78001820G,CDM,510,RC,69210,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
REMOVAL IMPACTED CERUMEN INSTRUMENTATION BILATERAL,78002890G,CDM,510,RC,69210,HCPCS,Outpatient,,,174,130.5,,160.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,161.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,168.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,174,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,168.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,167.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90.48,174,
"Removal impacted cerumen requiring instrumentation, unilater",78001820G,CDM,510,RC,69210,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,72600012,CDM,402,RC,76801,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.16,233,
US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATN,72600014,CDM,402,RC,76805,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.16,233,
HEMOGLOBIN HGB,70200572,CDM,300,RC,85018,HCPCS,Outpatient,,,64,48,,58.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.28,64,
TB SKIN TEST TUBERCULOSIS INTRADERMAL,70200748,CDM,300,RC,86580,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.84,42,
INFLUENZA A&B ID NOW,70200981,CDM,300,RC,87804,HCPCS,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.84,142,
IMMUNIZATION FIRST VACCINE/TOXOID THRU 18 YR,78001824,CDM,771,RC,90460,HCPCS,Outpatient,,,21.71,16.28,,19.97,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.29,21.71,
IMMUNIZATION FIRST VACCINE/TOXOID THRU 18 YR,78001824,CDM,771,RC,90460,HCPCS,Outpatient,,,21.71,16.28,,19.97,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.29,21.71,
IMMUNIZATION EA ADD'L VACCINE/TOXOID THRU 18 YR,78001825,CDM,771,RC,90461,HCPCS,Outpatient,,,21.71,16.28,,19.97,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.29,21.71,
IMMUNIZATION EA ADD'L VACCINE/TOXOID THRU 18 YR,78001825,CDM,771,RC,90461,HCPCS,Outpatient,,,21.71,16.28,,19.97,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.29,21.71,
IMMUNIZATION ADMINISTRATION ONE VACCINE,78001826,CDM,771,RC,90471,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,293.79,
IMMUNIZATION ADMIN BY INTRANASAL OR ORAL,78001828,CDM,771,RC,90473,HCPCS,Outpatient,,,83,62.25,,76.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,74.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,74.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,
IMMUNIZATION ADMINISTRATION ORAL/NASAL EACH ADDITIONAL,78002352,CDM,771,RC,90474,HCPCS,Outpatient,,,60,45,,55.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.2,60,
AMB PCV15 PNEUMOCOCCAL CONJUGATE VACCINE IM,78002189,CDM,636,RC,90671,HCPCS,Outpatient,,,800.72,600.54,,736.66,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,416.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,744.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,720.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,720.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,776.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,800.72,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,416.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,776.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,600.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,768.69,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,416.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,600.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,600.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,416.37,800.72,
RABIES VACCINE FOR INTRAMUSCULAR USE,78002169,CDM,636,RC,90675,HCPCS,Outpatient,,,1910.36,1432.77,,1757.53,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,993.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1776.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1719.32,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1719.32,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1853.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1910.36,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,993.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1853.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1432.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1833.95,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,993.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1432.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1432.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,293.79,1910.36,
AMB AREXY RESPIRATORY SYNCYTIAL VIRUS VACCINE IM,78002194,CDM,636,RC,90679,HCPCS,Outpatient,,,1008,756,,927.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,937.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,907.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,907.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,977.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1008,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,977.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,967.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,1008,
ECG ROUTINE ECG W/LEAST 12 LDS W/I and R,78001838G,CDM,730,RC,93000,HCPCS,Outpatient,,,237,177.75,,218.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,220.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,229.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,237,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.24,237,
ECG ROUTINE W/LEAST 12 LDS TRCG ONLY W/O I and R,78001840,CDM,730,RC,93005,HCPCS,Outpatient,,,237,177.75,,218.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,220.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,229.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,237,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.24,237,
EXTERNAL ECG RECORDING FOR > 48 HOURS UP TO 7 DAYS  CONNECTI,78002845,CDM,730,RC,93242,HCPCS,Outpatient,,,85,63.75,,78.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,44.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,76.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,76.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,82.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,44.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,63.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,44.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.2,85,
EXTERNAL ECG RECORDING FOR >7 DAYS UP TO 15 DAYS CONNECTION,78002847,CDM,730,RC,93246,HCPCS,Outpatient,,,144,108,,132.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,144,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,144,
UPPER/LWR PHYSILGC STUDIES OF ARTERIES 1-2 LVLS,72600040G,CDM,921,RC,93922,HCPCS,Outpatient,,,242,181.5,,222.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,217.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,217.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,234.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,242,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,234.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,232.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,125.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,125.84,242,
NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVELS,72600047G,CDM,921,RC,93923,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.16,233,
US SCAN XTR VEINS COMPLETE BILATERAL STUDY,72600043G,CDM,921,RC,93970,HCPCS,Outpatient,,,1865,1398.75,,1715.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,969.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1734.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1678.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1678.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1809.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1865,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,969.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1809.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1398.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1790.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,969.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1398.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1398.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,969.8,1865,
US SCAN XTR VEINS UNILATERAL/LIMITED STUDY,72600044G,CDM,921,RC,93971,HCPCS,Outpatient,,,1350,1012.5,,1242,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,702,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1255.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1215,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1215,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1309.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,702,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1309.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1012.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1296,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,702,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1012.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1012.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,702,1350,
SPIROMETRY W/VITAL CAPACITY EXPIRATORY FLO W/WO MXML VOL,78001844G,CDM,510,RC,94010,HCPCS,Outpatient,,,299,224.25,,275.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,278.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,269.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,269.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,290.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,299,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,290.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,287.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,155.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.48,299,
BRONCHO DILATOR RESPONSE SPIROMETRY PRE  and  POST,78001846G,CDM,510,RC,94060,HCPCS,Outpatient,,,696,522,,640.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,361.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,647.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,626.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,626.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,675.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,696,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,361.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,675.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,522,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,668.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,361.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,522,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,522,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,361.92,696,
PULMONARY STRESS TESTING 6-MINUTE WALK,74000004,CDM,510,RC,94618,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT,74000005,CDM,510,RC,94640,HCPCS,Outpatient,,,145,108.75,,133.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75.4,145,
PULSE OXIMETRY SINGLE DETERMINATION,74000013,CDM,510,RC,94760,HCPCS,Outpatient,,,60,45,,55.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.2,60,
PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS,78001848G,CDM,510,RC,95004,HCPCS,Outpatient,,,23,17.25,,21.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,11.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.96,23,
ALLERGY TEST WITH DRUG/BIOLOGICALS W/INTERP  and  REPORT,78001850G,CDM,510,RC,95018,HCPCS,Outpatient,,,57,42.75,,52.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.29,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,54.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.64,57,
INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS,78001852G,CDM,510,RC,95024,HCPCS,Outpatient,,,19,14.25,,17.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,9.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,9.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,14.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,9.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,14.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9.88,19,
INJECTION ALLERGEN 1,78001854,CDM,510,RC,95115,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,35,
INJECTION ALLERGEN 2 OR MORE,78001855,CDM,510,RC,95117,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.36,43,
PREPARATION  and  ALLERGEN IMMUNOTHERAPY,78001856G,CDM,510,RC,95165,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,35,
SLEEP STUDY AIRFLOW HRT RATE and O2 SAT EFFORT UNATT,74100002G,CDM,740,RC,95806,HCPCS,Outpatient,,,342,256.5,,314.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,177.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,307.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,307.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,331.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,342,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,177.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,256.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,328.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,177.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,256.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,256.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.84,342,
CANALITH REPOSITIONING PROCEDURE,78001859G,CDM,510,RC,95992,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,120,
INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,66100019,CDM,510,RC,96360,HCPCS,Outpatient,,,413,309.75,,379.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,214.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,384.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,371.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,371.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,400.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,413,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,214.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,400.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,309.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,396.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,214.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,309.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,309.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.76,413,
INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,66100019,CDM,510,RC,96360,HCPCS,Outpatient,,,413,309.75,,379.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,214.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,384.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,371.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,371.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,400.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,413,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,214.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,400.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,309.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,396.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,214.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,309.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,309.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.76,413,
INFUSION HYDRATION EACH ADDITIONAL HOUR,66100020,CDM,510,RC,96361,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
INFUSION HYDRATION EACH ADDITIONAL HOUR,66100020,CDM,510,RC,96361,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
INFUSION FIRST DRUG INITIAL HOUR,66100021,CDM,510,RC,96365,HCPCS,Outpatient,,,581,435.75,,534.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,302.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,540.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,522.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,522.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,563.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,581,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,302.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,563.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,435.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,557.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,302.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,435.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,435.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,302.12,581,
INFUSION EACH ADDITIONAL HOUR,66100022,CDM,510,RC,96366,HCPCS,Outpatient,,,223,167.25,,205.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,200.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,200.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,216.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,223,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,115.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,167.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.96,223,
INFUSION ADDL SEQUENTIAL NEW DRUG FIRST HOUR,66100023,CDM,510,RC,96367,HCPCS,Outpatient,,,133,99.75,,122.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,123.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,127.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.16,133,
INFUSION IV CONCURRENT,66100024,CDM,510,RC,96368,HCPCS,Outpatient,,,410,307.5,,377.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,381.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,369,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,369,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,397.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,410,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,397.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,393.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,213.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,307.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,213.2,410,
CLINIC INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
INJECTION INTRA-ARTERIAL,66100026,CDM,510,RC,96373,HCPCS,Outpatient,,,287,215.25,,264.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,266.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,258.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,278.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,287,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,278.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,275.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.24,287,
INJECTION IV PUSH SINGLE OR INITIAL DRUG,66100027,CDM,510,RC,96374,HCPCS,Outpatient,,,287,215.25,,264.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,266.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,258.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,278.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,287,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,278.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,275.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,215.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.24,287,
INJECTION IV PUSH EACH NEW DRUG,66100028,CDM,510,RC,96375,HCPCS,Outpatient,,,214,160.5,,196.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,111.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,192.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,192.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,207.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,214,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,111.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,160.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,205.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,111.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,160.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.28,214,
INJECTION IV PUSH EACH NEW DRUG,66100028,CDM,510,RC,96375,HCPCS,Outpatient,,,214,160.5,,196.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,111.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,192.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,192.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,207.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,214,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,111.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,207.58,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,160.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,205.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,111.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,160.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,160.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.28,214,
INJECTION EACH ADD'L SEQ IV PUSH SAME DRUG,66100029,CDM,510,RC,96376,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,158.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,163,
IRRIGATION IMPLNTD VENOUS ACCESS DRUG DLVRY SYS,66100036,CDM,510,RC,96523,HCPCS,Outpatient,,,144,108,,132.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,144,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,144,
DEBRIDEMENT OPEN WOUND 20 SQ CM/<,78001862G,CDM,510,RC,97597,HCPCS,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,337.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,363,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,352.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,348.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.76,363,
DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM,78001864G,CDM,510,RC,97598,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,315,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,350,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,182,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,182,350,
REMOVAL DEVITALIZD TISS N-SLCTV DBRDMT W/O ANES,78001866G,CDM,510,RC,97602,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,197.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,107.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.12,206,
NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQCM,78001867G,CDM,510,RC,97605,HCPCS,Outpatient,,,269,201.75,,247.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,250.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,242.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,242.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,260.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,269,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,260.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,258.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,139.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.88,269,
NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM,78001869G,CDM,510,RC,97606,HCPCS,Outpatient,,,420,315,,386.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,390.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,378,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,378,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,407.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,420,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,407.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,403.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,218.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,315,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,218.4,420,
NEGATIVE PRESSURE WOUND THERAPY NON DME </= 50 SQ CM,78001871G,CDM,510,RC,97607,HCPCS,Outpatient,,,874,655.5,,804.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,812.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,786.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,786.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,847.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,874,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,847.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,839.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,454.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,655.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,454.48,874,
NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM,78001873G,CDM,510,RC,97608,HCPCS,Outpatient,,,546,409.5,,502.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,507.78,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,491.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,546,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,529.62,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,283.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,409.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,283.92,546,
OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS,78001875G,CDM,510,RC,98925,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,
OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS,78001877G,CDM,510,RC,98926,HCPCS,Outpatient,,,99,74.25,,91.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,51.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,92.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,96.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,51.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,96.03,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,74.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,95.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,51.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.48,99,
OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS,78001879G,CDM,510,RC,98927,HCPCS,Outpatient,,,130,97.5,,119.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,124.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.6,130,
OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS,78001881G,CDM,510,RC,98928,HCPCS,Outpatient,,,159,119.25,,146.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,159,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.68,159,
OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS,78001883G,CDM,510,RC,98929,HCPCS,Outpatient,,,189,141.75,,173.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,175.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183.33,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,98.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,141.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.28,189,
EDUCATION  and  TRAIN FOR PATIENT SELF MANAGEMENT,74300027,CDM,510,RC,98960,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,70.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,39.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.52,76,
PHLEBOTOMY THERAPEUTIC,70201080,CDM,300,RC,99195,HCPCS,Outpatient,,,139,104.25,,127.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.28,139,
COMPLEX CHRONIC CARE MANAGEMENT SVC 1ST 60 MIN,78002016G,CDM,510,RC,99487,HCPCS,Outpatient,,,295,221.25,,271.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,153.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,274.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,265.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,265.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,286.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,295,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,153.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,286.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,221.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,283.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,153.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,221.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,221.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.4,295,
APPOINTMENT CANCELLATION/NO SHOW FEE,78002855,CDM,510,RC,99999,HCPCS,Outpatient,,,50,37.5,,46,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,46.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,48.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26,50,
INJECTION ALLERGEN 2 OR MORE,78001855,CDM,510,RC,95117,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.36,43,
INJECTION ALLERGEN 1,78001854,CDM,510,RC,95115,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,35,
BILIRUBIN TOTAL TRANSCUTANEOUS,70201066,CDM,300,RC,88720,HCPCS,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,10.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,20,
RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET,78002114,CDM,300,RC,87637,HCPCS,Outpatient,,,452,339,,415.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,235.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,420.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,406.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,406.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,438.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,452,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,235.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,438.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,339,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,433.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,235.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,339,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,235.04,452,
APPLY LOW CST SKIN SUB =<100SQCM TRUNK 1ST 25SQCM,78002050,CDM,510,RC,C5271,HCPCS,Outpatient,,,1123,842.25,,1033.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1044.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1123,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1078.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,583.96,1123,
APPLY LOW COST SKIN SUB =<100SQCM TRUNK ADDL 25,78002051,CDM,510,RC,C5272,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
APPLY LOW CST SKIN SUB =>100SQCM TRUNK 1ST 25SQCM,78002052,CDM,510,RC,C5273,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3415.89,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3305.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3673,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3562.81,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3526.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1909.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2754.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1909.96,3673,
APPLY LOW COST SKIN SUB =>100SQCM TRUNK ADDL 25,78002053,CDM,510,RC,C5274,HCPCS,Outpatient,,,808,606,,743.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,420.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,751.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,727.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,727.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,783.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,808,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,420.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,783.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,606,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,775.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,420.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,606,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,606,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,420.16,808,
APPLY LOW CST SKN SUB FACE <100SQCM 1ST 25SQCM =<,78002054,CDM,510,RC,C5275,HCPCS,Outpatient,,,1123,842.25,,1033.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1044.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1123,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1078.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,583.96,1123,
APPLY LOW COST SKIN SUB FACE <100SQCM EA ADDL 25,78002055,CDM,510,RC,C5276,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
APPLY LOW COST SKIN SUBS FACE 1ST 100 SQCM,78002056,CDM,510,RC,C5272,HCPCS,Outpatient,,,1123,842.25,,1033.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1044.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1123,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1089.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1078.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,583.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,842.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,583.96,1123,
APPLY LOW COST SKIN SUBS FACE EA ADDL 100 SQCM,78002057,CDM,510,RC,C5278,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
DESTRUCTION BENIGN LESIONS UP TO 14,78000316G,CDM,510,RC,17110,HCPCS,Outpatient,,,256,192,,235.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,133.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,230.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,230.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,248.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,256,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,133.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,192,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,133.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,192,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,192,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.12,256,
ASPIRATION INJECTION OF MEDIUM JOINT OR JOINT CAPSULE W/O US,78000362G,CDM,510,RC,20605,HCPCS,Outpatient,,,390,292.5,,358.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,202.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,362.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,351,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,351,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,378.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,390,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,202.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,378.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,292.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,374.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,202.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,292.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,202.8,390,
ASPIRATION INJECTION OF SMALL JOINT OR JOINT CAPSULE W/O US,78000356G,CDM,510,RC,20600,HCPCS,Outpatient,,,345,258.75,,317.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,179.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,310.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,310.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,334.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,345,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,179.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,334.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,258.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,179.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,258.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,179.4,345,
ECG ROUTINE ECG W/LEAST 12 LDS W/I and R,78001838G,CDM,730,RC,93000,HCPCS,Outpatient,,,237,177.75,,218.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,220.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,229.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,237,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,227.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,123.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,123.24,237,
REMOVAL OF GROWTH (0.5 CENTIMETERS OR LESS) OF THE SCALP NEC,78000088G,CDM,510,RC,11420,HCPCS,Outpatient,,,2049,1536.75,,1885.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1065.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1905.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1844.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1844.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1987.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2049,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1065.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1987.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1536.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1967.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1065.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1536.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1536.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1065.48,2049,
EXCISE BENIGN LESN MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM,78000090G,CDM,510,RC,11421,HCPCS,Outpatient,,,633,474.75,,582.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,329.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,588.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,569.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,569.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,614.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,633,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,329.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,614.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,474.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,607.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,329.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,474.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,474.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,329.16,633,
EXCISE BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM,78000104G,CDM,510,RC,11442,HCPCS,Outpatient,,,730,547.5,,671.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,678.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,657,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,730,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,708.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,700.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,379.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,547.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,379.6,730,
EXCISION NAIL MATRIX PERMANENT REMOVAL,78000148G,CDM,510,RC,11750,HCPCS,Outpatient,,,362,271.5,,333.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,188.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,336.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,325.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,325.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,351.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,362,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,188.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,351.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,271.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,347.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,188.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,271.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,271.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,188.24,362,
REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE UNI,78001819,CDM,510,RC,69209,HCPCS,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,149,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,143.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,77.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,77.48,149,
ADMINISTRATION INFLUENZA VACCINE,78001822,CDM,771,RC,G0008,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,118,
ADMINISTRATION OF PNEUMOCOCCAL VACCINE,78001823,CDM,771,RC,G0009,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,118,
PROSTATE CANCER SCREENING RECTAL EXAM,78002060G,CDM,510,RC,G0102,HCPCS,Outpatient,,,52,39,,47.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,27.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,46.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,46.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,27.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,27.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.04,52,
GLAUCOMA SCREENING HIGH RISK,78002062G,CDM,510,RC,G0117,HCPCS,Outpatient,,,141,105.75,,129.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,73.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,131.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,126.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,136.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,73.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,136.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,105.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,73.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.32,141,
GLAUCOMA SCREEN HIGH RISK PATIENT DIRECT SUPERVISION,78002064G,CDM,510,RC,G0118,HCPCS,Outpatient,,,95,71.25,,87.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,49.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,92.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,49.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,92.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,71.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,49.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.4,95,
TRIMMING OF DYSTROPHIC NAILS ANY NUMBER,78002066G,CDM,510,RC,G0127,HCPCS,Outpatient,,,53,39.75,,48.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,27.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.56,53,
HOME SLEEP TEST TYPE 3 PORT MONITOR UNATTENDED,78002074G,CDM,920,RC,G0399,HCPCS,Outpatient,,,318,238.5,,292.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,295.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,286.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,286.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,308.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,318,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,308.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,305.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,165.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,238.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,165.36,318,
GLUCOSE BLOOD GLUCOSCAN/METER FINGER STICK,70200322,CDM,300,RC,82962,HCPCS,Outpatient,,,68,51,,62.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,65.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,35.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.36,68,
HEMAGLOBIN A1C CLINIC POC,78002849,CDM,300,RC,83037,HCPCS,Outpatient,,,29,21.75,,26.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,28.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.08,29,
BLOOD OCCULT FECES,70200202,CDM,300,RC,82270,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
HEMOGLOBIN HGB,70200572,CDM,300,RC,85018,HCPCS,Outpatient,,,64,48,,58.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.28,64,
GLYCOHEMOGLOBIN,70200341,CDM,300,RC,83036,HCPCS,Outpatient,,,137,102.75,,126.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,71.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,127.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,123.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,123.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,132.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,137,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,71.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,102.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,131.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,71.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.24,137,
INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,78000348G,CDM,510,RC,20550,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,195.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,189,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,189,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,203.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,210,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,203.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,201.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,109.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,157.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,109.2,210,
INFLUENZA AB ID NOW,70200981,CDM,300,RC,87804,HCPCS,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.84,142,
INFLUENZA A and B ID NOW,70200981,CDM,300,RC,87804,HCPCS,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,132.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,127.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,137.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,136.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,73.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,73.84,142,
DENOSUMAB (PROLIA) 60MG INJ,78002768,CDM,636,RC,J0897,HCPCS,Outpatient,,,5848.35,4386.26,,5380.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3041.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5438.97,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,5263.52,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5263.52,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5672.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5848.35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3041.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5672.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,4386.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5614.42,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3041.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4386.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4386.26,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3041.14,5848.35,
ZILRETTA TRIAMCINOLONE ACETONIDE 40MG INJECTION,78002339,CDM,636,RC,J3304,HCPCS,Outpatient,,,2563.84,1922.88,,2358.73,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1333.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2384.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2307.46,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2307.46,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2486.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2563.84,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1333.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2486.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1922.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2461.29,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1333.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1922.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1922.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1333.2,2563.84,
ZOLEDRONIC ACID (RECLAST) 1MG INJ,78002871,CDM,636,RC,J3489,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,267.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,259.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,288,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,276.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,149.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,149.76,288,
ZOLEDRONIC ACID (RECLAST) 5MG INJ,78002871,CDM,636,RC,J3489,HCPCS,Outpatient,,,1440,1080,,1324.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,748.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1339.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1296,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1296,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1396.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1440,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,748.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1396.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1080,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1382.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,748.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1080,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1080,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,748.8,1440,
AMB DUROLANE 20MG/ML IV SOLUTION,78002335,CDM,636,RC,J7318,HCPCS,Outpatient,,,1606.8,1205.1,,1478.26,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,835.54,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1494.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1446.12,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1446.12,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1558.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1606.8,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,835.54,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1558.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1205.1,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1542.53,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,835.54,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1205.1,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1205.1,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,835.54,1606.8,
AMB HYALGAN 10MG/ML INJECTION (SNYVISC),78002337,CDM,636,RC,J7321,HCPCS,Outpatient,,,456,342,,419.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,237.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,424.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,410.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,410.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,442.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,456,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,237.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,442.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,342,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,437.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,237.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,342,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,456,
AMB SUPARTZ FX 10MG/ML INJECTION,78002338,CDM,636,RC,J7321,HCPCS,Outpatient,,,456,342,,419.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,237.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,424.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,410.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,410.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,442.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,456,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,237.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,442.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,342,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,437.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,237.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,342,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,342,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,456,
AMB EUFLEXXA 25MG INJECTION,78002333,CDM,636,RC,J7323,HCPCS,Outpatient,,,840.28,630.21,,773.06,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,436.95,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,781.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,756.25,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,756.25,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,815.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,840.28,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,436.95,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,815.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,630.21,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,806.67,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,436.95,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,630.21,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,630.21,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,436.95,840.28,
AMB GEL-ONE 10MG/ML INJECTION,78002334,CDM,636,RC,J7326,HCPCS,Outpatient,,,1840,1380,,1692.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,956.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1711.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1656,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1656,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1784.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1840,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,956.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1784.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1380,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1766.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,956.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1380,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1380,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,956.8,1840,
AMB GELSYN-3 8.4MG/ML INJECTION,78002336,CDM,636,RC,J7328,HCPCS,Outpatient,,,852.6,639.45,,784.39,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,443.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,792.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,767.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,767.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,827.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,852.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,443.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,827.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,639.45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,818.5,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,443.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,639.45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,443.35,852.6,
AMB DEXAMETHASONE 10MG ORAL SOLUTION,78002295,CDM,636,RC,J8540,HCPCS,Outpatient,,,4.11,3.08,,3.78,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.11,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3.95,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2.14,4.11,
AMB DEXAMETHASONE 10MG ORAL SOLUTION,78002295,CDM,636,RC,J8540,HCPCS,Outpatient,,,4.11,3.08,,3.78,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.11,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3.95,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2.14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3.08,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2.14,4.11,
Kyleena UID [MEMO],78002314,CDM,636,RC,J7296,HCPCS,Outpatient,,,3777.27,2832.95,,3475.09,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3512.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3777.27,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3626.18,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1964.18,3777.27,
ALBUMIN URINE MICROALBUMIN SEMIQUANTITATIVE,70200169,CDM,300,RC,82044,HCPCS,Outpatient,,,26,19.5,,23.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13.52,26,
BLOOD OCCULT FECES 1-3 SPECIMEN,70200204,CDM,300,RC,82272,HCPCS,Outpatient,,,69,51.75,,63.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,66.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66.93,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,35.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.88,69,
PROTHROMBIN TIME (FINGER STICK),70200608,CDM,300,RC,85610,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
APLIGRAF PER SQUARE CENTIMETER,78002778,CDM,636,RC,Q4101,HCPCS,Outpatient,,,121,90.75,,111.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.53,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,116.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.92,121,
OASIS WOUND MATRIX PER SQUARE CENTIMETER,78002779,CDM,636,RC,Q4102,HCPCS,Outpatient,,,36,27,,33.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,32.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,32.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.72,36,
OASIS BURN MATRIX PER SQUARE CENTIMETER,78002780,CDM,636,RC,Q4103,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
INTEGRA BILAYER MATRIX WOUND DRESSING PER SQUARE CENTIMETER,78002781,CDM,636,RC,Q4104,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,166.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,166.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,179.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,185,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,179.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,96.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,96.2,185,
INTEGRA DERMAL REGENERATION TEMPLATE PER SQUARE CENTIMETER,78002782,CDM,636,RC,Q4105,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,193.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,187.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,187.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,201.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,208,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,201.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,199.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,108.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.16,208,
DERMAGRAFT PER SQUARE CENTIMETER,78002783,CDM,636,RC,Q4106,HCPCS,Outpatient,,,117,87.75,,107.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.81,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,105.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.49,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.84,117,
GRAFTJACKET PER SQUARE CENTIMETER,78002784,CDM,636,RC,Q4107,HCPCS,Outpatient,,,365,273.75,,335.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,189.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,339.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,328.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,328.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,354.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,365,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,189.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,354.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,273.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,350.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,189.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,273.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,189.8,365,
INTEGRA MATRIX PER SQUARE CENTIMETER,78002785,CDM,636,RC,Q4108,HCPCS,Outpatient,,,212,159,,195.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,110.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,197.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,190.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,190.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,205.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,212,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,110.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,205.64,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,159,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,203.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,110.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,159,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,159,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,110.24,212,
PRIMATRIX PER SQUARE CENTIMETER,78002786,CDM,636,RC,Q4110,HCPCS,Outpatient,,,145,108.75,,133.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75.4,145,
ALLODERM PER SQUARE CENTIMETER,78002787,CDM,636,RC,Q4116,HCPCS,Outpatient,,,174,130.5,,160.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,161.82,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,168.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,174,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,168.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,167.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,90.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,130.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90.48,174,
MATRISTEM MICROMATRIX 1MG,10839952,CDM,636,RC,Q4118,HCPCS,Outpatient,,,18,13.5,,16.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,9.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,17.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,9.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,13.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,9.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,13.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9.36,18,
THERASKIN PER SQUARE CENTIMETER,78002789,CDM,636,RC,Q4121,HCPCS,Outpatient,,,202,151.5,,185.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,187.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,195.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,202,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,195.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,193.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.04,202,
THERASKIN PER SQUARE CENTIMETER,78002789,CDM,636,RC,Q4121,HCPCS,Outpatient,,,202,151.5,,185.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,187.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,195.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,202,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,195.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,193.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,105.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,151.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.04,202,
OASIS ULTRA TRI-LAYER WOUND MATRIX PER SQUARE CENTIMETER,78002790,CDM,636,RC,Q4124,HCPCS,Outpatient,,,54,40.5,,49.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,28.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,48.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,48.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,28.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,40.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,51.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,28.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.08,54,
GRAFIX PRIME STRAVIX AND STRAVIXPL PER SQUARE CENTIMETER,78002792,CDM,636,RC,Q4133,HCPCS,Outpatient,,,425,318.75,,391,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,395.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,382.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,382.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,412.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,425,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,412.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,408,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,221,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,318.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,221,425,
EPIFIX PER SQUARE CENTIMETER,78002791,CDM,636,RC,Q4186,HCPCS,Outpatient,,,439,329.25,,403.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,228.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,408.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,395.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,395.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,425.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,439,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,228.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,425.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,329.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,421.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,228.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,329.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,329.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,228.28,439,
PURAPLY PER SQUARE CENTIMETER,78002793,CDM,636,RC,Q4195,HCPCS,Outpatient,,,375,281.25,,345,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,348.75,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,337.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,337.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,363.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,375,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,363.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,360,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,195,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,281.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,195,375,
PURAPLY AM PER SQUARE CENTIMETER,78002794,CDM,636,RC,Q4196,HCPCS,Outpatient,,,320,240,,294.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,166.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,297.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,288,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,288,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,310.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,320,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,166.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,310.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,240,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,307.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,166.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,240,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,166.4,320,
RESPIRATORY SYNCYTIAL VIRUS (RSV),70200965,CDM,300,RC,87634,HCPCS,Outpatient,,,253,189.75,,232.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,131.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,235.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,227.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,227.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,245.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,253,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,131.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,189.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,242.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,131.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,189.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,189.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,131.56,253,
STREP SCREEN RAPID,70200984,CDM,300,RC,87880,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,
REMOVAL OF SUTURES,78002103G,CDM,510,RC,S0630,HCPCS,Outpatient,,,4,3,,3.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2.08,4,
SARS COV-2 COVID-19 AMPLIFIED PROBE,70200966,CDM,300,RC,87635,HCPCS,Outpatient,,,130,97.5,,119.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,126.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,124.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,67.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.6,130,
TB SKIN TEST TUBERCULOSIS INTRADERMAL,70200748,CDM,300,RC,86580,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.84,42,
SLEEP STD AIRFLOW HRT RATE and O2 SAT EFFORT UNATT,74100002G,CDM,730,RC,95806,HCPCS,Outpatient,,,342,256.5,,314.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,177.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,318.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,307.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,307.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,331.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,342,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,177.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,256.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,328.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,177.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,256.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,256.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,177.84,342,
SPIROMETRY PRE & POST MEDICATION ADMIN,78001846G,CDM,410,RC,94060,HCPCS,Outpatient,,,696,522,,640.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,361.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,647.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,626.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,626.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,675.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,696,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,361.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,675.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,522,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,668.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,361.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,522,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,522,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,361.92,696,
TRIMMING OF FINGERNAILS OR TOENAILS,78000136G,CDM,510,RC,11719,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.32,66,
URINALYSIS COMPONENT W/O MICROSCOPY,70200121,CDM,300,RC,81003,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.99,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,41.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,22.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.36,43,
URINE DRUG PROFILE DIRECT OPTICAL OBSERVATION,70200048,CDM,300,RC,80305,HCPCS,Outpatient,,,153,114.75,,140.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,142.29,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,148.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,153,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,148.41,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,79.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,114.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,79.56,153,
ALBUMIN URINE MICROALBUMIN SEMIQUANTITATIVE,70200169,CDM,300,RC,82044,HCPCS,Outpatient,,,26,19.5,,23.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13.52,26,
URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS,70200125,CDM,300,RC,81025,HCPCS,Outpatient,,,85,63.75,,78.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,44.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,76.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,76.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,82.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,44.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.45,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,63.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,44.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,44.2,85,
WET PREP,70200908,CDM,300,RC,87210,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,78.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,78.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,84.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.24,87,
Sendout Miscellaneous,PATH99,CDM,310,RC,,,Outpatient,,,0.01,0.01,,0.01,92,,,percent of total billed charges,92% of total billed charges,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,93,,,percent of total billed charges,93% of total billed charges,0.01,90,,,percent of total billed charges,90% of total billed charges,0.01,90,,,percent of total billed charges,90% of total billed charges,0.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,97,,,percent of total billed charges,97% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,96,,,percent of total billed charges,96% of total billed charges,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,0.01,
INSERT NON-INDWELLING BLADDER CATHETER,78001532G,CDM,510,RC,51701,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,124.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,69.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,69.68,134,
PSYCHOTHERAPY PATIENT / FAMILY 30 MINUTES,78001829G,CDM,510,RC,90832,HCPCS,Outpatient,,,171,128.25,,157.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,88.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,159.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,153.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,153.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,165.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,171,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,88.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,128.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,88.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,128.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.92,171,
PSYCHOTHERAPY PATIENT / FAMILY 45 MINUTES,78001832G,CDM,510,RC,90834,HCPCS,Outpatient,,,226,169.5,,207.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,219.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,226,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,219.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,216.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,117.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,169.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,117.52,226,
PSYCHOTHERAPY PATIENT / FAMILY 60 MINUTES,78001835G,CDM,510,RC,90837,HCPCS,Outpatient,,,331,248.25,,304.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,172.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,307.83,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,321.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,331,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,172.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,321.07,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,248.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,317.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,172.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,248.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,248.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.12,331,
SPECIMAN HANDLING - OFFICE,70201077,CDM,300,RC,99000,HCPCS,Outpatient,,,24,18,,22.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,13.6,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,24,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,23.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,12.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12.48,24,
SPEC NEW PATIENT VISIT LEVEL 2,78001893,CDM,510,RC,G0463,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,178,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,172.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.88,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,92.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.56,178,
NEW PATIENT VISIT LEVEL 2,78001891,CDM,510,RC,99202,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,162,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.24,162,
NEW PATIENT VISIT LEVEL 3,78001895,CDM,510,RC,99203,HCPCS,Outpatient,,,219,164.25,,201.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,203.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,219,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.88,219,
NEW PATIENT VISIT LEVEL 4,78001899,CDM,510,RC,99204,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.04,327,
NEW PATIENT VISIT LEVEL 4,78001899,CDM,510,RC,99204,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,304.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.19,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,313.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,170.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,170.04,327,
NEW PATIENT VISIT LEVEL 5,78001903,CDM,510,RC,99205,HCPCS,Outpatient,,,432,324,,397.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,401.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,388.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,388.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,419.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,432,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,419.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,414.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,224.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,324,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.64,432,
ESTABLISHED PATIENT VISIT LEVEL 1,78001907,CDM,510,RC,99211,HCPCS,Outpatient,,,51,38.25,,46.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.52,51,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,510,RC,99212,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,510,RC,99212,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,510,RC,99212,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
ESTABLISHED PATIENT VISIT LEVEL 3,78001915,CDM,510,RC,99213,HCPCS,Outpatient,,,180,135,,165.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,167.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,180,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.6,180,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,510,RC,99214,HCPCS,Outpatient,,,249,186.75,,229.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,249,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,249,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,510,RC,99214,HCPCS,Outpatient,,,249,186.75,,229.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,249,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,249,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,510,RC,99214,HCPCS,Outpatient,,,249,186.75,,229.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,231.57,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,249,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.53,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,129.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,249,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,510,RC,99215,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.6,330,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,510,RC,99215,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.6,330,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,510,RC,99215,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,306.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,316.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,171.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,171.6,330,
OFFICE CONSULTATION NEW/EST PAT 30 MIN,78001947,CDM,510,RC,99242,HCPCS,Outpatient,,,255,191.25,,234.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,237.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,255,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.6,255,
PATIENT OFFICE CONSULTATION  TYPICALLY 40 MINUTES,78001949,CDM,510,RC,99243,HCPCS,Outpatient,,,266,199.5,,244.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,138.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.38,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,239.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,258.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,266,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,138.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,199.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,255.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,138.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,199.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,199.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.32,266,
OFFICE CONSULTATION NEW/EST PAT 60 MIN,78001951,CDM,510,RC,99244,HCPCS,Outpatient,,,396,297,,364.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,368.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,356.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,356.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,384.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,396,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,384.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,380.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,205.92,396,
OFFICE CONSULTATION NEW/EST PAT 60 MIN,78001951G,CDM,510,RC,99244,HCPCS,Outpatient,,,396,297,,364.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,368.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,356.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,356.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,384.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,396,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,384.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,380.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,205.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,297,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,205.92,396,
OFFICE CONSULTATION NEW/EST PAT 80 MIN,78001953,CDM,510,RC,99245,HCPCS,Outpatient,,,483,362.25,,444.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,251.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,449.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,434.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,434.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,468.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,483,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,251.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,468.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,362.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,463.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,251.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,362.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,362.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,251.16,483,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 40 MIN,78001956P,CDM,510,RC,99252,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges,99.84,52,,,percent of total billed charges,52% of total billed charges,178.56,93,,,percent of total billed charges,93% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,186.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,99.84,52,,,percent of total billed charges,52% of total billed charges,186.24,97,,,percent of total billed charges,97% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,184.32,96,,,percent of total billed charges,96% of total billed charges,99.84,52,,,percent of total billed charges,52% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,99.84,186.24,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 55 MIN,78001957P,CDM,510,RC,99253,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,154.96,52,,,percent of total billed charges,52% of total billed charges,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,154.96,52,,,percent of total billed charges,52% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,154.96,52,,,percent of total billed charges,52% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,154.96,289.06,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 80 MIN,78001958P,CDM,510,RC,99254,HCPCS,Outpatient,,,430,322.5,,395.6,92,,,percent of total billed charges,92% of total billed charges,223.6,52,,,percent of total billed charges,52% of total billed charges,399.9,93,,,percent of total billed charges,93% of total billed charges,387,90,,,percent of total billed charges,90% of total billed charges,387,90,,,percent of total billed charges,90% of total billed charges,417.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,223.6,52,,,percent of total billed charges,52% of total billed charges,417.1,97,,,percent of total billed charges,97% of total billed charges,322.5,75,,,percent of total billed charges,75% of total billed charges,412.8,96,,,percent of total billed charges,96% of total billed charges,223.6,52,,,percent of total billed charges,52% of total billed charges,322.5,75,,,percent of total billed charges,75% of total billed charges,322.5,75,,,percent of total billed charges,75% of total billed charges,223.6,417.1,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 110 MIN,78001959P,CDM,510,RC,99255,HCPCS,Outpatient,,,519,389.25,,477.48,92,,,percent of total billed charges,92% of total billed charges,269.88,52,,,percent of total billed charges,52% of total billed charges,482.67,93,,,percent of total billed charges,93% of total billed charges,467.1,90,,,percent of total billed charges,90% of total billed charges,467.1,90,,,percent of total billed charges,90% of total billed charges,503.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,269.88,52,,,percent of total billed charges,52% of total billed charges,503.43,97,,,percent of total billed charges,97% of total billed charges,389.25,75,,,percent of total billed charges,75% of total billed charges,498.24,96,,,percent of total billed charges,96% of total billed charges,269.88,52,,,percent of total billed charges,52% of total billed charges,389.25,75,,,percent of total billed charges,75% of total billed charges,389.25,75,,,percent of total billed charges,75% of total billed charges,269.88,503.43,
ER VISIT LEVEL 1 PROBLEM FOCUSED,68500030,CDM,510,RC,99281,HCPCS,Outpatient,,,259,194.25,,238.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,240.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,233.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,233.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,251.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,259,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,248.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,134.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,194.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.68,259,
ER VISIT LEVEL 2 EXPANDED PROBLEM FOCUSED,68500033,CDM,510,RC,99282,HCPCS,Outpatient,,,423,317.25,,389.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,219.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,393.39,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,380.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,380.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,410.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,423,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,219.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,410.31,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,317.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,406.08,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,219.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,317.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,317.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,219.96,423,
ER VISIT LEVEL 3 MOD SEVERITY,68500036,CDM,510,RC,99283,HCPCS,Outpatient,,,747,560.25,,687.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,694.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,672.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,672.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,724.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,747,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,724.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,717.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,388.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,560.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,388.44,747,
ER VISIT LEVEL 4 HIGH SEVERITY,68500039,CDM,510,RC,99284,HCPCS,Outpatient,,,1216,912,,1118.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,632.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1130.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1094.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1094.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1179.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1216,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,632.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1179.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,912,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1167.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,632.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,912,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,912,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,632.32,1216,
ER VISIT LEVEL 5 HIGH SEVERITY,68500042,CDM,510,RC,99285,HCPCS,Outpatient,,,1797,1347.75,,1653.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,934.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1671.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1617.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1617.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1743.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1797,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,934.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1743.09,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1347.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1725.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,934.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1347.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1347.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,934.44,1797,
INITIAL PREVENTIVE MEDICINE NEW PAT <1 YR,78001972,CDM,510,RC,99381,HCPCS,Outpatient,,,244,183,,224.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,219.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,219.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,236.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,244,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,234.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,126.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,183,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,126.88,244,
INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS,78001974,CDM,510,RC,99382,HCPCS,Outpatient,,,254,190.5,,233.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,132.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,236.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,228.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,228.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,246.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,132.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,246.38,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,190.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,243.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,132.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,190.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,190.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.08,254,
INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS,78001976,CDM,510,RC,99383,HCPCS,Outpatient,,,264,198,,242.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,137.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,245.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,237.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,237.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,256.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,264,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,137.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,256.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,198,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,253.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,137.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,198,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,198,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,137.28,264,
INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR,78001978,CDM,510,RC,99384,HCPCS,Outpatient,,,300,225,,276,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,300,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156,300,
INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS,78001980,CDM,510,RC,99385,HCPCS,Outpatient,,,291,218.25,,267.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,151.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,270.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,261.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,261.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,282.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,291,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,151.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,282.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,218.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,279.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,151.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,218.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,218.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,151.32,291,
INITIAL PREVENTIVE MEDICINE NEW PAT 40-64YRS,78001982,CDM,510,RC,99386,HCPCS,Outpatient,,,336,252,,309.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,174.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,312.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,302.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,302.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,325.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,336,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,174.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,325.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,252,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,322.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,174.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,252,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,252,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.72,336,
INITIAL PREVENTIVE MEDICINE NEW PAT 65YRS and >,78001984,CDM,510,RC,99387,HCPCS,Outpatient,,,364,273,,334.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,189.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,338.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,327.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,327.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,353.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,364,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,189.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,353.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,273,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,349.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,189.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,273,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,273,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,189.28,364,
PERIODIC PREVENTIVE MED EST PAT <1Y,78001986,CDM,510,RC,99391,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,114.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,204.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,198,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,198,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,213.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,220,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,114.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,213.4,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,165,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,211.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,114.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,165,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,165,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,114.4,220,
PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS,78001988,CDM,510,RC,99392,HCPCS,Outpatient,,,234,175.5,,215.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,217.62,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,210.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,210.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,234,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,175.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,224.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,175.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,175.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.68,234,
PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS,78001990,CDM,510,RC,99393,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.69,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,226.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,121.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.16,233,
PERIODIC PREVENTIVE MED EST PAT 12-17YRS,78001992,CDM,510,RC,99394,HCPCS,Outpatient,,,255,191.25,,234.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,237.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,229.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,255,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,247.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,244.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,132.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,191.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,132.6,255,
PERIODIC PREVENTIVE MED EST PAT 18-39 YRS,78001994,CDM,510,RC,99395,HCPCS,Outpatient,,,260,195,,239.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,135.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,241.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,234,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,234,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,252.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,260,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,135.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,252.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,195,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,249.6,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,135.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,195,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,195,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,135.2,260,
PERIODIC PREVENTIVE MED EST PAT 40-64YRS,78001996,CDM,510,RC,99396,HCPCS,Outpatient,,,280,210,,257.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,145.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,260.4,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,252,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,252,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,271.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,280,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,145.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,271.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,210,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,268.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,145.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,145.6,280,
PERIODIC PREVENTATIVE MED EST PAT 65 YRS and  OLDER,78001998,CDM,510,RC,99397,HCPCS,Outpatient,,,301,225.75,,276.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,279.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,270.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,301,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,291.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,288.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,156.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,225.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,156.52,301,
SMOKING/TOBACCO CESSATION INTENSIVE >3/<10 MIN,78002001,CDM,942,RC,99406,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.9,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,15.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.6,30,
SMOKING/TOBACCO CESSATION INTENSIVE >10 MIN,78002003,CDM,942,RC,99407,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
COMPLEX CHRONIC CARE MANAGEMENT SVC 1ST 60 MIN,78002016,CDM,510,RC,99487,HCPCS,Outpatient,,,295,221.25,,271.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,153.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,274.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,265.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,265.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,286.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,295,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,153.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,286.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,221.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,283.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,153.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,221.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,221.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.4,295,
COMPLEX CHRONIC CARE MGMT SERVICE EA ADDL 30MIN,78002018,CDM,510,RC,99489,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,144.15,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,150.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.35,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,148.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,80.6,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.6,155,
ADVANCE CARE PLANNING FIRST 30 MINS,78002024,CDM,510,RC,99497,HCPCS,Outpatient,,,187,140.25,,172.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,97.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,173.91,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,168.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,168.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,181.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,97.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,181.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,140.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,179.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,97.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,140.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,97.24,187,
ADVANCE CARE PLANNING ADDITIONAL 30 MINS,78002026,CDM,510,RC,99498,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,150.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,162,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,157.14,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,155.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,84.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.24,162,
DOT OR PRE-EMPLOYMENT PHYSICIAL,78002028,CDM,510,RC,99499,HCPCS,Outpatient,,,150,112.5,,138,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,150,
CERVICAL OR VAGINAL CANCER SCREEN W/BREAST EXAM,78002058,CDM,510,RC,G0101,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,85.36,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.76,88,
COUNSELING VISIT TO DISCUSS LDCT ELIGIBIITY,78002068,CDM,510,RC,G0296,HCPCS,Outpatient,,,64,48,,58.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.28,64,
ALCOHOL OR SUBSTANCE MISUSE ASSESSMENT 15-30MIN,78002070,CDM,510,RC,G0396,HCPCS,Outpatient,,,79,59.25,,72.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,73.47,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,71.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,71.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,76.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.63,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,59.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,59.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.08,79,
ALCOHOL OR SUBSTANCE MISUSE ASSESSMENT 30+ MIN,78002072,CDM,510,RC,G0397,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,146.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,151,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,146.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.52,151,
ANNUAL ALCOHOL MISUSE SCREENING 15 MINUTES,78002083,CDM,510,RC,G0442,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.06,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.74,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,40.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.84,42,
BRIEF ALCOHOL COUNSELING EACH 15 MINUTES,78002085,CDM,510,RC,G0443,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
DEPRESSION SCREENING EACH 15 MINUTES,78002087,CDM,510,RC,G0444,HCPCS,Outpatient,,,41,30.75,,37.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.13,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,39.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.32,41,
HIGH INTENS BEHAVIORAL COUNSEL FOR STD'S 30 MIN,78002089,CDM,510,RC,G0445,HCPCS,Outpatient,,,61,45.75,,56.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.73,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.17,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,31.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.72,61,
BEHAVIORAL THERAPY CARDIOVASCULAR DISEASE 15MIN,78002091,CDM,510,RC,G0446,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
BEHAVIOR COUNSELING FOR OBESITY 15 MINUTES,78002093,CDM,510,RC,G0447,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,53.94,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,56.26,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,30.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.16,58,
PROLONGED PREVENTATIVE SERVICE EA ADDL 30 MIN,78002095,CDM,510,RC,G0514,HCPCS,Outpatient,,,144,108,,132.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,133.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,144,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,138.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,74.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,74.88,144,
ALCOHOL AND/OR SUBSTANCE MISUSE ASSESS 5-14 MIN,78002098,CDM,510,RC,G2011,HCPCS,Outpatient,,,37,27.75,,34.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,34.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,35.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.24,37,
OBTAINING SCREEN PAP SMEAR,78002101,CDM,510,RC,Q0091,HCPCS,Outpatient,,,96,72,,88.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,49.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,89.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,86.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,86.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,93.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,96,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,49.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,92.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,49.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.92,96,
Health Fair A1C,70200341,CDM,300,RC,83036,HCPCS,Outpatient,,,10.83,8.12,,9.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,9.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.83,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5.63,10.83,
Health Fair CBC ,70200575,CDM,300,RC,85027,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
Health Fair CMP,70200005,CDM,300,RC,80053,HCPCS,Outpatient,,,10.84,8.13,,9.97,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,9.76,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9.76,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.84,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,8.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.41,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5.64,10.84,
Health Fair Estradiol,70200279,CDM,300,RC,82670,HCPCS,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.8,40,
Health Fair FSH,70200327,CDM,300,RC,83001,HCPCS,Outpatient,,,172,129,,158.24,92,,,percent of total billed charges,92% of total billed charges,89.44,52,,,percent of total billed charges,52% of total billed charges,159.96,93,,,percent of total billed charges,93% of total billed charges,154.8,90,,,percent of total billed charges,90% of total billed charges,154.8,90,,,percent of total billed charges,90% of total billed charges,166.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,89.44,52,,,percent of total billed charges,52% of total billed charges,166.84,97,,,percent of total billed charges,97% of total billed charges,129,75,,,percent of total billed charges,75% of total billed charges,165.12,96,,,percent of total billed charges,96% of total billed charges,89.44,52,,,percent of total billed charges,52% of total billed charges,129,75,,,percent of total billed charges,75% of total billed charges,129,75,,,percent of total billed charges,75% of total billed charges,89.44,166.84,
Health Fair Lipid Panel,70200007,CDM,300,RC,80061,HCPCS,Outpatient,,,10.83,8.12,,9.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,9.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.83,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5.63,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.12,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5.63,10.83,
Health Fair PSA,70200474,CDM,300,RC,84153,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.08,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,34.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,54.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,29.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,56,
Health Fair T3 ,70200527,CDM,300,RC,84481,HCPCS,Outpatient,,,159,119.25,,146.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,147.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,159,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,154.23,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,152.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,82.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.68,159,
Health Fair T4  ,70200517,CDM,300,RC,84439,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
Health Fair TPO,70200736,CDM,300,RC,86376,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.23,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,106.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.72,111,
Health Fair TSH,70200519,CDM,300,RC,84443,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.7,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87.3,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,86.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,46.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,46.8,90,
Health Fair Testosterone ,70200512,CDM,300,RC,84403,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.71,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,222.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.59,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,237.12,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.44,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.44,247,
Health Fair Vitamin B12,70200272,CDM,300,RC,82607,HCPCS,Outpatient,,,281,210.75,,258.52,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,261.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,252.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,252.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,272.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,281,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,272.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,269.76,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,146.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,146.12,281,
Health Fair Vitamin D,70200276,CDM,300,RC,82652,HCPCS,Outpatient,,,27.5,20.63,,25.3,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,14.3,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.58,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,26.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,14.3,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.68,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,20.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,14.3,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14.3,27.5,
UA Microalb/Creat Ratio POCT,70200266,CDM,300,RC,82570,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.09,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.76,113,
UA Microalbumin POCT,70200169,CDM,300,RC,82044,HCPCS,Outpatient,,,26,19.5,,23.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,13.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13.52,26,
INFUSION EACH ADDITIONAL HOUR,66100022,CDM,260,RC,96366,HCPCS,Outpatient,,,139,104.25,,127.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,129.27,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.83,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,72.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,72.28,139,
INFUSION FIRST DRUG INITIAL HOUR,66100021,CDM,260,RC,96365,HCPCS,Outpatient,,,468,351,,430.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,243.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,435.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,421.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,421.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,453.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,468,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,243.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,453.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,351,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,449.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,243.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,351,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,351,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,243.36,468,
IMMUNIZATION ADMINISTRATION EACH ADD'L VACCINE,78001827,CDM,771,RC,90472,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.64,82,
IMMUNIZATION ADMINISTRATION ONE VACCINE,78001826,CDM,771,RC,90471,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,293.79,
Mirena Charge [MEMO],78002316,CDM,636,RC,J7298,HCPCS,Outpatient,,,3777.27,2832.95,,3475.09,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3512.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3777.27,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3626.18,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1964.18,3777.27,
NEW PATIENT VISIT LEVEL 3,78001895G,CDM,510,RC,99203,HCPCS,Outpatient,,,219,164.25,,201.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,203.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,219,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,210.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,113.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,113.88,219,
DOT OR PRE-EMPLOYMENT PHYSICIAL,78002028,CDM,510,RC,99499,HCPCS,Outpatient,,,150,112.5,,138,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,139.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,145.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,144,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78,150,
BLOOD OCCULT FECES,70200202,CDM,300,RC,82270,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
HEMOGLOBIN HGB,70200572,CDM,300,RC,85018,HCPCS,Outpatient,,,64,48,,58.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,59.52,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.08,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.28,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.28,64,
BLOOD OCCULT FECES,70200202,CDM,300,RC,82270,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,64.99,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.32,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,34.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.84,67,
PROTHROMBIN TIME (FINGER STICK),70200608,CDM,300,RC,85610,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.45,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,63.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,33.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,33.8,65,
STREP SCREEN RAPID QUICKVUE,70200984,CDM,300,RC,87651,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.1,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.9,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,
AMB EPINEPHRINE 0.15ML EPI-PEN INJECTOR,78002302,CDM,636,RC,J0171,HCPCS,Outpatient,,,8.97,6.73,,8.25,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,8.07,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8.07,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.97,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,6.73,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6.73,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6.73,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4.66,8.97,
AMB EPINEPHRINE 0.30ML INJECTION,78002303,CDM,636,RC,J0171,HCPCS,Outpatient,,,26.92,20.19,,24.77,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,24.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,24.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,26.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.92,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,20.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,14,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.19,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14,26.92,
PROMETHAZINE (PHENERGAN) 25MG INJ,78002771,CDM,636,RC,J2550,HCPCS,Outpatient,,,11.09,8.32,,10.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5.77,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.31,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,9.98,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,9.98,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.09,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5.77,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,8.32,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.65,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5.77,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.32,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.32,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5.77,11.09,
AMB NALOXONE 0.4MG/1ML INJ,78002324,CDM,636,RC,J2310,HCPCS,Outpatient,,,94.98,71.24,,87.38,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,49.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.33,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,85.48,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,85.48,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,92.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.98,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,49.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,92.13,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,71.24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91.18,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,49.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,71.24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,71.24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.39,94.98,
DIPHTH/TET/ACELL PERT DTAP VACC <7 YR IM DOSE,78002139,CDM,636,RC,90700,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,100.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,103.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.16,108,
AMB AMB DIPHTH/TET/ACELL PERT/HEP-B/POLIO VACC IM,78002129,CDM,636,RC,90723,HCPCS,Outpatient,,,407.03,305.27,,374.47,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,211.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,378.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,366.33,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,366.33,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,394.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,407.03,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,211.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,394.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,305.27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,390.75,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,211.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,305.27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,305.27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,211.66,407.03,
0.5 mL Hep A Vaccine,78002153,CDM,636,RC,90633,HCPCS,Outpatient,,,179.35,134.51,,165,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,166.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,161.42,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,161.42,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,173.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,179.35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,173.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,134.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.18,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.26,179.35,
AMB HEPATITIS B VACC PED/ADULT 3 DOSE IM,78002123,CDM,636,RC,90744,HCPCS,Outpatient,,,81.7,61.28,,75.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81.7,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.43,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.48,81.7,
HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE,78002795,CDM,636,RC,90648,HCPCS,Outpatient,,,108.68,81.51,,99.99,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,97.81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,97.81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.68,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.33,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.51,108.68,
AMB MEASLES/MUMPS/RUBELLA VACC LIVE SC,78002142,CDM,636,RC,90707,HCPCS,Outpatient,,,246.37,184.78,,226.66,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,128.11,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,229.12,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,221.73,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,221.73,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,238.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,246.37,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,128.11,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,238.98,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,184.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,236.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,128.11,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,184.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,184.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,128.11,246.37,
MEASLES  MUMPS RUBELLA VARICELLA VACC LIVE SC,78002145,CDM,636,RC,90710,HCPCS,Outpatient,,,337,252.75,,310.04,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,175.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,313.41,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,303.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,303.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,326.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,337,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,175.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,326.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,252.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,323.52,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,175.24,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,252.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,252.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,175.24,337,
MENINOCOCCAL VACCINES,78002150,CDM,636,RC,90620,HCPCS,Outpatient,,,805.16,603.87,,740.75,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,418.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,748.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,724.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,724.64,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,781.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,805.16,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,418.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,781.01,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,603.87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,772.95,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,418.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,603.87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,603.87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,418.68,805.16,
AMB AREXY RESPIRATORY SYNCYTIAL VIRUS VACCINE IM,78002194,CDM,636,RC,90679,HCPCS,Outpatient,,,1008,756,,927.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,937.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,907.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,907.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,977.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1008,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,977.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,967.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,1008,
DIPHTH/TET/ACELL PERTUSSIS TDAP VACC >7 YR IM,78002133,CDM,636,RC,90715,HCPCS,Outpatient,,,239.9,179.93,,220.71,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,124.75,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,223.11,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,215.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,215.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,232.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,239.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,124.75,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,232.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,179.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,230.3,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,124.75,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,179.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,179.93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,239.9,
AMB HEPATITIS A VACCINE 720 EI.U/0.5ML INJ,78002152,CDM,636,RC,90633,HCPCS,Outpatient,,,179.35,134.51,,165,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,93.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,166.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,161.42,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,161.42,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,173.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,179.35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,93.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,173.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,134.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,172.18,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,93.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,134.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93.26,179.35,
AMB MENINGOCOCCAL CONJ VACC A/C/Y/W-135 IM,78002300,CDM,636,RC,90734,HCPCS,Outpatient,,,646.28,484.71,,594.58,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,336.07,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,601.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,581.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,581.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,626.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,646.28,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,336.07,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,626.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,484.71,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,620.43,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,336.07,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,484.71,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,484.71,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,336.07,646.28,
PNEUMOCOCCAL 23 VAL 25MCG/0.5ML VACCINE,78002128,CDM,636,RC,90732,HCPCS,Outpatient,,,468.32,351.24,,430.85,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,243.53,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,435.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,421.49,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,421.49,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,454.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,468.32,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,243.53,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,454.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,351.24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,449.59,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,243.53,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,351.24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,351.24,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,243.53,468.32,
POLIOVIRUS VACC INACTIVATED SC/IM,78002136,CDM,636,RC,90713,HCPCS,Outpatient,,,121.56,91.17,,111.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,63.21,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,113.05,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,109.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,109.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,117.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,63.21,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.91,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,91.17,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,116.7,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,63.21,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,91.17,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,91.17,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,63.21,121.56,
AMB VARICELLA VIRUS VACC LIVE SC,78002131,CDM,636,RC,90716,HCPCS,Outpatient,,,639.96,479.97,,588.76,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,332.78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,595.16,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,575.96,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,575.96,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,620.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,639.96,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,332.78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,620.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,479.97,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,614.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,332.78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,479.97,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,479.97,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,332.78,639.96,
AMB ZOSTER VACCINE SHINGRIX IM,78002341,CDM,636,RC,90750,HCPCS,Outpatient,,,440.17,330.13,,404.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,228.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,409.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,396.15,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,396.15,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,426.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,440.17,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,228.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,426.96,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,330.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,422.56,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,228.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,330.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,330.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,228.89,440.17,
AMB TETANUS DIPTHER TOXID UNDER 7 YRS 0.5ML INJECTION,78002140,CDM,636,RC,90702,HCPCS,Outpatient,,,189.55,142.16,,174.39,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,98.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,176.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,170.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,170.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,183.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189.55,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,98.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,183.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,142.16,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,181.97,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,98.57,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,142.16,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,142.16,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.57,189.55,
AMB CEFTRIAXONE 1G INJECTION,78002290,CDM,636,RC,J0696,HCPCS,Outpatient,,,102.16,76.62,,93.99,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,53.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,95.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,91.94,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,91.94,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,102.16,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,53.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.1,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,76.62,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,98.07,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,53.12,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.62,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.62,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,102.16,
AMB EPINEPHRINE 1MG/ML INJECTION,78002304,CDM,636,RC,J0171,HCPCS,Outpatient,,,50.01,37.51,,46.01,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,46.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45.01,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.01,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,48.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.01,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.01,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26.01,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.01,50.01,
AMB RABIES IMMUNE GLOBULIN 150U/ML 10ML INJ,78002169,CDM,636,RC,90675,HCPCS,Outpatient,,,1910.36,1432.77,,1757.53,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,993.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1776.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1719.32,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1719.32,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1853.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,1910.36,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,993.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1853.05,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1432.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1833.95,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,993.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1432.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1432.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,293.79,1910.36,
AMB HEPATITIS A VACCINE 2-DOSE SCHEDULE IM,78002153,CDM,636,RC,90632,HCPCS,Outpatient,,,345.02,258.77,,317.42,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,179.41,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,320.87,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,310.52,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,310.52,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,334.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,345.02,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,179.41,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,334.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,258.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,331.22,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,179.41,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,258.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,258.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,179.41,345.02,
AMB ROTAVIRUS VACCINE 1ML (ROTARIX),78002301,CDM,636,RC,90681,HCPCS,Outpatient,,,419.35,314.51,,385.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,218.06,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,390,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,377.42,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,377.42,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,406.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,419.35,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,218.06,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,406.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,314.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,402.58,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,218.06,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,314.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,314.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,218.06,419.35,
AMB LIDOCAINE HCL 1% 10ML INJECTION,78002318,CDM,636,RC,J2001,HCPCS,Outpatient,,,12.48,9.36,,11.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,6.49,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11.61,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,11.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,11.23,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,12.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.48,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,6.49,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,12.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,9.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.98,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,6.49,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6.49,12.48,
AMB SILVER SULFADIAZINE TOPICAL 1% 50GM CREAM,78002331,CDM,637,RC,A9270,HCPCS,Outpatient,,,1.66,1.25,,1.53,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,0.86,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1.54,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1.49,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1.49,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.66,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,0.86,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1.61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1.59,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,0.86,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.86,1.66,
AMB CYANOCOBALAM B-12 1000MCG/ML INJECTION,78002292,CDM,636,RC,J3420,HCPCS,Outpatient,,,43.7,32.78,,40.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,22.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,40.64,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,39.33,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,39.33,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,42.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.7,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,22.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,42.39,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,32.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.95,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,22.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,32.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.72,43.7,
BICILLIN LA 1.2MU/2ML INJECTION,78002329,CDM,636,RC,J0561,HCPCS,Outpatient,,,413.16,309.87,,380.11,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,214.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,384.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,371.84,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,371.84,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,400.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,413.16,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,214.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,400.77,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,309.87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,396.63,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,214.84,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,309.87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,309.87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,214.84,413.16,
AMB ALBUTEROL 1.25MG INH,78002284,CDM,636,RC,J7614,HCPCS,Outpatient,,,8.93,6.7,,8.22,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,8.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8.04,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.93,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.66,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,6.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.57,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4.64,8.93,
AMB DEXAMETHASONE 10MG/ML INJECTION,78002761,CDM,636,RC,J1100,HCPCS,Outpatient,,,41.1,30.83,,37.81,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,21.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.22,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36.99,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.99,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,39.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.1,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,21.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,39.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30.83,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,39.46,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,21.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.83,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.83,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.37,41.1,
AMB BUPIVACAINE HCL 2.5MG/ML 10ML INJECTION,78002287,CDM,636,RC,J0665,HCPCS,Outpatient,,,11.45,8.59,,10.53,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,5.95,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,10.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,10.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,11.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.45,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,5.95,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,8.59,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.99,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,5.95,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.59,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.59,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5.95,11.45,
AMB HEPATITIS B VACC PED/ADULT 3 DOSE IM,78002123,CDM,636,RC,90744,HCPCS,Outpatient,,,81.7,61.28,,75.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,75.98,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81.7,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,78.43,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,42.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.48,81.7,
AMB TRIAMCINOLONE ACET,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,20.03,15.02,,18.43,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.63,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18.03,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18.03,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.03,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15.02,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.23,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,10.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15.02,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.02,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.42,20.03,
AMB METHYLPREDNISOLONE SOD SUCC 125MG INJ,78002322,CDM,636,RC,J2930,HCPCS,Outpatient,,,69.9,52.43,,64.31,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,36.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,62.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,62.91,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,67.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,36.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,67.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,52.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,67.1,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,36.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,52.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,52.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.35,69.9,
AMB KETOROLAC 15MG/ML INJECTION,78002309,CDM,636,RC,J1885,HCPCS,Outpatient,,,19,14.25,,17.48,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,9.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,9.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,14.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,9.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,14.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9.88,19,
AMB DEPO-PROVERA 150MG/1ML INJECTION,78002345,CDM,636,RC,J1050,HCPCS,Outpatient,,,283.5,212.63,,260.82,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,147.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,263.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,255.15,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,255.15,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,275,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,283.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,147.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,275,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,212.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,272.16,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,147.42,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,212.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,212.63,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,147.42,283.5,
AMB GELSYN-3 16.8 MG/ML INJECTION,78002861,CDM,636,RC,J7328,HCPCS,Outpatient,,,1705.2,1278.9,,1568.78,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,886.7,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1585.84,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1534.68,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1534.68,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1654.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1705.2,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,886.7,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1654.04,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1278.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1636.99,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,886.7,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1278.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1278.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,886.7,1705.2,
AMB ACETAMINOPHEN 160MG TAB,78002282,CDM,637,RC,A9270,HCPCS,Outpatient,,,1,0.75,,0.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,0.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,0.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,0.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.52,1,
AMB HEPATITIS B VACC ADULT 3 DOSE IM,78002122,CDM,636,RC,90746,HCPCS,Outpatient,,,355.95,266.96,,327.47,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,185.09,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,331.03,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,320.36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,320.36,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,345.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,355.95,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,185.09,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,345.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,266.96,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,341.71,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,185.09,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,266.96,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,266.96,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,185.09,355.95,
CEFTRIAXONE 2GM INJ,78002907,CDM,636,RC,J0696,HCPCS,Outpatient,,,51.08,38.31,,46.99,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45.97,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45.97,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,49.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.08,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,49.55,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,38.31,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,49.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26.56,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.31,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.31,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,51.08,
AMB ROTAVIRUS VACCINE 2ML ORAL DOSE,78002170,CDM,636,RC,90680,HCPCS,Outpatient,,,1150,862.5,,1058,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,598,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1069.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1035,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1035,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1115.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1150,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,598,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1115.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,862.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1104,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,598,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,862.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,862.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,598,1150,
AMB ONDANESTRON HCL 2MG/ML 2ML INJ,78002326,CDM,636,RC,J2405,HCPCS,Outpatient,,,20.5,15.38,,18.86,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,10.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,18.45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,18.45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,10.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.89,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,15.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,10.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,10.66,20.5,
AMB LIDOCAINE HCL 2% 10ML INJECTION,78002317,CDM,636,RC,J2001,HCPCS,Outpatient,,,23.21,17.41,,21.35,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,12.07,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,20.89,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,20.89,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.21,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,12.07,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.28,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,12.07,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.41,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12.07,23.21,
AMB CYANOCOBALAM B-12 1000MCG/ML INJECTION,78002292,CDM,636,RC,J3420,HCPCS,Outpatient,,,87.4,65.55,,80.41,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,45.45,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.28,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,78.66,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,78.66,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,84.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,45.45,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.78,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,65.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.9,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,45.45,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,65.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45.45,87.4,
AMB ALBUTEROL 2.5MG/3ML 0.083% INHALATION SOL,78002285,CDM,636,RC,J7613,HCPCS,Outpatient,,,4,3,,3.68,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.72,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3.84,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2.08,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2.08,4,
AMB DUROLANE 20MG/ML IV SOLUTION,78002335,CDM,636,RC,J7318,HCPCS,Outpatient,,,1606.8,1205.1,,1478.26,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,835.54,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1494.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1446.12,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1446.12,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1558.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1606.8,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,835.54,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1558.6,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1205.1,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1542.53,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,835.54,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1205.1,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1205.1,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,835.54,1606.8,
METHYLPREDNISOLONE ACETATE 20MG,78002154,CDM,636,RC,J1020,HCPCS,Outpatient,,,31.7,23.78,,29.16,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,16.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,29.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,28.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,28.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,30.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.7,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,16.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,23.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.43,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,16.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,23.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,23.78,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.48,31.7,
AMB TRIAMCINOLOONE ACET,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,40.06,30.05,,36.86,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,20.83,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,36.05,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.05,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,38.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.06,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,20.83,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,38.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,30.05,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,38.46,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,20.83,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,30.05,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,30.05,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,20.83,40.06,
AMB CEFTRIAXONE 250MG INJECTION,78002288,CDM,636,RC,J0696,HCPCS,Outpatient,,,25,18.75,,23,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,23.25,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,24.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.25,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,18.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,24,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,13,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,18.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13,25,
AMB BETAMETHASONE (CELESTONE) 3MG INJ,78002766,CDM,636,RC,J0702,HCPCS,Outpatient,,,62.89,47.17,,57.86,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.7,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.49,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,62.89,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.7,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.17,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.37,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.7,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.17,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.17,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.7,62.89,
AMB KETOROLAC 30MG/ML INJECTION,78002310,CDM,636,RC,J1885,HCPCS,Outpatient,,,38,28.5,,34.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.76,38,
RHO D IMMUNE GLOBIN (RHOGAM) 300MCG INJ,78002772,CDM,636,RC,J2790,HCPCS,Outpatient,,,504.56,378.42,,464.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,262.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,469.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,454.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,454.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,489.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,504.56,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,262.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,489.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,378.42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,484.38,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,262.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,378.42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,378.42,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,262.37,504.56,
AMB ACETAMINOPHEN 325MG TAB,78002283,CDM,637,RC,A9270,HCPCS,Outpatient,,,1,0.75,,0.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,0.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,0.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,0.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.52,1,
AMB DEXAMETHASONE 4MG/ML INJECTION,78002294,CDM,636,RC,J1100,HCPCS,Outpatient,,,11.84,8.88,,10.89,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,6.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11.01,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,10.66,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10.66,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,11.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.84,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,6.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11.48,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,8.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.37,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,6.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6.16,11.84,
AMB ONDANSETRON 4MG TAB,78002327,CDM,637,RC,A9270,HCPCS,Outpatient,,,111.46,83.6,,102.54,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.66,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,100.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,100.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.46,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.12,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,83.6,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.96,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,83.6,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.6,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.96,111.46,
AMB SOLU-MEDROL (PF) 40 MG/ML SOLUTION FOR INJECTION,78002323,CDM,636,RC,J2920,HCPCS,Outpatient,,,36.3,27.23,,33.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,18.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,33.76,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,32.67,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,32.67,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,35.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.3,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,18.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.21,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,27.23,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,34.85,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,18.88,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.23,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.23,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,18.88,36.3,
AMB FUROSEMIDE 10MG/ML 4ML INJECTION,78002306,CDM,636,RC,J1940,HCPCS,Outpatient,,,7.15,5.36,,6.58,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,3.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,6.44,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6.44,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,6.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.15,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,3.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6.94,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,5.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6.86,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,3.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5.36,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3.72,7.15,
AMB DEPO-MEDROL 40MG/ML INJECTION,78002319,CDM,636,RC,J1030,HCPCS,Outpatient,,,63.4,47.55,,58.33,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.97,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.96,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,57.06,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,57.06,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.4,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.97,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.86,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.97,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.55,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.97,63.4,
AMB TRIAMCINOLONE ACET (KENALOG) 40MG,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,80.12,60.09,,73.71,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,41.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,74.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,72.11,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,72.11,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,77.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.12,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,41.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.72,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,60.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,76.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,41.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,60.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.09,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,41.66,80.12,
AMB KETOROLAC 45MG/ML INJECTION,78002803,CDM,636,RC,J1885,HCPCS,Outpatient,,,28.5,21.38,,26.22,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,14.82,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,26.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,25.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,25.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,27.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,14.82,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,27.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,21.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,27.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,14.82,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,21.38,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,14.82,28.5,
AMB DIPHENHYDRAMINE HCl 50MG/ML INJ,78002296,CDM,636,RC,J3490,HCPCS,Outpatient,,,16.65,12.49,,15.32,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,8.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,14.99,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,14.99,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,16.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.65,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,8.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.15,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,12.49,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,15.98,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,8.66,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,12.49,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12.49,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.66,16.65,
AMB CEFTRIAXONE 500MG INJECTION,78002289,CDM,636,RC,J0696,HCPCS,Outpatient,,,50,37.5,,46,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,46.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,48.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,48.5,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,26,50,
AMB KETOROLAC 60MG/ML INJECTION,78002311,CDM,636,RC,J1885,HCPCS,Outpatient,,,38,28.5,,34.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,35.34,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,36.86,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,36.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,19.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.76,38,
AMB DENOSUMAB (PROLIA) 1MG INJ,78002768,CDM,636,RC,J0897,HCPCS,Outpatient,,,5317.8,3988.35,,4892.38,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2765.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4945.55,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4786.02,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4786.02,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,5158.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5317.8,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2765.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,5158.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3988.35,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,5105.09,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2765.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3988.35,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3988.35,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2765.26,5317.8,
AMB BICILLIN LA 600K UNITS INJECTION,78002328,CDM,636,RC,J0561,HCPCS,Outpatient,,,232.44,174.33,,213.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,120.87,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,216.17,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,209.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,209.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,225.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232.44,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,120.87,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,225.47,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,174.33,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,223.14,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,120.87,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,174.33,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,174.33,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.87,232.44,
AMB TRIAMCINOLONE ACET,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,120.18,90.14,,110.57,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,62.49,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,111.77,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,108.16,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.16,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,116.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.18,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,62.49,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,116.57,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,90.14,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,62.49,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,90.14,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,90.14,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.49,120.18,
AMB NEXPLANON 68MG IUD IMPLANT,78002305,CDM,636,RC,J7307,HCPCS,Outpatient,,,3710.31,2782.73,,3413.49,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1929.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3450.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3339.28,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3339.28,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3599,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3710.31,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1929.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3599,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2782.73,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3561.9,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1929.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2782.73,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2782.73,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1929.36,3710.31,
AMB DEXAMETHASONE 4MG/ML INJECTION,78002294,CDM,636,RC,J1100,HCPCS,Outpatient,,,23.68,17.76,,21.79,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,12.31,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,21.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.31,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,22.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.68,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,12.31,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,22.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,17.76,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,22.73,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,12.31,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,17.76,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,17.76,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12.31,23.68,
SODIUM BICARBONATE 8.4% IV SOLUTION,78002894,CDM,250,RC,,,Outpatient,,,26.5,19.88,,24.38,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,13.78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,24.65,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,23.85,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,23.85,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,25.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.5,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,13.78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,25.71,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,19.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,25.44,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,13.78,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,19.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,19.88,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,13.78,26.5,
AMB GELSYN-3 8.4MG/ML INJECTION,78002336,CDM,636,RC,J7328,HCPCS,Outpatient,,,852.6,639.45,,784.39,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,443.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,792.92,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,767.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,767.34,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,827.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,852.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,443.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,827.02,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,639.45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,818.5,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,443.35,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,639.45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,639.45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,443.35,852.6,
AMB DEPO-MEDROL 80MG/ML INJECTION,78002320,CDM,636,RC,J1040,HCPCS,Outpatient,,,110.05,82.54,,101.25,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,57.23,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,102.35,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,99.05,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,99.05,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,110.05,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,57.23,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,106.75,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,82.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,105.65,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,57.23,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,82.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,82.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,57.23,110.05,
AMB TRIAMCINOLONE ACET (KENALOG) 40MG,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,160.24,120.18,,147.42,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,83.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,149.02,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,144.22,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,144.22,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,155.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,160.24,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,83.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,155.43,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,120.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,153.83,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,83.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.18,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,83.32,160.24,
AMB ASPRIN 81MG CHEWABLE TABLET,78002286,CDM,637,RC,A9270,HCPCS,Outpatient,,,1,0.75,,0.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,0.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,0.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,0.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.52,1,
IMMUNIZATION FIRST VACCINE/TOXOID THRU 18 YR,78001824,CDM,771,RC,90460,HCPCS,Outpatient,,,21.71,16.28,,19.97,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.29,21.71,
IMMUNIZATION EA ADD'L VACCINE/TOXOID THRU 18 YR,78001825,CDM,771,RC,90461,HCPCS,Outpatient,,,21.71,16.28,,19.97,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,20.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,19.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.71,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,21.06,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.29,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.28,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.29,21.71,
IMMUNIZATION ADMIN BY INTRANASAL OR ORAL,78001828,CDM,771,RC,90473,HCPCS,Outpatient,,,83,62.25,,76.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,77.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,74.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,74.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,80.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.51,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,
IMMUNIZATION ADMINISTRATION ORAL/NASAL EACH ADDITIONAL,78002352,CDM,771,RC,90474,HCPCS,Outpatient,,,60,45,,55.2,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,55.8,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.2,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,31.2,60,
94640: Inhalation/Aerosol,74000005,CDM,410,RC,94640,HCPCS,Outpatient,,,145,108.75,,133.4,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,134.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,140.65,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,139.2,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,75.4,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,108.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,75.4,145,
BOOSTRIX,78002133,CDM,636,RC,90715,HCPCS,Outpatient,,,257.9,193.43,,237.27,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,134.11,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.85,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,232.11,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,232.11,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,250.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,257.9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,134.11,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,250.16,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,193.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.58,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,134.11,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,193.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,193.43,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,257.9,
IMMUNIZATION ADMINISTRATION EACH ADD'L VACCINE,78001827,CDM,771,RC,90472,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,76.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,79.54,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,42.64,82,
IMMUNIZATION ADMINISTRATION ONE VACCINE,78001826,CDM,771,RC,90471,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,293.79,
AMB INFLUENZA FLUZONE HIGH DOSE QUAD VACCINE IM,78002165,CDM,636,RC,90662,HCPCS,Outpatient,,,270.43,202.82,,248.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,140.62,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,251.5,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,243.39,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,243.39,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,262.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,270.43,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,140.62,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,262.32,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,202.82,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,259.61,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,140.62,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,202.82,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,202.82,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,140.62,270.43,
AMB INFLUENZA FLUARIX QUAD VACCINE,78002178,CDM,636,RC,90686,HCPCS,Outpatient,,,112.29,84.22,,103.31,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,101.06,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.06,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112.29,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84.22,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.22,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.22,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.39,112.29,
ADMINISTRATION INFLUENZA VACCINE,78001822,CDM,771,RC,G0008,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,118,
ADMINISTRATION OF PNEUMOCOCCAL VACCINE,78001823,CDM,771,RC,G0009,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,109.74,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,114.46,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.36,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,61.36,118,
G0010: Medicare Hep B,78001826,CDM,771,RC,G0010,HCPCS,Outpatient,,,107,80.25,,98.44,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,55.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,99.51,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,103.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,55.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,103.79,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,80.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.64,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,80.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,80.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,55.64,107,
AMB HUMAN PAPILLOMAVIRUS VACC  2 OR 3 DOSE SCHEDULE,78002160,CDM,636,RC,90651,HCPCS,Outpatient,,,1289.51,967.13,,1186.35,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,670.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1199.24,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1160.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1160.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1250.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1289.51,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,670.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1250.82,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,967.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1237.93,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,670.55,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,967.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,967.13,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,670.55,1289.51,
HIB Vaccine,78002795,CDM,636,RC,90648,HCPCS,Outpatient,,,108.68,81.51,,99.99,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,56.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,101.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,97.81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,97.81,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,105.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.68,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,56.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,105.42,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,81.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,104.33,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,56.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,81.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,81.51,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,56.51,108.68,
INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
AMB DTAP-IPV VACC KINRIX CHILD 4-6 YRS FOR IM USE,78002147,CDM,636,RC,90696,HCPCS,Outpatient,,,257.48,193.11,,236.88,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,133.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,239.46,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,231.73,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,231.73,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,249.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,257.48,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,133.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,249.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,193.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,247.18,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,133.89,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,193.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,193.11,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,133.89,257.48,
AMB LEVONORGESTREL-RELEASING (KYLEENA) 19.5MG IUD,78002314,CDM,636,RC,J7296,HCPCS,Outpatient,,,3777.27,2832.95,,3475.09,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3512.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3777.27,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3626.18,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1964.18,3777.27,
AMB LEVONORGESTREL-RELEASING INTRAUTERINE (MIRENA) 52MG IUD,78002316,CDM,636,RC,J7298,HCPCS,Outpatient,,,3777.27,2832.95,,3475.09,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3512.86,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3399.54,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3777.27,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3663.95,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3626.18,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1964.18,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2832.95,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1964.18,3777.27,
VFC HEPATITIS A VACCINE 720 EI.U/0.5ML INJ,78002154,CDM,636,RC,90633,HCPCS,Outpatient,,,31.7,23.78,,29.16,92,,,percent of total billed charges,92% of total billed charges,16.48,52,,,percent of total billed charges,52% of total billed charges,29.48,93,,,percent of total billed charges,93% of total billed charges,28.53,90,,,percent of total billed charges,90% of total billed charges,28.53,90,,,percent of total billed charges,90% of total billed charges,30.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.48,52,,,percent of total billed charges,52% of total billed charges,30.75,97,,,percent of total billed charges,97% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,30.43,96,,,percent of total billed charges,96% of total billed charges,16.48,52,,,percent of total billed charges,52% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,16.48,30.75,
0.5 mL Hep A Vaccine,78002154,CDM,636,RC,90633,HCPCS,Outpatient,,,31.7,23.78,,29.16,92,,,percent of total billed charges,92% of total billed charges,16.48,52,,,percent of total billed charges,52% of total billed charges,29.48,93,,,percent of total billed charges,93% of total billed charges,28.53,90,,,percent of total billed charges,90% of total billed charges,28.53,90,,,percent of total billed charges,90% of total billed charges,30.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.48,52,,,percent of total billed charges,52% of total billed charges,30.75,97,,,percent of total billed charges,97% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,30.43,96,,,percent of total billed charges,96% of total billed charges,16.48,52,,,percent of total billed charges,52% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,16.48,30.75,
VFC DIPHTH/TET/ACELL PERT DTAP VACC <7 YR IM,78002134,CDM,636,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
AMB ORTHOVISC 30MG/2ML INJECTION,78002308,CDM,636,RC,J7324,HCPCS,Outpatient,,,2007.6,1505.7,,1846.99,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1043.95,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1867.07,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1806.84,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1806.84,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1947.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2007.6,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1043.95,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1947.37,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1505.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1927.3,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1043.95,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1505.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1505.7,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1043.95,2007.6,
Pneumococcal 15-valent Conjugate Vaccine,78002189,CDM,636,RC,90671,HCPCS,Outpatient,,,800.72,600.54,,736.66,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,416.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,744.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,720.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,720.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,776.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,800.72,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,416.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,776.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,600.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,768.69,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,416.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,600.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,600.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,416.37,800.72,
AMB AREXY RESPIRATORY SYNCYTIAL VIRUS VACCINE IM,78002194,CDM,636,RC,90679,HCPCS,Outpatient,,,1008,756,,927.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,937.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,907.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,907.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,977.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1008,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,977.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,967.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,1008,
AMB PCV15 PNEUMOCOCCAL CONJUGATE VACCINE IM,78002189,CDM,636,RC,90671,HCPCS,Outpatient,,,800.72,600.54,,736.66,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,416.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,744.67,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,720.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,720.65,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,776.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,800.72,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,416.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,776.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,600.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,768.69,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,416.37,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,600.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,600.54,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,416.37,800.72,
AMB PREDNISOLONE 15MG/5ML ORAL,78002343,CDM,636,RC,J7510,HCPCS,Outpatient,,,12.03,9.02,,11.07,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,6.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11.19,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,10.83,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,10.83,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,11.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.03,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,6.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,11.67,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,9.02,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,11.55,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,6.26,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,9.02,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,9.02,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6.26,12.03,
AMB LEVONORGESTRE (SKYLA) 13.5MG IMPLANT,78002315,CDM,636,RC,J7301,HCPCS,Outpatient,,,3145.2,2358.9,,2893.58,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,1635.5,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2925.04,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,2830.68,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,2830.68,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,3050.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3145.2,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,1635.5,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3050.84,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,2358.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3019.39,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,1635.5,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,2358.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2358.9,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1635.5,3145.2,
AMB HYLAN G-F,78002297,CDM,636,RC,J7325,HCPCS,Outpatient,,,1752,1314,,1611.84,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1629.36,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1576.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1576.8,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1699.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1752,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1699.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1681.92,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,911.04,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,911.04,1752,
AMB HYALURONATE SODIUM 48MG/6ML INJ,78002856,CDM,636,RC,J7325,HCPCS,Outpatient,,,4930.62,3697.97,,4536.17,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2563.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4585.48,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4437.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4437.56,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4782.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4930.62,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2563.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4782.7,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3697.97,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4733.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2563.92,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3697.97,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3697.97,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2563.92,4930.62,
AMB IBUPROFEN 200MG TAB,78002298,CDM,637,RC,A9270,HCPCS,Outpatient,,,1,0.75,,0.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,0.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,0.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,0.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.52,1,
ALBUTEROL-IPRATROPIUM 2.5-0.5MG/3ML INH,78002299,CDM,636,RC,J7613,HCPCS,Outpatient,,,9,6.75,,8.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,6.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4.68,9,
AMB LEVALBUTEROL 1.25MG/0.5ML INHALATION,78002313,CDM,636,RC,J7615,HCPCS,Outpatient,,,16.77,12.58,,15.43,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,8.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,15.6,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,15.09,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,15.09,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,16.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.77,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,8.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,16.27,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,12.58,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,8.72,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,12.58,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,12.58,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.72,16.77,
AMB NITROGLYCERIN 0.4MG TAB,78002325,CDM,637,RC,A9270,HCPCS,Outpatient,,,5.03,3.77,,4.63,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2.62,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4.68,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4.53,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.03,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2.62,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4.88,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4.83,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2.62,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3.77,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2.62,5.03,
AMB ROPIVACAINE 0.5% 5MG/ML 20ML INJ,78002330,CDM,636,RC,J2795,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,117.18,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,113.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,122.22,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,120.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,65.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,65.52,126,
AMB SODIUM BICARBONATE 4% IV SOLUTION,78002332,CDM,250,RC,,,Outpatient,,,4.58,3.44,,4.21,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2.38,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4.12,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4.12,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2.38,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2.38,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2.38,4.58,
AMB SODIUM PHOSPHATES PED ENEMA,78002344,CDM,250,RC,,,Outpatient,,,1,0.75,,0.92,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.93,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,0.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,0.9,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,0.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.97,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.96,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,0.52,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,0.52,1,
AMB PREVNAR PNEUMOCOCCAL 13 VAL CONJ 0.5ML VACC,78002166,CDM,636,RC,90670,HCPCS,Outpatient,,,1016.36,762.27,,935.05,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,528.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,945.21,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,914.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,914.72,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,985.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1016.36,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,528.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,985.87,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,762.27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,975.71,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,528.51,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,762.27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,762.27,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,528.51,1016.36,
Zoledronic acid (Reclast),78002871,CDM,636,RC,J3489,HCPCS,Outpatient,,,1440,1080,,1324.8,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,748.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1339.2,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,1296,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1296,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1396.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1440,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,748.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1396.8,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,1080,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1382.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,748.8,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1080,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1080,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,748.8,1440,
AMB AREXY RESPIRATORY SYNCYTIAL VIRUS VACCINE IM,78002194,CDM,636,RC,90679,HCPCS,Outpatient,,,1008,756,,927.36,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,937.44,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,907.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,907.2,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,977.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1008,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,977.76,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,967.68,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,524.16,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,756,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,524.16,1008,
INFLUENZA VIRUS VACCINE INACTIVATED,78002178,CDM,636,RC,90686,HCPCS,Outpatient,,,112.29,84.22,,103.31,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,58.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,104.43,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,101.06,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,101.06,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,108.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112.29,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,58.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,108.92,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,84.22,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,107.8,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,58.39,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,84.22,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,84.22,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,58.39,112.29,
PULMONARY STRESS TESTING 6-MINUTE WALK,74000004,CDM,510,RC,94618,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,115.32,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,120.28,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,119.04,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,64.48,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,64.48,124,
FINE NEEDLE ASPIRATION BX W/US GDN EA ADD'L,78002853,CDM,402,RC,10006,HCPCS,Outpatient,,,665,498.75,,611.8,92,,,percent of total billed charges,92% of total billed charges,345.8,52,,,percent of total billed charges,52% of total billed charges,618.45,93,,,percent of total billed charges,93% of total billed charges,598.5,90,,,percent of total billed charges,90% of total billed charges,598.5,90,,,percent of total billed charges,90% of total billed charges,645.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,345.8,52,,,percent of total billed charges,52% of total billed charges,645.05,97,,,percent of total billed charges,97% of total billed charges,498.75,75,,,percent of total billed charges,75% of total billed charges,638.4,96,,,percent of total billed charges,96% of total billed charges,345.8,52,,,percent of total billed charges,52% of total billed charges,498.75,75,,,percent of total billed charges,75% of total billed charges,498.75,75,,,percent of total billed charges,75% of total billed charges,345.8,645.05,
FINE NEEDLE ASPIRATION BX W/US GDN EA ADD'L,78002853,CDM,402,RC,10006,HCPCS,Outpatient,,,665,498.75,,611.8,92,,,percent of total billed charges,92% of total billed charges,345.8,52,,,percent of total billed charges,52% of total billed charges,618.45,93,,,percent of total billed charges,93% of total billed charges,598.5,90,,,percent of total billed charges,90% of total billed charges,598.5,90,,,percent of total billed charges,90% of total billed charges,645.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,345.8,52,,,percent of total billed charges,52% of total billed charges,645.05,97,,,percent of total billed charges,97% of total billed charges,498.75,75,,,percent of total billed charges,75% of total billed charges,638.4,96,,,percent of total billed charges,96% of total billed charges,345.8,52,,,percent of total billed charges,52% of total billed charges,498.75,75,,,percent of total billed charges,75% of total billed charges,498.75,75,,,percent of total billed charges,75% of total billed charges,345.8,645.05,
EPIFIX TISSUE GRAFT 4IN X 4IN,47101,CDM,636,RC,Q4186,HCPCS,Outpatient,,,10437,7827.75,,9602.04,92,,,percent of total billed charges,92% of total billed charges,5427.24,52,,,percent of total billed charges,52% of total billed charges,9706.41,93,,,percent of total billed charges,93% of total billed charges,9393.3,90,,,percent of total billed charges,90% of total billed charges,9393.3,90,,,percent of total billed charges,90% of total billed charges,10123.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5427.24,52,,,percent of total billed charges,52% of total billed charges,10123.89,97,,,percent of total billed charges,97% of total billed charges,7827.75,75,,,percent of total billed charges,75% of total billed charges,10019.52,96,,,percent of total billed charges,96% of total billed charges,5427.24,52,,,percent of total billed charges,52% of total billed charges,7827.75,75,,,percent of total billed charges,75% of total billed charges,7827.75,75,,,percent of total billed charges,75% of total billed charges,5427.24,10123.89,
SCREW NON-LOCKING 3.5MM,5135005,CDM,278,RC,C1713,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges,36.4,52,,,percent of total billed charges,52% of total billed charges,65.1,93,,,percent of total billed charges,93% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,67.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.4,52,,,percent of total billed charges,52% of total billed charges,67.9,97,,,percent of total billed charges,97% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,67.2,96,,,percent of total billed charges,96% of total billed charges,36.4,52,,,percent of total billed charges,52% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,36.4,67.9,
AMB ALBUTEROL-IPRATROPIUM 2.5-0.5MG/3ML INH,78002299,CDM,636,RC,J7644,HCPCS,Outpatient,,,9,6.75,,8.28,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,4.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.37,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,8.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,4.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,8.73,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,6.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,8.64,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,4.68,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,6.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4.68,9,
APPLY SKIN GRFT FACE NCK GENIT HAND FT TO 100SQCM 1ST 25SQCM,78000290G,CDM,361,RC,15275,HCPCS,Outpatient,,,1838,1378.5,,1690.96,92,,,percent of total billed charges,92% of total billed charges,955.76,52,,,percent of total billed charges,52% of total billed charges,1709.34,93,,,percent of total billed charges,93% of total billed charges,1654.2,90,,,percent of total billed charges,90% of total billed charges,1654.2,90,,,percent of total billed charges,90% of total billed charges,1782.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,955.76,52,,,percent of total billed charges,52% of total billed charges,1782.86,97,,,percent of total billed charges,97% of total billed charges,1378.5,75,,,percent of total billed charges,75% of total billed charges,1764.48,96,,,percent of total billed charges,96% of total billed charges,955.76,52,,,percent of total billed charges,52% of total billed charges,1378.5,75,,,percent of total billed charges,75% of total billed charges,1378.5,75,,,percent of total billed charges,75% of total billed charges,955.76,1782.86,
AMB ZOSTER VACCINE LIVE 0.5ML,78002347,CDM,636,RC,90736,HCPCS,Outpatient,,,1047.63,785.72,,963.82,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,544.77,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,974.3,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,942.87,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,942.87,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,1016.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1047.63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,544.77,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,1016.2,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,785.72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,1005.72,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,544.77,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,785.72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,785.72,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,544.77,1047.63,
INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,58.59,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,61.11,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.48,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,32.76,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,32.76,63,
SODIUM BICARBONATE 4% IV SOLUTION,78002332,CDM,250,RC,,,Outpatient,,,4.58,3.44,,4.21,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,2.38,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4.26,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,4.12,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4.12,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,4.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.58,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,2.38,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,4.44,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,3.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,4.4,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,2.38,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,3.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,3.44,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,2.38,4.58,
INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,107.88,93,,,percent of total billed charges,93% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,90% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116,100,,,Fee Schedule,Pays at 100% of WY Medicaid Fee Schedule,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,112.52,97,,,percent of total billed charges,97% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,111.36,96,,,percent of total billed charges,96% of total billed charges for outpatient setting,60.32,52,,,percent of total billed charges,52% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,,percent of total billed charges,75% of total billed charges for outpatient setting,60.32,116,
COLLECTION VENOUS BLOOD VENIPUNCTURE,78001297,CDM,300,RC,36415,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges,15.6,52,,,percent of total billed charges,52% of total billed charges,27.9,93,,,percent of total billed charges,93% of total billed charges,27,90,,,percent of total billed charges,90% of total billed charges,27,90,,,percent of total billed charges,90% of total billed charges,29.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.6,52,,,percent of total billed charges,52% of total billed charges,29.1,97,,,percent of total billed charges,97% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges,28.8,96,,,percent of total billed charges,96% of total billed charges,15.6,52,,,percent of total billed charges,52% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges,15.6,29.1,
COLLECTION CAPILLARY BLOOD SPECIMEN,78001299,CDM,510,RC,36416,HCPCS,Outpatient,,,17,12.75,,15.64,92,,,percent of total billed charges,92% of total billed charges,8.84,52,,,percent of total billed charges,52% of total billed charges,15.81,93,,,percent of total billed charges,93% of total billed charges,15.3,90,,,percent of total billed charges,90% of total billed charges,15.3,90,,,percent of total billed charges,90% of total billed charges,16.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.84,52,,,percent of total billed charges,52% of total billed charges,16.49,97,,,percent of total billed charges,97% of total billed charges,12.75,75,,,percent of total billed charges,75% of total billed charges,16.32,96,,,percent of total billed charges,96% of total billed charges,8.84,52,,,percent of total billed charges,52% of total billed charges,12.75,75,,,percent of total billed charges,75% of total billed charges,12.75,75,,,percent of total billed charges,75% of total billed charges,8.84,16.49,
MEAS POST-VOIDING RESIDUAL URINE/BLADDER CAP,78001540,CDM,510,RC,51798,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.13,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.13,22.13,
REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE UNI,78001819,CDM,510,RC,69209,HCPCS,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges,77.48,52,,,percent of total billed charges,52% of total billed charges,138.57,93,,,percent of total billed charges,93% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,144.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,77.48,52,,,percent of total billed charges,52% of total billed charges,144.53,97,,,percent of total billed charges,97% of total billed charges,111.75,75,,,percent of total billed charges,75% of total billed charges,143.04,96,,,percent of total billed charges,96% of total billed charges,77.48,52,,,percent of total billed charges,52% of total billed charges,111.75,75,,,percent of total billed charges,75% of total billed charges,111.75,75,,,percent of total billed charges,75% of total billed charges,77.48,144.53,
IMMUNIZATION ADMINISTRATION ONE VACCINE,78001826,CDM,771,RC,90471,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,293.79,
RABIES VACCINE FOR INTRAMUSCULAR USE,78002169,CDM,636,RC,90675,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,293.79,
PULMONARY STRESS TESTING 6-MINUTE WALK,74000004,CDM,510,RC,94618,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges,64.48,52,,,percent of total billed charges,52% of total billed charges,115.32,93,,,percent of total billed charges,93% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,120.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.48,52,,,percent of total billed charges,52% of total billed charges,120.28,97,,,percent of total billed charges,97% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,119.04,96,,,percent of total billed charges,96% of total billed charges,64.48,52,,,percent of total billed charges,52% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,64.48,120.28,
PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT,74000005,CDM,510,RC,94640,HCPCS,Outpatient,,,145,108.75,,133.4,92,,,percent of total billed charges,92% of total billed charges,75.4,52,,,percent of total billed charges,52% of total billed charges,134.85,93,,,percent of total billed charges,93% of total billed charges,130.5,90,,,percent of total billed charges,90% of total billed charges,130.5,90,,,percent of total billed charges,90% of total billed charges,140.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,75.4,52,,,percent of total billed charges,52% of total billed charges,140.65,97,,,percent of total billed charges,97% of total billed charges,108.75,75,,,percent of total billed charges,75% of total billed charges,139.2,96,,,percent of total billed charges,96% of total billed charges,75.4,52,,,percent of total billed charges,52% of total billed charges,108.75,75,,,percent of total billed charges,75% of total billed charges,108.75,75,,,percent of total billed charges,75% of total billed charges,75.4,140.65,
PULSE OXIMETRY SINGLE DETERMINATION,74000013,CDM,510,RC,94760,HCPCS,Outpatient,,,60,45,,55.2,92,,,percent of total billed charges,92% of total billed charges,31.2,52,,,percent of total billed charges,52% of total billed charges,55.8,93,,,percent of total billed charges,93% of total billed charges,54,90,,,percent of total billed charges,90% of total billed charges,54,90,,,percent of total billed charges,90% of total billed charges,58.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,31.2,52,,,percent of total billed charges,52% of total billed charges,58.2,97,,,percent of total billed charges,97% of total billed charges,45,75,,,percent of total billed charges,75% of total billed charges,57.6,96,,,percent of total billed charges,96% of total billed charges,31.2,52,,,percent of total billed charges,52% of total billed charges,45,75,,,percent of total billed charges,75% of total billed charges,45,75,,,percent of total billed charges,75% of total billed charges,31.2,58.2,
INJECTION ALLERGEN 1,78001854,CDM,510,RC,95115,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges,18.2,52,,,percent of total billed charges,52% of total billed charges,32.55,93,,,percent of total billed charges,93% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.2,52,,,percent of total billed charges,52% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,33.6,96,,,percent of total billed charges,96% of total billed charges,18.2,52,,,percent of total billed charges,52% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,18.2,33.95,
INJECTION ALLERGEN 2 OR MORE,78001855,CDM,510,RC,95117,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges,22.36,52,,,percent of total billed charges,52% of total billed charges,39.99,93,,,percent of total billed charges,93% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,41.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.36,52,,,percent of total billed charges,52% of total billed charges,41.71,97,,,percent of total billed charges,97% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,41.28,96,,,percent of total billed charges,96% of total billed charges,22.36,52,,,percent of total billed charges,52% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,22.36,41.71,
INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,66100019,CDM,510,RC,96360,HCPCS,Outpatient,,,413,309.75,,379.96,92,,,percent of total billed charges,92% of total billed charges,214.76,52,,,percent of total billed charges,52% of total billed charges,384.09,93,,,percent of total billed charges,93% of total billed charges,371.7,90,,,percent of total billed charges,90% of total billed charges,371.7,90,,,percent of total billed charges,90% of total billed charges,400.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,214.76,52,,,percent of total billed charges,52% of total billed charges,400.61,97,,,percent of total billed charges,97% of total billed charges,309.75,75,,,percent of total billed charges,75% of total billed charges,396.48,96,,,percent of total billed charges,96% of total billed charges,214.76,52,,,percent of total billed charges,52% of total billed charges,309.75,75,,,percent of total billed charges,75% of total billed charges,309.75,75,,,percent of total billed charges,75% of total billed charges,214.76,400.61,
INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,66100019,CDM,510,RC,96360,HCPCS,Outpatient,,,413,309.75,,379.96,92,,,percent of total billed charges,92% of total billed charges,214.76,52,,,percent of total billed charges,52% of total billed charges,384.09,93,,,percent of total billed charges,93% of total billed charges,371.7,90,,,percent of total billed charges,90% of total billed charges,371.7,90,,,percent of total billed charges,90% of total billed charges,400.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,214.76,52,,,percent of total billed charges,52% of total billed charges,400.61,97,,,percent of total billed charges,97% of total billed charges,309.75,75,,,percent of total billed charges,75% of total billed charges,396.48,96,,,percent of total billed charges,96% of total billed charges,214.76,52,,,percent of total billed charges,52% of total billed charges,309.75,75,,,percent of total billed charges,75% of total billed charges,309.75,75,,,percent of total billed charges,75% of total billed charges,214.76,400.61,
INFUSION HYDRATION EACH ADDITIONAL HOUR,66100020,CDM,510,RC,96361,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges,107.12,52,,,percent of total billed charges,52% of total billed charges,191.58,93,,,percent of total billed charges,93% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,199.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,107.12,52,,,percent of total billed charges,52% of total billed charges,199.82,97,,,percent of total billed charges,97% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,197.76,96,,,percent of total billed charges,96% of total billed charges,107.12,52,,,percent of total billed charges,52% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,107.12,199.82,
INFUSION HYDRATION EACH ADDITIONAL HOUR,66100020,CDM,510,RC,96361,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges,107.12,52,,,percent of total billed charges,52% of total billed charges,191.58,93,,,percent of total billed charges,93% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,199.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,107.12,52,,,percent of total billed charges,52% of total billed charges,199.82,97,,,percent of total billed charges,97% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,197.76,96,,,percent of total billed charges,96% of total billed charges,107.12,52,,,percent of total billed charges,52% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,107.12,199.82,
INFUSION FIRST DRUG INITIAL HOUR,66100021,CDM,510,RC,96365,HCPCS,Outpatient,,,581,435.75,,534.52,92,,,percent of total billed charges,92% of total billed charges,302.12,52,,,percent of total billed charges,52% of total billed charges,540.33,93,,,percent of total billed charges,93% of total billed charges,522.9,90,,,percent of total billed charges,90% of total billed charges,522.9,90,,,percent of total billed charges,90% of total billed charges,563.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,302.12,52,,,percent of total billed charges,52% of total billed charges,563.57,97,,,percent of total billed charges,97% of total billed charges,435.75,75,,,percent of total billed charges,75% of total billed charges,557.76,96,,,percent of total billed charges,96% of total billed charges,302.12,52,,,percent of total billed charges,52% of total billed charges,435.75,75,,,percent of total billed charges,75% of total billed charges,435.75,75,,,percent of total billed charges,75% of total billed charges,302.12,563.57,
INFUSION EACH ADDITIONAL HOUR,66100022,CDM,510,RC,96366,HCPCS,Outpatient,,,223,167.25,,205.16,92,,,percent of total billed charges,92% of total billed charges,115.96,52,,,percent of total billed charges,52% of total billed charges,207.39,93,,,percent of total billed charges,93% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,216.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,115.96,52,,,percent of total billed charges,52% of total billed charges,216.31,97,,,percent of total billed charges,97% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges,214.08,96,,,percent of total billed charges,96% of total billed charges,115.96,52,,,percent of total billed charges,52% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges,115.96,216.31,
INFUSION ADDL SEQUENTIAL NEW DRUG FIRST HOUR,66100023,CDM,510,RC,96367,HCPCS,Outpatient,,,133,99.75,,122.36,92,,,percent of total billed charges,92% of total billed charges,69.16,52,,,percent of total billed charges,52% of total billed charges,123.69,93,,,percent of total billed charges,93% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,129.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,69.16,52,,,percent of total billed charges,52% of total billed charges,129.01,97,,,percent of total billed charges,97% of total billed charges,99.75,75,,,percent of total billed charges,75% of total billed charges,127.68,96,,,percent of total billed charges,96% of total billed charges,69.16,52,,,percent of total billed charges,52% of total billed charges,99.75,75,,,percent of total billed charges,75% of total billed charges,99.75,75,,,percent of total billed charges,75% of total billed charges,69.16,129.01,
INFUSION IV CONCURRENT,66100024,CDM,510,RC,96368,HCPCS,Outpatient,,,410,307.5,,377.2,92,,,percent of total billed charges,92% of total billed charges,213.2,52,,,percent of total billed charges,52% of total billed charges,381.3,93,,,percent of total billed charges,93% of total billed charges,369,90,,,percent of total billed charges,90% of total billed charges,369,90,,,percent of total billed charges,90% of total billed charges,397.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,213.2,52,,,percent of total billed charges,52% of total billed charges,397.7,97,,,percent of total billed charges,97% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges,393.6,96,,,percent of total billed charges,96% of total billed charges,213.2,52,,,percent of total billed charges,52% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges,213.2,397.7,
CLINIC INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,58.59,93,,,percent of total billed charges,93% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.76,52,,,percent of total billed charges,52% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,60.48,96,,,percent of total billed charges,96% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,32.76,61.11,
INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,58.59,93,,,percent of total billed charges,93% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.76,52,,,percent of total billed charges,52% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,60.48,96,,,percent of total billed charges,96% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,32.76,61.11,
INJECTION INTRA-ARTERIAL,66100026,CDM,510,RC,96373,HCPCS,Outpatient,,,287,215.25,,264.04,92,,,percent of total billed charges,92% of total billed charges,149.24,52,,,percent of total billed charges,52% of total billed charges,266.91,93,,,percent of total billed charges,93% of total billed charges,258.3,90,,,percent of total billed charges,90% of total billed charges,258.3,90,,,percent of total billed charges,90% of total billed charges,278.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,149.24,52,,,percent of total billed charges,52% of total billed charges,278.39,97,,,percent of total billed charges,97% of total billed charges,215.25,75,,,percent of total billed charges,75% of total billed charges,275.52,96,,,percent of total billed charges,96% of total billed charges,149.24,52,,,percent of total billed charges,52% of total billed charges,215.25,75,,,percent of total billed charges,75% of total billed charges,215.25,75,,,percent of total billed charges,75% of total billed charges,149.24,278.39,
INJECTION IV PUSH SINGLE OR INITIAL DRUG,66100027,CDM,510,RC,96374,HCPCS,Outpatient,,,287,215.25,,264.04,92,,,percent of total billed charges,92% of total billed charges,149.24,52,,,percent of total billed charges,52% of total billed charges,266.91,93,,,percent of total billed charges,93% of total billed charges,258.3,90,,,percent of total billed charges,90% of total billed charges,258.3,90,,,percent of total billed charges,90% of total billed charges,278.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,149.24,52,,,percent of total billed charges,52% of total billed charges,278.39,97,,,percent of total billed charges,97% of total billed charges,215.25,75,,,percent of total billed charges,75% of total billed charges,275.52,96,,,percent of total billed charges,96% of total billed charges,149.24,52,,,percent of total billed charges,52% of total billed charges,215.25,75,,,percent of total billed charges,75% of total billed charges,215.25,75,,,percent of total billed charges,75% of total billed charges,149.24,278.39,
INJECTION IV PUSH EACH NEW DRUG,66100028,CDM,510,RC,96375,HCPCS,Outpatient,,,214,160.5,,196.88,92,,,percent of total billed charges,92% of total billed charges,111.28,52,,,percent of total billed charges,52% of total billed charges,199.02,93,,,percent of total billed charges,93% of total billed charges,192.6,90,,,percent of total billed charges,90% of total billed charges,192.6,90,,,percent of total billed charges,90% of total billed charges,207.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,111.28,52,,,percent of total billed charges,52% of total billed charges,207.58,97,,,percent of total billed charges,97% of total billed charges,160.5,75,,,percent of total billed charges,75% of total billed charges,205.44,96,,,percent of total billed charges,96% of total billed charges,111.28,52,,,percent of total billed charges,52% of total billed charges,160.5,75,,,percent of total billed charges,75% of total billed charges,160.5,75,,,percent of total billed charges,75% of total billed charges,111.28,207.58,
INJECTION IV PUSH EACH NEW DRUG,66100028,CDM,510,RC,96375,HCPCS,Outpatient,,,214,160.5,,196.88,92,,,percent of total billed charges,92% of total billed charges,111.28,52,,,percent of total billed charges,52% of total billed charges,199.02,93,,,percent of total billed charges,93% of total billed charges,192.6,90,,,percent of total billed charges,90% of total billed charges,192.6,90,,,percent of total billed charges,90% of total billed charges,207.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,111.28,52,,,percent of total billed charges,52% of total billed charges,207.58,97,,,percent of total billed charges,97% of total billed charges,160.5,75,,,percent of total billed charges,75% of total billed charges,205.44,96,,,percent of total billed charges,96% of total billed charges,111.28,52,,,percent of total billed charges,52% of total billed charges,160.5,75,,,percent of total billed charges,75% of total billed charges,160.5,75,,,percent of total billed charges,75% of total billed charges,111.28,207.58,
INJECTION EACH ADD'L SEQ IV PUSH SAME DRUG,66100029,CDM,510,RC,96376,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges,84.76,52,,,percent of total billed charges,52% of total billed charges,151.59,93,,,percent of total billed charges,93% of total billed charges,146.7,90,,,percent of total billed charges,90% of total billed charges,146.7,90,,,percent of total billed charges,90% of total billed charges,158.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,84.76,52,,,percent of total billed charges,52% of total billed charges,158.11,97,,,percent of total billed charges,97% of total billed charges,122.25,75,,,percent of total billed charges,75% of total billed charges,156.48,96,,,percent of total billed charges,96% of total billed charges,84.76,52,,,percent of total billed charges,52% of total billed charges,122.25,75,,,percent of total billed charges,75% of total billed charges,122.25,75,,,percent of total billed charges,75% of total billed charges,84.76,158.11,
IRRIGATION IMPLNTD VENOUS ACCESS DRUG DLVRY SYS,66100036,CDM,510,RC,96523,HCPCS,Outpatient,,,144,108,,132.48,92,,,percent of total billed charges,92% of total billed charges,74.88,52,,,percent of total billed charges,52% of total billed charges,133.92,93,,,percent of total billed charges,93% of total billed charges,129.6,90,,,percent of total billed charges,90% of total billed charges,129.6,90,,,percent of total billed charges,90% of total billed charges,139.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,74.88,52,,,percent of total billed charges,52% of total billed charges,139.68,97,,,percent of total billed charges,97% of total billed charges,108,75,,,percent of total billed charges,75% of total billed charges,138.24,96,,,percent of total billed charges,96% of total billed charges,74.88,52,,,percent of total billed charges,52% of total billed charges,108,75,,,percent of total billed charges,75% of total billed charges,108,75,,,percent of total billed charges,75% of total billed charges,74.88,139.68,
EDUCATION  and  TRAIN FOR PATIENT SELF MANAGEMENT,74300027,CDM,510,RC,98960,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,39.52,52,,,percent of total billed charges,52% of total billed charges,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.52,52,,,percent of total billed charges,52% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,39.52,52,,,percent of total billed charges,52% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,39.52,73.72,
APPOINTMENT CANCELLATION/NO SHOW FEE,78002855,CDM,510,RC,99999,HCPCS,Outpatient,,,50,37.5,,46,92,,,percent of total billed charges,92% of total billed charges,26,52,,,percent of total billed charges,52% of total billed charges,46.5,93,,,percent of total billed charges,93% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,45,90,,,percent of total billed charges,90% of total billed charges,48.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26,52,,,percent of total billed charges,52% of total billed charges,48.5,97,,,percent of total billed charges,97% of total billed charges,37.5,75,,,percent of total billed charges,75% of total billed charges,48,96,,,percent of total billed charges,96% of total billed charges,26,52,,,percent of total billed charges,52% of total billed charges,37.5,75,,,percent of total billed charges,75% of total billed charges,37.5,75,,,percent of total billed charges,75% of total billed charges,26,48.5,
INJECTION ALLERGEN 2 OR MORE,78001855,CDM,510,RC,95117,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges,22.36,52,,,percent of total billed charges,52% of total billed charges,39.99,93,,,percent of total billed charges,93% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,41.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.36,52,,,percent of total billed charges,52% of total billed charges,41.71,97,,,percent of total billed charges,97% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,41.28,96,,,percent of total billed charges,96% of total billed charges,22.36,52,,,percent of total billed charges,52% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,22.36,41.71,
INJECTION ALLERGEN 1,78001854,CDM,510,RC,95115,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges,18.2,52,,,percent of total billed charges,52% of total billed charges,32.55,93,,,percent of total billed charges,93% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.2,52,,,percent of total billed charges,52% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,33.6,96,,,percent of total billed charges,96% of total billed charges,18.2,52,,,percent of total billed charges,52% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,18.2,33.95,
RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET,78002114,CDM,300,RC,87637,HCPCS,Outpatient,,,452,339,,415.84,92,,,percent of total billed charges,92% of total billed charges,235.04,52,,,percent of total billed charges,52% of total billed charges,420.36,93,,,percent of total billed charges,93% of total billed charges,406.8,90,,,percent of total billed charges,90% of total billed charges,406.8,90,,,percent of total billed charges,90% of total billed charges,438.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,235.04,52,,,percent of total billed charges,52% of total billed charges,438.44,97,,,percent of total billed charges,97% of total billed charges,339,75,,,percent of total billed charges,75% of total billed charges,433.92,96,,,percent of total billed charges,96% of total billed charges,235.04,52,,,percent of total billed charges,52% of total billed charges,339,75,,,percent of total billed charges,75% of total billed charges,339,75,,,percent of total billed charges,75% of total billed charges,235.04,438.44,
APPLY LOW CST SKIN SUB =<100SQCM TRUNK 1ST 25SQCM,78002050,CDM,510,RC,C5271,HCPCS,Outpatient,,,1123,842.25,,1033.16,92,,,percent of total billed charges,92% of total billed charges,583.96,52,,,percent of total billed charges,52% of total billed charges,1044.39,93,,,percent of total billed charges,93% of total billed charges,1010.7,90,,,percent of total billed charges,90% of total billed charges,1010.7,90,,,percent of total billed charges,90% of total billed charges,1089.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,583.96,52,,,percent of total billed charges,52% of total billed charges,1089.31,97,,,percent of total billed charges,97% of total billed charges,842.25,75,,,percent of total billed charges,75% of total billed charges,1078.08,96,,,percent of total billed charges,96% of total billed charges,583.96,52,,,percent of total billed charges,52% of total billed charges,842.25,75,,,percent of total billed charges,75% of total billed charges,842.25,75,,,percent of total billed charges,75% of total billed charges,583.96,1089.31,
APPLY LOW COST SKIN SUB =<100SQCM TRUNK ADDL 25,78002051,CDM,510,RC,C5272,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges,128.44,52,,,percent of total billed charges,52% of total billed charges,229.71,93,,,percent of total billed charges,93% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,239.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,128.44,52,,,percent of total billed charges,52% of total billed charges,239.59,97,,,percent of total billed charges,97% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,237.12,96,,,percent of total billed charges,96% of total billed charges,128.44,52,,,percent of total billed charges,52% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,128.44,239.59,
APPLY LOW CST SKIN SUB =>100SQCM TRUNK 1ST 25SQCM,78002052,CDM,510,RC,C5273,HCPCS,Outpatient,,,3673,2754.75,,3379.16,92,,,percent of total billed charges,92% of total billed charges,1909.96,52,,,percent of total billed charges,52% of total billed charges,3415.89,93,,,percent of total billed charges,93% of total billed charges,3305.7,90,,,percent of total billed charges,90% of total billed charges,3305.7,90,,,percent of total billed charges,90% of total billed charges,3562.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1909.96,52,,,percent of total billed charges,52% of total billed charges,3562.81,97,,,percent of total billed charges,97% of total billed charges,2754.75,75,,,percent of total billed charges,75% of total billed charges,3526.08,96,,,percent of total billed charges,96% of total billed charges,1909.96,52,,,percent of total billed charges,52% of total billed charges,2754.75,75,,,percent of total billed charges,75% of total billed charges,2754.75,75,,,percent of total billed charges,75% of total billed charges,1909.96,3562.81,
APPLY LOW COST SKIN SUB =>100SQCM TRUNK ADDL 25,78002053,CDM,510,RC,C5274,HCPCS,Outpatient,,,808,606,,743.36,92,,,percent of total billed charges,92% of total billed charges,420.16,52,,,percent of total billed charges,52% of total billed charges,751.44,93,,,percent of total billed charges,93% of total billed charges,727.2,90,,,percent of total billed charges,90% of total billed charges,727.2,90,,,percent of total billed charges,90% of total billed charges,783.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,420.16,52,,,percent of total billed charges,52% of total billed charges,783.76,97,,,percent of total billed charges,97% of total billed charges,606,75,,,percent of total billed charges,75% of total billed charges,775.68,96,,,percent of total billed charges,96% of total billed charges,420.16,52,,,percent of total billed charges,52% of total billed charges,606,75,,,percent of total billed charges,75% of total billed charges,606,75,,,percent of total billed charges,75% of total billed charges,420.16,783.76,
APPLY LOW CST SKN SUB FACE <100SQCM 1ST 25SQCM =<,78002054,CDM,510,RC,C5275,HCPCS,Outpatient,,,1123,842.25,,1033.16,92,,,percent of total billed charges,92% of total billed charges,583.96,52,,,percent of total billed charges,52% of total billed charges,1044.39,93,,,percent of total billed charges,93% of total billed charges,1010.7,90,,,percent of total billed charges,90% of total billed charges,1010.7,90,,,percent of total billed charges,90% of total billed charges,1089.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,583.96,52,,,percent of total billed charges,52% of total billed charges,1089.31,97,,,percent of total billed charges,97% of total billed charges,842.25,75,,,percent of total billed charges,75% of total billed charges,1078.08,96,,,percent of total billed charges,96% of total billed charges,583.96,52,,,percent of total billed charges,52% of total billed charges,842.25,75,,,percent of total billed charges,75% of total billed charges,842.25,75,,,percent of total billed charges,75% of total billed charges,583.96,1089.31,
APPLY LOW COST SKIN SUB FACE <100SQCM EA ADDL 25,78002055,CDM,510,RC,C5276,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges,128.44,52,,,percent of total billed charges,52% of total billed charges,229.71,93,,,percent of total billed charges,93% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,239.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,128.44,52,,,percent of total billed charges,52% of total billed charges,239.59,97,,,percent of total billed charges,97% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,237.12,96,,,percent of total billed charges,96% of total billed charges,128.44,52,,,percent of total billed charges,52% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,128.44,239.59,
APPLY LOW COST SKIN SUBS FACE 1ST 100 SQCM,78002056,CDM,510,RC,C5272,HCPCS,Outpatient,,,1123,842.25,,1033.16,92,,,percent of total billed charges,92% of total billed charges,583.96,52,,,percent of total billed charges,52% of total billed charges,1044.39,93,,,percent of total billed charges,93% of total billed charges,1010.7,90,,,percent of total billed charges,90% of total billed charges,1010.7,90,,,percent of total billed charges,90% of total billed charges,1089.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,583.96,52,,,percent of total billed charges,52% of total billed charges,1089.31,97,,,percent of total billed charges,97% of total billed charges,842.25,75,,,percent of total billed charges,75% of total billed charges,1078.08,96,,,percent of total billed charges,96% of total billed charges,583.96,52,,,percent of total billed charges,52% of total billed charges,842.25,75,,,percent of total billed charges,75% of total billed charges,842.25,75,,,percent of total billed charges,75% of total billed charges,583.96,1089.31,
APPLY LOW COST SKIN SUBS FACE EA ADDL 100 SQCM,78002057,CDM,510,RC,C5278,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges,128.44,52,,,percent of total billed charges,52% of total billed charges,229.71,93,,,percent of total billed charges,93% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,239.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,128.44,52,,,percent of total billed charges,52% of total billed charges,239.59,97,,,percent of total billed charges,97% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,237.12,96,,,percent of total billed charges,96% of total billed charges,128.44,52,,,percent of total billed charges,52% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,128.44,239.59,
REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE UNI,78001819,CDM,510,RC,69209,HCPCS,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges,77.48,52,,,percent of total billed charges,52% of total billed charges,138.57,93,,,percent of total billed charges,93% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,144.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,77.48,52,,,percent of total billed charges,52% of total billed charges,144.53,97,,,percent of total billed charges,97% of total billed charges,111.75,75,,,percent of total billed charges,75% of total billed charges,143.04,96,,,percent of total billed charges,96% of total billed charges,77.48,52,,,percent of total billed charges,52% of total billed charges,111.75,75,,,percent of total billed charges,75% of total billed charges,111.75,75,,,percent of total billed charges,75% of total billed charges,77.48,144.53,
HEMAGLOBIN A1C CLINIC POC,78002849,CDM,300,RC,83037,HCPCS,Outpatient,,,29,21.75,,26.68,92,,,percent of total billed charges,92% of total billed charges,15.08,52,,,percent of total billed charges,52% of total billed charges,26.97,93,,,percent of total billed charges,93% of total billed charges,26.1,90,,,percent of total billed charges,90% of total billed charges,26.1,90,,,percent of total billed charges,90% of total billed charges,28.13,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.08,52,,,percent of total billed charges,52% of total billed charges,28.13,97,,,percent of total billed charges,97% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges,27.84,96,,,percent of total billed charges,96% of total billed charges,15.08,52,,,percent of total billed charges,52% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges,21.75,75,,,percent of total billed charges,75% of total billed charges,15.08,28.13,
STREP SCREEN RAPID,70200984,CDM,300,RC,87880,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges,36.4,52,,,percent of total billed charges,52% of total billed charges,65.1,93,,,percent of total billed charges,93% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,67.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.4,52,,,percent of total billed charges,52% of total billed charges,67.9,97,,,percent of total billed charges,97% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,67.2,96,,,percent of total billed charges,96% of total billed charges,36.4,52,,,percent of total billed charges,52% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,36.4,67.9,
Sendout Miscellaneous,PATH99,CDM,310,RC,,,Outpatient,,,0.01,0.01,,0.01,92,,,percent of total billed charges,92% of total billed charges,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,93,,,percent of total billed charges,93% of total billed charges,0.01,90,,,percent of total billed charges,90% of total billed charges,0.01,90,,,percent of total billed charges,90% of total billed charges,0.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,97,,,percent of total billed charges,97% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,96,,,percent of total billed charges,96% of total billed charges,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,0.01,
SPECIMAN HANDLING - OFFICE,70201077,CDM,300,RC,99000,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.6,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.6,13.6,
Health Fair CBC ,70200575,CDM,300,RC,85027,HCPCS,Outpatient,,,65,48.75,,59.8,92,,,percent of total billed charges,92% of total billed charges,33.8,52,,,percent of total billed charges,52% of total billed charges,60.45,93,,,percent of total billed charges,93% of total billed charges,58.5,90,,,percent of total billed charges,90% of total billed charges,58.5,90,,,percent of total billed charges,90% of total billed charges,63.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.8,52,,,percent of total billed charges,52% of total billed charges,63.05,97,,,percent of total billed charges,97% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges,62.4,96,,,percent of total billed charges,96% of total billed charges,33.8,52,,,percent of total billed charges,52% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges,48.75,75,,,percent of total billed charges,75% of total billed charges,33.8,63.05,
Health Fair CMP,70200005,CDM,300,RC,80053,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges,109.2,52,,,percent of total billed charges,52% of total billed charges,195.3,93,,,percent of total billed charges,93% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,203.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,109.2,52,,,percent of total billed charges,52% of total billed charges,203.7,97,,,percent of total billed charges,97% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,201.6,96,,,percent of total billed charges,96% of total billed charges,109.2,52,,,percent of total billed charges,52% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,109.2,203.7,
Health Fair Estradiol,70200279,CDM,300,RC,82670,HCPCS,Outpatient,,,317,237.75,,291.64,92,,,percent of total billed charges,92% of total billed charges,164.84,52,,,percent of total billed charges,52% of total billed charges,294.81,93,,,percent of total billed charges,93% of total billed charges,285.3,90,,,percent of total billed charges,90% of total billed charges,285.3,90,,,percent of total billed charges,90% of total billed charges,307.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,164.84,52,,,percent of total billed charges,52% of total billed charges,307.49,97,,,percent of total billed charges,97% of total billed charges,237.75,75,,,percent of total billed charges,75% of total billed charges,304.32,96,,,percent of total billed charges,96% of total billed charges,164.84,52,,,percent of total billed charges,52% of total billed charges,237.75,75,,,percent of total billed charges,75% of total billed charges,237.75,75,,,percent of total billed charges,75% of total billed charges,164.84,307.49,
Health Fair FSH,70200327,CDM,300,RC,83001,HCPCS,Outpatient,,,172,129,,158.24,92,,,percent of total billed charges,92% of total billed charges,89.44,52,,,percent of total billed charges,52% of total billed charges,159.96,93,,,percent of total billed charges,93% of total billed charges,154.8,90,,,percent of total billed charges,90% of total billed charges,154.8,90,,,percent of total billed charges,90% of total billed charges,166.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,89.44,52,,,percent of total billed charges,52% of total billed charges,166.84,97,,,percent of total billed charges,97% of total billed charges,129,75,,,percent of total billed charges,75% of total billed charges,165.12,96,,,percent of total billed charges,96% of total billed charges,89.44,52,,,percent of total billed charges,52% of total billed charges,129,75,,,percent of total billed charges,75% of total billed charges,129,75,,,percent of total billed charges,75% of total billed charges,89.44,166.84,
Health Fair Lipid Panel,70200007,CDM,300,RC,80061,HCPCS,Outpatient,,,10.83,8.12,,9.96,92,,,percent of total billed charges,92% of total billed charges,5.63,52,,,percent of total billed charges,52% of total billed charges,10.07,93,,,percent of total billed charges,93% of total billed charges,9.75,90,,,percent of total billed charges,90% of total billed charges,9.75,90,,,percent of total billed charges,90% of total billed charges,10.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.63,52,,,percent of total billed charges,52% of total billed charges,10.51,97,,,percent of total billed charges,97% of total billed charges,8.12,75,,,percent of total billed charges,75% of total billed charges,10.4,96,,,percent of total billed charges,96% of total billed charges,5.63,52,,,percent of total billed charges,52% of total billed charges,8.12,75,,,percent of total billed charges,75% of total billed charges,8.12,75,,,percent of total billed charges,75% of total billed charges,5.63,10.51,
Health Fair PSA,70200474,CDM,300,RC,84153,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.16,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.16,34.16,
Health Fair T3 ,70200527,CDM,300,RC,84481,HCPCS,Outpatient,,,159,119.25,,146.28,92,,,percent of total billed charges,92% of total billed charges,82.68,52,,,percent of total billed charges,52% of total billed charges,147.87,93,,,percent of total billed charges,93% of total billed charges,143.1,90,,,percent of total billed charges,90% of total billed charges,143.1,90,,,percent of total billed charges,90% of total billed charges,154.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.68,52,,,percent of total billed charges,52% of total billed charges,154.23,97,,,percent of total billed charges,97% of total billed charges,119.25,75,,,percent of total billed charges,75% of total billed charges,152.64,96,,,percent of total billed charges,96% of total billed charges,82.68,52,,,percent of total billed charges,52% of total billed charges,119.25,75,,,percent of total billed charges,75% of total billed charges,119.25,75,,,percent of total billed charges,75% of total billed charges,82.68,154.23,
Health Fair T4  ,70200517,CDM,300,RC,84439,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges,78.52,52,,,percent of total billed charges,52% of total billed charges,140.43,93,,,percent of total billed charges,93% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,146.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,78.52,52,,,percent of total billed charges,52% of total billed charges,146.47,97,,,percent of total billed charges,97% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,144.96,96,,,percent of total billed charges,96% of total billed charges,78.52,52,,,percent of total billed charges,52% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,78.52,146.47,
Health Fair TPO,70200736,CDM,300,RC,86376,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,57.72,52,,,percent of total billed charges,52% of total billed charges,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.72,52,,,percent of total billed charges,52% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,57.72,52,,,percent of total billed charges,52% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,57.72,107.67,
Health Fair TSH,70200519,CDM,300,RC,84443,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges,46.8,52,,,percent of total billed charges,52% of total billed charges,83.7,93,,,percent of total billed charges,93% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,87.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.8,52,,,percent of total billed charges,52% of total billed charges,87.3,97,,,percent of total billed charges,97% of total billed charges,67.5,75,,,percent of total billed charges,75% of total billed charges,86.4,96,,,percent of total billed charges,96% of total billed charges,46.8,52,,,percent of total billed charges,52% of total billed charges,67.5,75,,,percent of total billed charges,75% of total billed charges,67.5,75,,,percent of total billed charges,75% of total billed charges,46.8,87.3,
Health Fair Testosterone ,70200512,CDM,300,RC,84403,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges,128.44,52,,,percent of total billed charges,52% of total billed charges,229.71,93,,,percent of total billed charges,93% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,239.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,128.44,52,,,percent of total billed charges,52% of total billed charges,239.59,97,,,percent of total billed charges,97% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,237.12,96,,,percent of total billed charges,96% of total billed charges,128.44,52,,,percent of total billed charges,52% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,128.44,239.59,
Health Fair Vitamin B12,70200272,CDM,300,RC,82607,HCPCS,Outpatient,,,281,210.75,,258.52,92,,,percent of total billed charges,92% of total billed charges,146.12,52,,,percent of total billed charges,52% of total billed charges,261.33,93,,,percent of total billed charges,93% of total billed charges,252.9,90,,,percent of total billed charges,90% of total billed charges,252.9,90,,,percent of total billed charges,90% of total billed charges,272.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,146.12,52,,,percent of total billed charges,52% of total billed charges,272.57,97,,,percent of total billed charges,97% of total billed charges,210.75,75,,,percent of total billed charges,75% of total billed charges,269.76,96,,,percent of total billed charges,96% of total billed charges,146.12,52,,,percent of total billed charges,52% of total billed charges,210.75,75,,,percent of total billed charges,75% of total billed charges,210.75,75,,,percent of total billed charges,75% of total billed charges,146.12,272.57,
Health Fair Vitamin D,70200276,CDM,300,RC,82652,HCPCS,Outpatient,,,301,225.75,,276.92,92,,,percent of total billed charges,92% of total billed charges,156.52,52,,,percent of total billed charges,52% of total billed charges,279.93,93,,,percent of total billed charges,93% of total billed charges,270.9,90,,,percent of total billed charges,90% of total billed charges,270.9,90,,,percent of total billed charges,90% of total billed charges,291.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,156.52,52,,,percent of total billed charges,52% of total billed charges,291.97,97,,,percent of total billed charges,97% of total billed charges,225.75,75,,,percent of total billed charges,75% of total billed charges,288.96,96,,,percent of total billed charges,96% of total billed charges,156.52,52,,,percent of total billed charges,52% of total billed charges,225.75,75,,,percent of total billed charges,75% of total billed charges,225.75,75,,,percent of total billed charges,75% of total billed charges,156.52,291.97,
UA Microalb/Creat Ratio POCT,70200266,CDM,300,RC,82570,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges,58.76,52,,,percent of total billed charges,52% of total billed charges,105.09,93,,,percent of total billed charges,93% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,109.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.76,52,,,percent of total billed charges,52% of total billed charges,109.61,97,,,percent of total billed charges,97% of total billed charges,84.75,75,,,percent of total billed charges,75% of total billed charges,108.48,96,,,percent of total billed charges,96% of total billed charges,58.76,52,,,percent of total billed charges,52% of total billed charges,84.75,75,,,percent of total billed charges,75% of total billed charges,84.75,75,,,percent of total billed charges,75% of total billed charges,58.76,109.61,
IMMUNIZATION ADMINISTRATION ONE VACCINE,78001826,CDM,771,RC,90471,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,293.79,
MISC CHARGE,MISC99,CDM,510,RC,,,Outpatient,,,0.01,0.01,,0.01,92,,,percent of total billed charges,92% of total billed charges,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,93,,,percent of total billed charges,93% of total billed charges,0.01,90,,,percent of total billed charges,90% of total billed charges,0.01,90,,,percent of total billed charges,90% of total billed charges,0.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,97,,,percent of total billed charges,97% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,96,,,percent of total billed charges,96% of total billed charges,0.01,52,,,percent of total billed charges,52% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,75,,,percent of total billed charges,75% of total billed charges,0.01,0.01,
STREP SCREEN RAPID QUICKVUE,70200984,CDM,300,RC,87651,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges,36.4,52,,,percent of total billed charges,52% of total billed charges,65.1,93,,,percent of total billed charges,93% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,67.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,36.4,52,,,percent of total billed charges,52% of total billed charges,67.9,97,,,percent of total billed charges,97% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,67.2,96,,,percent of total billed charges,96% of total billed charges,36.4,52,,,percent of total billed charges,52% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,36.4,67.9,
DIPHTH/TET/ACELL PERT DTAP VACC <7 YR IM DOSE,78002139,CDM,636,RC,90700,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,56.16,52,,,percent of total billed charges,52% of total billed charges,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.16,52,,,percent of total billed charges,52% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,56.16,52,,,percent of total billed charges,52% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,56.16,104.76,
DIPHTH/TET/ACELL PERTUSSIS TDAP VACC >7 YR IM,78002133,CDM,636,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
AMB ZOSTER VACCINE SHINGRIX IM,78002341,CDM,636,RC,90750,HCPCS,Outpatient,,,440.17,330.13,,404.96,92,,,percent of total billed charges,92% of total billed charges,228.89,52,,,percent of total billed charges,52% of total billed charges,409.36,93,,,percent of total billed charges,93% of total billed charges,396.15,90,,,percent of total billed charges,90% of total billed charges,396.15,90,,,percent of total billed charges,90% of total billed charges,426.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,228.89,52,,,percent of total billed charges,52% of total billed charges,426.96,97,,,percent of total billed charges,97% of total billed charges,330.13,75,,,percent of total billed charges,75% of total billed charges,422.56,96,,,percent of total billed charges,96% of total billed charges,228.89,52,,,percent of total billed charges,52% of total billed charges,330.13,75,,,percent of total billed charges,75% of total billed charges,330.13,75,,,percent of total billed charges,75% of total billed charges,228.89,426.96,
AMB RABIES IMMUNE GLOBULIN 150U/ML 10ML INJ,78002169,CDM,636,RC,90675,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,293.79,
AMB CYANOCOBALAM B-12 1000MCG/ML INJECTION,78002292,CDM,636,RC,J3420,HCPCS,Outpatient,,,43.7,32.78,,40.2,92,,,percent of total billed charges,92% of total billed charges,22.72,52,,,percent of total billed charges,52% of total billed charges,40.64,93,,,percent of total billed charges,93% of total billed charges,39.33,90,,,percent of total billed charges,90% of total billed charges,39.33,90,,,percent of total billed charges,90% of total billed charges,42.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.72,52,,,percent of total billed charges,52% of total billed charges,42.39,97,,,percent of total billed charges,97% of total billed charges,32.78,75,,,percent of total billed charges,75% of total billed charges,41.95,96,,,percent of total billed charges,96% of total billed charges,22.72,52,,,percent of total billed charges,52% of total billed charges,32.78,75,,,percent of total billed charges,75% of total billed charges,32.78,75,,,percent of total billed charges,75% of total billed charges,22.72,42.39,
BICILLIN LA 1.2MU/2ML INJECTION,78002329,CDM,636,RC,J0561,HCPCS,Outpatient,,,413.16,309.87,,380.11,92,,,percent of total billed charges,92% of total billed charges,214.84,52,,,percent of total billed charges,52% of total billed charges,384.24,93,,,percent of total billed charges,93% of total billed charges,371.84,90,,,percent of total billed charges,90% of total billed charges,371.84,90,,,percent of total billed charges,90% of total billed charges,400.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,214.84,52,,,percent of total billed charges,52% of total billed charges,400.77,97,,,percent of total billed charges,97% of total billed charges,309.87,75,,,percent of total billed charges,75% of total billed charges,396.63,96,,,percent of total billed charges,96% of total billed charges,214.84,52,,,percent of total billed charges,52% of total billed charges,309.87,75,,,percent of total billed charges,75% of total billed charges,309.87,75,,,percent of total billed charges,75% of total billed charges,214.84,400.77,
AMB DEXAMETHASONE 10MG/ML INJECTION,78002761,CDM,636,RC,J1100,HCPCS,Outpatient,,,41.1,30.83,,37.81,92,,,percent of total billed charges,92% of total billed charges,21.37,52,,,percent of total billed charges,52% of total billed charges,38.22,93,,,percent of total billed charges,93% of total billed charges,36.99,90,,,percent of total billed charges,90% of total billed charges,36.99,90,,,percent of total billed charges,90% of total billed charges,39.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.37,52,,,percent of total billed charges,52% of total billed charges,39.87,97,,,percent of total billed charges,97% of total billed charges,30.83,75,,,percent of total billed charges,75% of total billed charges,39.46,96,,,percent of total billed charges,96% of total billed charges,21.37,52,,,percent of total billed charges,52% of total billed charges,30.83,75,,,percent of total billed charges,75% of total billed charges,30.83,75,,,percent of total billed charges,75% of total billed charges,21.37,39.87,
AMB TRIAMCINOLONE ACET,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,20.03,15.02,,18.43,92,,,percent of total billed charges,92% of total billed charges,10.42,52,,,percent of total billed charges,52% of total billed charges,18.63,93,,,percent of total billed charges,93% of total billed charges,18.03,90,,,percent of total billed charges,90% of total billed charges,18.03,90,,,percent of total billed charges,90% of total billed charges,19.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.42,52,,,percent of total billed charges,52% of total billed charges,19.43,97,,,percent of total billed charges,97% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,19.23,96,,,percent of total billed charges,96% of total billed charges,10.42,52,,,percent of total billed charges,52% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,10.42,19.43,
AMB CYANOCOBALAM B-12 1000MCG/ML INJECTION,78002292,CDM,636,RC,J3420,HCPCS,Outpatient,,,43.7,32.78,,40.2,92,,,percent of total billed charges,92% of total billed charges,22.72,52,,,percent of total billed charges,52% of total billed charges,40.64,93,,,percent of total billed charges,93% of total billed charges,39.33,90,,,percent of total billed charges,90% of total billed charges,39.33,90,,,percent of total billed charges,90% of total billed charges,42.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.72,52,,,percent of total billed charges,52% of total billed charges,42.39,97,,,percent of total billed charges,97% of total billed charges,32.78,75,,,percent of total billed charges,75% of total billed charges,41.95,96,,,percent of total billed charges,96% of total billed charges,22.72,52,,,percent of total billed charges,52% of total billed charges,32.78,75,,,percent of total billed charges,75% of total billed charges,32.78,75,,,percent of total billed charges,75% of total billed charges,22.72,42.39,
METHYLPREDNISOLONE ACETATE 20MG,78002154,CDM,636,RC,J1020,HCPCS,Outpatient,,,31.7,23.78,,29.16,92,,,percent of total billed charges,92% of total billed charges,16.48,52,,,percent of total billed charges,52% of total billed charges,29.48,93,,,percent of total billed charges,93% of total billed charges,28.53,90,,,percent of total billed charges,90% of total billed charges,28.53,90,,,percent of total billed charges,90% of total billed charges,30.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.48,52,,,percent of total billed charges,52% of total billed charges,30.75,97,,,percent of total billed charges,97% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,30.43,96,,,percent of total billed charges,96% of total billed charges,16.48,52,,,percent of total billed charges,52% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,16.48,30.75,
AMB TRIAMCINOLOONE ACET,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,20.03,15.02,,18.43,92,,,percent of total billed charges,92% of total billed charges,10.42,52,,,percent of total billed charges,52% of total billed charges,18.63,93,,,percent of total billed charges,93% of total billed charges,18.03,90,,,percent of total billed charges,90% of total billed charges,18.03,90,,,percent of total billed charges,90% of total billed charges,19.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.42,52,,,percent of total billed charges,52% of total billed charges,19.43,97,,,percent of total billed charges,97% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,19.23,96,,,percent of total billed charges,96% of total billed charges,10.42,52,,,percent of total billed charges,52% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,10.42,19.43,
AMB DEXAMETHASONE 4MG/ML INJECTION,78002294,CDM,636,RC,J1100,HCPCS,Outpatient,,,11.84,8.88,,10.89,92,,,percent of total billed charges,92% of total billed charges,6.16,52,,,percent of total billed charges,52% of total billed charges,11.01,93,,,percent of total billed charges,93% of total billed charges,10.66,90,,,percent of total billed charges,90% of total billed charges,10.66,90,,,percent of total billed charges,90% of total billed charges,11.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.16,52,,,percent of total billed charges,52% of total billed charges,11.48,97,,,percent of total billed charges,97% of total billed charges,8.88,75,,,percent of total billed charges,75% of total billed charges,11.37,96,,,percent of total billed charges,96% of total billed charges,6.16,52,,,percent of total billed charges,52% of total billed charges,8.88,75,,,percent of total billed charges,75% of total billed charges,8.88,75,,,percent of total billed charges,75% of total billed charges,6.16,11.48,
AMB DEPO-MEDROL 40MG/ML INJECTION,78002319,CDM,636,RC,J1030,HCPCS,Outpatient,,,63.4,47.55,,58.33,92,,,percent of total billed charges,92% of total billed charges,32.97,52,,,percent of total billed charges,52% of total billed charges,58.96,93,,,percent of total billed charges,93% of total billed charges,57.06,90,,,percent of total billed charges,90% of total billed charges,57.06,90,,,percent of total billed charges,90% of total billed charges,61.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.97,52,,,percent of total billed charges,52% of total billed charges,61.5,97,,,percent of total billed charges,97% of total billed charges,47.55,75,,,percent of total billed charges,75% of total billed charges,60.86,96,,,percent of total billed charges,96% of total billed charges,32.97,52,,,percent of total billed charges,52% of total billed charges,47.55,75,,,percent of total billed charges,75% of total billed charges,47.55,75,,,percent of total billed charges,75% of total billed charges,32.97,61.5,
AMB TRIAMCINOLONE ACET (KENALOG) 40MG,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,20.03,15.02,,18.43,92,,,percent of total billed charges,92% of total billed charges,10.42,52,,,percent of total billed charges,52% of total billed charges,18.63,93,,,percent of total billed charges,93% of total billed charges,18.03,90,,,percent of total billed charges,90% of total billed charges,18.03,90,,,percent of total billed charges,90% of total billed charges,19.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.42,52,,,percent of total billed charges,52% of total billed charges,19.43,97,,,percent of total billed charges,97% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,19.23,96,,,percent of total billed charges,96% of total billed charges,10.42,52,,,percent of total billed charges,52% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,10.42,19.43,
AMB TRIAMCINOLONE ACET,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,20.03,15.02,,18.43,92,,,percent of total billed charges,92% of total billed charges,10.42,52,,,percent of total billed charges,52% of total billed charges,18.63,93,,,percent of total billed charges,93% of total billed charges,18.03,90,,,percent of total billed charges,90% of total billed charges,18.03,90,,,percent of total billed charges,90% of total billed charges,19.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.42,52,,,percent of total billed charges,52% of total billed charges,19.43,97,,,percent of total billed charges,97% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,19.23,96,,,percent of total billed charges,96% of total billed charges,10.42,52,,,percent of total billed charges,52% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,10.42,19.43,
AMB DEXAMETHASONE 4MG/ML INJECTION,78002294,CDM,636,RC,J1100,HCPCS,Outpatient,,,11.84,8.88,,10.89,92,,,percent of total billed charges,92% of total billed charges,6.16,52,,,percent of total billed charges,52% of total billed charges,11.01,93,,,percent of total billed charges,93% of total billed charges,10.66,90,,,percent of total billed charges,90% of total billed charges,10.66,90,,,percent of total billed charges,90% of total billed charges,11.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.16,52,,,percent of total billed charges,52% of total billed charges,11.48,97,,,percent of total billed charges,97% of total billed charges,8.88,75,,,percent of total billed charges,75% of total billed charges,11.37,96,,,percent of total billed charges,96% of total billed charges,6.16,52,,,percent of total billed charges,52% of total billed charges,8.88,75,,,percent of total billed charges,75% of total billed charges,8.88,75,,,percent of total billed charges,75% of total billed charges,6.16,11.48,
AMB DEPO-MEDROL 80MG/ML INJECTION,78002320,CDM,636,RC,J1040,HCPCS,Outpatient,,,110.05,82.54,,101.25,92,,,percent of total billed charges,92% of total billed charges,57.23,52,,,percent of total billed charges,52% of total billed charges,102.35,93,,,percent of total billed charges,93% of total billed charges,99.05,90,,,percent of total billed charges,90% of total billed charges,99.05,90,,,percent of total billed charges,90% of total billed charges,106.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.23,52,,,percent of total billed charges,52% of total billed charges,106.75,97,,,percent of total billed charges,97% of total billed charges,82.54,75,,,percent of total billed charges,75% of total billed charges,105.65,96,,,percent of total billed charges,96% of total billed charges,57.23,52,,,percent of total billed charges,52% of total billed charges,82.54,75,,,percent of total billed charges,75% of total billed charges,82.54,75,,,percent of total billed charges,75% of total billed charges,57.23,106.75,
AMB TRIAMCINOLONE ACET (KENALOG) 40MG,78002799,CDM,636,RC,J3301,HCPCS,Outpatient,,,20.03,15.02,,18.43,92,,,percent of total billed charges,92% of total billed charges,10.42,52,,,percent of total billed charges,52% of total billed charges,18.63,93,,,percent of total billed charges,93% of total billed charges,18.03,90,,,percent of total billed charges,90% of total billed charges,18.03,90,,,percent of total billed charges,90% of total billed charges,19.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.42,52,,,percent of total billed charges,52% of total billed charges,19.43,97,,,percent of total billed charges,97% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,19.23,96,,,percent of total billed charges,96% of total billed charges,10.42,52,,,percent of total billed charges,52% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,15.02,75,,,percent of total billed charges,75% of total billed charges,10.42,19.43,
BOOSTRIX,78002133,CDM,636,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
IMMUNIZATION ADMINISTRATION EACH ADD'L VACCINE,78001827,CDM,771,RC,90472,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges,42.64,52,,,percent of total billed charges,52% of total billed charges,76.26,93,,,percent of total billed charges,93% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,79.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,42.64,52,,,percent of total billed charges,52% of total billed charges,79.54,97,,,percent of total billed charges,97% of total billed charges,61.5,75,,,percent of total billed charges,75% of total billed charges,78.72,96,,,percent of total billed charges,96% of total billed charges,42.64,52,,,percent of total billed charges,52% of total billed charges,61.5,75,,,percent of total billed charges,75% of total billed charges,61.5,75,,,percent of total billed charges,75% of total billed charges,42.64,79.54,
IMMUNIZATION ADMINISTRATION ONE VACCINE,78001826,CDM,771,RC,90471,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,293.79,293.79,
AMB HUMAN PAPILLOMAVIRUS VACC  2 OR 3 DOSE SCHEDULE,78002160,CDM,636,RC,90651,HCPCS,Outpatient,,,1704,1278,,1567.68,92,,,percent of total billed charges,92% of total billed charges,886.08,52,,,percent of total billed charges,52% of total billed charges,1584.72,93,,,percent of total billed charges,93% of total billed charges,1533.6,90,,,percent of total billed charges,90% of total billed charges,1533.6,90,,,percent of total billed charges,90% of total billed charges,1652.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,886.08,52,,,percent of total billed charges,52% of total billed charges,1652.88,97,,,percent of total billed charges,97% of total billed charges,1278,75,,,percent of total billed charges,75% of total billed charges,1635.84,96,,,percent of total billed charges,96% of total billed charges,886.08,52,,,percent of total billed charges,52% of total billed charges,1278,75,,,percent of total billed charges,75% of total billed charges,1278,75,,,percent of total billed charges,75% of total billed charges,886.08,1652.88,
INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,58.59,93,,,percent of total billed charges,93% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.76,52,,,percent of total billed charges,52% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,60.48,96,,,percent of total billed charges,96% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,32.76,61.11,
INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,58.59,93,,,percent of total billed charges,93% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.76,52,,,percent of total billed charges,52% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,60.48,96,,,percent of total billed charges,96% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,32.76,61.11,
VFC HEPATITIS A VACCINE 720 EI.U/0.5ML INJ,78002154,CDM,636,RC,90633,HCPCS,Outpatient,,,31.7,23.78,,29.16,92,,,percent of total billed charges,92% of total billed charges,16.48,52,,,percent of total billed charges,52% of total billed charges,29.48,93,,,percent of total billed charges,93% of total billed charges,28.53,90,,,percent of total billed charges,90% of total billed charges,28.53,90,,,percent of total billed charges,90% of total billed charges,30.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.48,52,,,percent of total billed charges,52% of total billed charges,30.75,97,,,percent of total billed charges,97% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,30.43,96,,,percent of total billed charges,96% of total billed charges,16.48,52,,,percent of total billed charges,52% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,16.48,30.75,
0.5 mL Hep A Vaccine,78002154,CDM,636,RC,90633,HCPCS,Outpatient,,,31.7,23.78,,29.16,92,,,percent of total billed charges,92% of total billed charges,16.48,52,,,percent of total billed charges,52% of total billed charges,29.48,93,,,percent of total billed charges,93% of total billed charges,28.53,90,,,percent of total billed charges,90% of total billed charges,28.53,90,,,percent of total billed charges,90% of total billed charges,30.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.48,52,,,percent of total billed charges,52% of total billed charges,30.75,97,,,percent of total billed charges,97% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,30.43,96,,,percent of total billed charges,96% of total billed charges,16.48,52,,,percent of total billed charges,52% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,23.78,75,,,percent of total billed charges,75% of total billed charges,16.48,30.75,
VFC DIPHTH/TET/ACELL PERT DTAP VACC <7 YR IM,78002134,CDM,636,RC,90715,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,100,,,Fee Schedule,pays at 100% of LHI Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.75,48.75,
AMB LEVONORGESTRE (SKYLA) 13.5MG IMPLANT,78002315,CDM,636,RC,J7301,HCPCS,Outpatient,,,3145.2,2358.9,,2893.58,92,,,percent of total billed charges,92% of total billed charges,1635.5,52,,,percent of total billed charges,52% of total billed charges,2925.04,93,,,percent of total billed charges,93% of total billed charges,2830.68,90,,,percent of total billed charges,90% of total billed charges,2830.68,90,,,percent of total billed charges,90% of total billed charges,3050.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1635.5,52,,,percent of total billed charges,52% of total billed charges,3050.84,97,,,percent of total billed charges,97% of total billed charges,2358.9,75,,,percent of total billed charges,75% of total billed charges,3019.39,96,,,percent of total billed charges,96% of total billed charges,1635.5,52,,,percent of total billed charges,52% of total billed charges,2358.9,75,,,percent of total billed charges,75% of total billed charges,2358.9,75,,,percent of total billed charges,75% of total billed charges,1635.5,3050.84,
AMB HYLAN G-F,78002297,CDM,636,RC,J7325,HCPCS,Outpatient,,,1752,1314,,1611.84,92,,,percent of total billed charges,92% of total billed charges,911.04,52,,,percent of total billed charges,52% of total billed charges,1629.36,93,,,percent of total billed charges,93% of total billed charges,1576.8,90,,,percent of total billed charges,90% of total billed charges,1576.8,90,,,percent of total billed charges,90% of total billed charges,1699.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,911.04,52,,,percent of total billed charges,52% of total billed charges,1699.44,97,,,percent of total billed charges,97% of total billed charges,1314,75,,,percent of total billed charges,75% of total billed charges,1681.92,96,,,percent of total billed charges,96% of total billed charges,911.04,52,,,percent of total billed charges,52% of total billed charges,1314,75,,,percent of total billed charges,75% of total billed charges,1314,75,,,percent of total billed charges,75% of total billed charges,911.04,1699.44,
AMB HYALURONATE SODIUM 48MG/6ML INJ,78002856,CDM,636,RC,J7325,HCPCS,Outpatient,,,4930.62,3697.97,,4536.17,92,,,percent of total billed charges,92% of total billed charges,2563.92,52,,,percent of total billed charges,52% of total billed charges,4585.48,93,,,percent of total billed charges,93% of total billed charges,4437.56,90,,,percent of total billed charges,90% of total billed charges,4437.56,90,,,percent of total billed charges,90% of total billed charges,4782.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2563.92,52,,,percent of total billed charges,52% of total billed charges,4782.7,97,,,percent of total billed charges,97% of total billed charges,3697.97,75,,,percent of total billed charges,75% of total billed charges,4733.4,96,,,percent of total billed charges,96% of total billed charges,2563.92,52,,,percent of total billed charges,52% of total billed charges,3697.97,75,,,percent of total billed charges,75% of total billed charges,3697.97,75,,,percent of total billed charges,75% of total billed charges,2563.92,4782.7,
PULMONARY STRESS TESTING 6-MINUTE WALK,74000004,CDM,510,RC,94618,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges,64.48,52,,,percent of total billed charges,52% of total billed charges,115.32,93,,,percent of total billed charges,93% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,120.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.48,52,,,percent of total billed charges,52% of total billed charges,120.28,97,,,percent of total billed charges,97% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,119.04,96,,,percent of total billed charges,96% of total billed charges,64.48,52,,,percent of total billed charges,52% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,64.48,120.28,
INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,58.59,93,,,percent of total billed charges,93% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.76,52,,,percent of total billed charges,52% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,60.48,96,,,percent of total billed charges,96% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,32.76,61.11,
INJECTION SUBQ OR IM,66100025,CDM,510,RC,96372,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,58.59,93,,,percent of total billed charges,93% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.76,52,,,percent of total billed charges,52% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,60.48,96,,,percent of total billed charges,96% of total billed charges,32.76,52,,,percent of total billed charges,52% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,32.76,61.11,
TELEMETRY,60200016,CDM,121,RC,,,Inpatient,,,803,602.25,,738.76,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,746.79,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,722.7,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,722.7,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,778.91,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,778.91,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,602.25,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,770.88,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,602.25,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,602.25,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
ROOM/BED: ICU,61000001,CDM,200,RC,,,Inpatient,,,4553,3414.75,,4188.76,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,4234.29,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,4097.7,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,4097.7,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,4416.41,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,4416.41,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,3414.75,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,4370.88,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,3414.75,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,3414.75,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
DAILY ICU ISOLATION ROOM CHARGE,61000002,CDM,200,RC,,,Inpatient,,,5132,3849,,4721.44,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,4772.76,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,4618.8,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,4618.8,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,4978.04,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,4978.04,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,3849,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,4926.72,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,3849,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,3849,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4978.04,
RB SEMI-PRIVATE MEDICAL ISOLATION,60200003,CDM,164,RC,,,Inpatient,,,4559,3419.25,,4194.28,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,4239.87,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,4103.1,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,4103.1,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,4422.23,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,4422.23,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,3419.25,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,4376.64,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,3419.25,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,3419.25,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
RB SEMI-PRIVATE MEDICAL OVERFLOW,60200001,CDM,121,RC,,,Inpatient,,,3178,2383.5,,2923.76,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,2955.54,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,2860.2,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,2860.2,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,3082.66,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,3082.66,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,2383.5,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,3050.88,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,2383.5,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,2383.5,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
HC RB NURSERY SAME DAY TRANSFER,65000004,CDM,173,RC,,,Inpatient,,,2316,1737,,2130.72,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,2153.88,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,2084.4,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,2084.4,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,2246.52,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,2246.52,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,1737,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,2223.36,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,1737,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,1737,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
RB NURSERY LEVEL I,65000001,CDM,171,RC,,,Inpatient,,,1425,1068.75,,1311,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,1325.25,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,1282.5,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,1282.5,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,1382.25,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,1382.25,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,1068.75,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,1368,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,1068.75,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,1068.75,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
RB NURSERY LEVEL II,65000002,CDM,172,RC,,,Inpatient,,,1620,1215,,1490.4,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,1506.6,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,1458,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,1458,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,1571.4,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,1571.4,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,1215,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,1555.2,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,1215,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,1215,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
RB NURSERY LEVEL III,65000003,CDM,173,RC,,,Inpatient,,,2316,1737,,2130.72,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,2153.88,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,2084.4,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,2084.4,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,2246.52,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,2246.52,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,1737,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,2223.36,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,1737,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,1737,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
RB OB/GYN SEMI-PRIVATE,60500001,CDM,122,RC,,,Inpatient,,,3086,2314.5,,2839.12,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,2869.98,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,2777.4,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,2777.4,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,2993.42,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,2993.42,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,2314.5,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,2962.56,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,2314.5,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,2314.5,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
RB PSYCH EMERGENCY DETENTION,60200004,CDM,114,RC,,,Inpatient,,,1977,1482.75,,1818.84,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,1838.61,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,1779.3,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,1779.3,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,1917.69,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,1917.69,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,1482.75,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,4966,100,,,per diem,paid based on per day rate,1482.75,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,1482.75,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
RB SEMI-PRIVATE MEDICAL,60200001,CDM,121,RC,,,Inpatient,,,3178,2383.5,,2923.76,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,2955.54,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,2860.2,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,2860.2,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,3082.66,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,3082.66,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,2383.5,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,3050.88,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,2383.5,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,2383.5,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
RB SEMI-PRIVATE SWING BED,60200005,CDM,120,RC,,,Inpatient,,,3932,2949,,3617.44,92,,,percent of total billed charges,pays at 92% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,3656.76,93,,,percent of total billed charges,pays at 93% of total billed charges for inpatient setting,3538.8,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,3538.8,90,,,percent of total billed charges,pays at 90% of total billed charges for inpatient setting,3814.04,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,,,,,Other,Not Separately reimbursable,256.88,100,,,per diem,paid based on per day rate,4966,100,,,per diem,paid based on per day rate,3814.04,97,,,percent of total billed charges,pays at 97% of total billed charges for inpatient setting,2949,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,3774.72,96,,,percent of total billed charges,pays at 96% of total billed charges for inpatient setting,4966,100,,,per diem,paid based on per day rate,2949,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,2949,75,,,percent of total billed charges,pays at 75% of total billed charges for inpatient setting,256.88,4966,
CLOSED TREATMENT OF FRACTURE OF LOWER WEIGHT BEARING JOINT O,78001010G,CDM,983,RC,27825,HCPCS,Outpatient,,,2487,1865.25,,2288.04,92,,,percent of total billed charges,92% of total billed charges,53.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2312.91,93,,,percent of total billed charges,93% of total billed charges,2238.3,90,,,percent of total billed charges,90% of total billed charges,2238.3,90,,,percent of total billed charges,90% of total billed charges,2412.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2412.39,97,,,percent of total billed charges,97% of total billed charges,1865.25,75,,,percent of total billed charges,75% of total billed charges,2387.52,96,,,percent of total billed charges,96% of total billed charges,53.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1865.25,75,,,percent of total billed charges,75% of total billed charges,1865.25,75,,,percent of total billed charges,75% of total billed charges,53.22,2412.39,
SHVG SKIN LESN 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,78002891G,CDM,960,RC,11302,HCPCS,Outpatient,,,306,229.5,,281.52,92,,,percent of total billed charges,92% of total billed charges,5.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.58,93,,,percent of total billed charges,93% of total billed charges,275.4,90,,,percent of total billed charges,90% of total billed charges,275.4,90,,,percent of total billed charges,90% of total billed charges,296.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.82,97,,,percent of total billed charges,97% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges,293.76,96,,,percent of total billed charges,96% of total billed charges,5.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,229.5,75,,,percent of total billed charges,75% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges,5.02,296.82,
Central Line Performing Procedure.,78001315,CDM,964,RC,36558,HCPCS,Outpatient,,,5901,4425.75,,5428.92,92,,,percent of total billed charges,92% of total billed charges,26.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5487.93,93,,,percent of total billed charges,93% of total billed charges,5310.9,90,,,percent of total billed charges,90% of total billed charges,5310.9,90,,,percent of total billed charges,90% of total billed charges,5723.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5723.97,97,,,percent of total billed charges,97% of total billed charges,4425.75,75,,,percent of total billed charges,75% of total billed charges,5664.96,96,,,percent of total billed charges,96% of total billed charges,26.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4425.75,75,,,percent of total billed charges,75% of total billed charges,4425.75,75,,,percent of total billed charges,75% of total billed charges,26.14,5723.97,
PF CT ABDOMEN  PELVIS W  W/O CONT:  PRO FEE ADD ON,72300054P,CDM,972,RC,74178,HCPCS,Outpatient,,,978,733.5,,899.76,92,,,percent of total billed charges,92% of total billed charges,9.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,909.54,93,,,percent of total billed charges,93% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,948.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,948.66,97,,,percent of total billed charges,97% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,938.88,96,,,percent of total billed charges,96% of total billed charges,9.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,733.5,75,,,percent of total billed charges,75% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,9.63,948.66,
PF CT ABDOMEN  PELVIS W/O CONT:  PRO FEE ADD ON,72300052P,CDM,972,RC,74176,HCPCS,Outpatient,,,559,419.25,,514.28,92,,,percent of total billed charges,92% of total billed charges,4.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,519.87,93,,,percent of total billed charges,93% of total billed charges,503.1,90,,,percent of total billed charges,90% of total billed charges,503.1,90,,,percent of total billed charges,90% of total billed charges,542.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,542.23,97,,,percent of total billed charges,97% of total billed charges,419.25,75,,,percent of total billed charges,75% of total billed charges,536.64,96,,,percent of total billed charges,96% of total billed charges,4.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,419.25,75,,,percent of total billed charges,75% of total billed charges,419.25,75,,,percent of total billed charges,75% of total billed charges,4.21,542.23,
PF CT ABDOMEN  PELVIS W/CONT:  PRO FEE ADD ON,72300053P,CDM,972,RC,74177,HCPCS,Outpatient,,,873,654.75,,803.16,92,,,percent of total billed charges,92% of total billed charges,8.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,811.89,93,,,percent of total billed charges,93% of total billed charges,785.7,90,,,percent of total billed charges,90% of total billed charges,785.7,90,,,percent of total billed charges,90% of total billed charges,846.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,846.81,97,,,percent of total billed charges,97% of total billed charges,654.75,75,,,percent of total billed charges,75% of total billed charges,838.08,96,,,percent of total billed charges,96% of total billed charges,8.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,654.75,75,,,percent of total billed charges,75% of total billed charges,654.75,75,,,percent of total billed charges,75% of total billed charges,8.35,846.81,
PF CT ANGIO ABDOMEN:  PRO FEE ADD ON,72300051P,CDM,972,RC,74175,HCPCS,Outpatient,,,869,651.75,,799.48,92,,,percent of total billed charges,92% of total billed charges,8.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,808.17,93,,,percent of total billed charges,93% of total billed charges,782.1,90,,,percent of total billed charges,90% of total billed charges,782.1,90,,,percent of total billed charges,90% of total billed charges,842.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.93,97,,,percent of total billed charges,97% of total billed charges,651.75,75,,,percent of total billed charges,75% of total billed charges,834.24,96,,,percent of total billed charges,96% of total billed charges,8.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,651.75,75,,,percent of total billed charges,75% of total billed charges,651.75,75,,,percent of total billed charges,75% of total billed charges,8.71,842.93,
PF CT GUIDANCE NEEDLE PLACEMENT:  PRO FEE ADD ON,72300059P,CDM,972,RC,77012,HCPCS,Outpatient,,,427,320.25,,392.84,92,,,percent of total billed charges,92% of total billed charges,2.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,397.11,93,,,percent of total billed charges,93% of total billed charges,384.3,90,,,percent of total billed charges,90% of total billed charges,384.3,90,,,percent of total billed charges,90% of total billed charges,414.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,414.19,97,,,percent of total billed charges,97% of total billed charges,320.25,75,,,percent of total billed charges,75% of total billed charges,409.92,96,,,percent of total billed charges,96% of total billed charges,2.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,320.25,75,,,percent of total billed charges,75% of total billed charges,320.25,75,,,percent of total billed charges,75% of total billed charges,2.71,414.19,
PF CT LUMBAR SPINE W/O  and  W/CONTRAST:  ADD ON PRO FEE,72300028P,CDM,972,RC,72133,HCPCS,Outpatient,,,559,419.25,,514.28,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,519.87,93,,,percent of total billed charges,93% of total billed charges,503.1,90,,,percent of total billed charges,90% of total billed charges,503.1,90,,,percent of total billed charges,90% of total billed charges,542.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,542.23,97,,,percent of total billed charges,97% of total billed charges,419.25,75,,,percent of total billed charges,75% of total billed charges,536.64,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,419.25,75,,,percent of total billed charges,75% of total billed charges,419.25,75,,,percent of total billed charges,75% of total billed charges,5.5,542.23,
PF CT LUMBAR SPINE W/CONTRAST MATERIAL: ADD ON PRO FEE,72300027P,CDM,972,RC,72132,HCPCS,Outpatient,,,476,357,,437.92,92,,,percent of total billed charges,92% of total billed charges,4.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,442.68,93,,,percent of total billed charges,93% of total billed charges,428.4,90,,,percent of total billed charges,90% of total billed charges,428.4,90,,,percent of total billed charges,90% of total billed charges,461.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,461.72,97,,,percent of total billed charges,97% of total billed charges,357,75,,,percent of total billed charges,75% of total billed charges,456.96,96,,,percent of total billed charges,96% of total billed charges,4.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,357,75,,,percent of total billed charges,75% of total billed charges,357,75,,,percent of total billed charges,75% of total billed charges,4.56,461.72,
PF CT LUMBAR SPINE W/O CONTRAST MATERIAL:  ADD ON PRO FEE,72300026P,CDM,972,RC,72131,HCPCS,Outpatient,,,415,311.25,,381.8,92,,,percent of total billed charges,92% of total billed charges,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,385.95,93,,,percent of total billed charges,93% of total billed charges,373.5,90,,,percent of total billed charges,90% of total billed charges,373.5,90,,,percent of total billed charges,90% of total billed charges,402.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,402.55,97,,,percent of total billed charges,97% of total billed charges,311.25,75,,,percent of total billed charges,75% of total billed charges,398.4,96,,,percent of total billed charges,96% of total billed charges,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,311.25,75,,,percent of total billed charges,75% of total billed charges,311.25,75,,,percent of total billed charges,75% of total billed charges,3.23,402.55,
PF MG DIAGNOSTIC TOMO BILATERAL:  PRO FEE ADD ON,71800509P,CDM,972,RC,77062,HCPCS,Outpatient,,,27,20.25,,24.84,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,25.11,93,,,percent of total billed charges,93% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,26.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.19,97,,,percent of total billed charges,97% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,25.92,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,20.25,75,,,percent of total billed charges,75% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,20.25,26.19,
PF MG DIAGNOSTIC TOMO LEFT:  PRO FEE ADD ON,71800508P,CDM,972,RC,77061,HCPCS,Outpatient,,,27,20.25,,24.84,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,25.11,93,,,percent of total billed charges,93% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,26.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.19,97,,,percent of total billed charges,97% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,25.92,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,20.25,75,,,percent of total billed charges,75% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,20.25,26.19,
PF MG DIAGNOSTIC TOMO RIGHT:  PRO FEE ADD ON,71800508P,CDM,972,RC,77061,HCPCS,Outpatient,,,27,20.25,,24.84,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,25.11,93,,,percent of total billed charges,93% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,26.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.19,97,,,percent of total billed charges,97% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,25.92,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,20.25,75,,,percent of total billed charges,75% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,20.25,26.19,
PF MG SCREENING TOMO BILAT:  PRO FEE ADD ON,71800511P,CDM,972,RC,77063,HCPCS,Outpatient,,,27,20.25,,24.84,92,,,percent of total billed charges,92% of total billed charges,0.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,25.11,93,,,percent of total billed charges,93% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,26.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,26.19,97,,,percent of total billed charges,97% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,25.92,96,,,percent of total billed charges,96% of total billed charges,0.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,20.25,75,,,percent of total billed charges,75% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,0.83,26.19,
PF MG SCREENING TOMO LEFT:  PRO FEE ADD ON,71800513P,CDM,972,RC,77063,HCPCS,Outpatient,,,27,20.25,,24.84,92,,,percent of total billed charges,92% of total billed charges,0.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,25.11,93,,,percent of total billed charges,93% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,26.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,26.19,97,,,percent of total billed charges,97% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,25.92,96,,,percent of total billed charges,96% of total billed charges,0.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,20.25,75,,,percent of total billed charges,75% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,0.83,26.19,
PF MG SCREENING TOMO RIGHT:  PRO FEE ADD ON,71800513P,CDM,972,RC,77063,HCPCS,Outpatient,,,27,20.25,,24.84,92,,,percent of total billed charges,92% of total billed charges,0.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,25.11,93,,,percent of total billed charges,93% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,26.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,26.19,97,,,percent of total billed charges,97% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,25.92,96,,,percent of total billed charges,96% of total billed charges,0.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,20.25,75,,,percent of total billed charges,75% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,0.83,26.19,
PF US GUIDANCE NEEDLE PLACEMENT:  PRO FEE ADD ON,72600031P,CDM,972,RC,76942,HCPCS,Outpatient,,,642,481.5,,590.64,92,,,percent of total billed charges,92% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,597.06,93,,,percent of total billed charges,93% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,622.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,622.74,97,,,percent of total billed charges,97% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,616.32,96,,,percent of total billed charges,96% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,481.5,75,,,percent of total billed charges,75% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,1.25,622.74,
PF US PREG UTERUS DETAILED EXAM 1ST GEST:  PRO FEE ADD ON,72600016P,CDM,972,RC,76811,HCPCS,Outpatient,,,602,451.5,,553.84,92,,,percent of total billed charges,92% of total billed charges,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,559.86,93,,,percent of total billed charges,93% of total billed charges,541.8,90,,,percent of total billed charges,90% of total billed charges,541.8,90,,,percent of total billed charges,90% of total billed charges,583.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,583.94,97,,,percent of total billed charges,97% of total billed charges,451.5,75,,,percent of total billed charges,75% of total billed charges,577.92,96,,,percent of total billed charges,96% of total billed charges,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,451.5,75,,,percent of total billed charges,75% of total billed charges,451.5,75,,,percent of total billed charges,75% of total billed charges,3.86,583.94,
PF US PREG UTERUS AFTER 1ST TRIMEST SINGLE:  PRO FEE ADD ON,72600014P,CDM,972,RC,76805,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,93,,,percent of total billed charges,93% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,72.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72.75,97,,,percent of total billed charges,97% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,72,96,,,percent of total billed charges,96% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.25,75,,,percent of total billed charges,75% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,3.61,72.75,
PF US PREG UTERUS 14 WK TRANSABDL 1/1ST GE: PRO FEE ADD ON,72600012P,CDM,972,RC,76801,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges,2.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,93,,,percent of total billed charges,93% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,72.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72.75,97,,,percent of total billed charges,97% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,72,96,,,percent of total billed charges,96% of total billed charges,2.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.25,75,,,percent of total billed charges,75% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,2.72,72.75,
PF INJECT CERVICAL/THORACIC 1ST LEVEL LEFT:  PRO FEE ADD ON,78001756P,CDM,960,RC,64490,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,386.88,93,,,percent of total billed charges,93% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,403.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.52,97,,,percent of total billed charges,97% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,399.36,96,,,percent of total billed charges,96% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312,75,,,percent of total billed charges,75% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,8.5,403.52,
PF INJECT CERVICAL/THORACIC 1ST LEVEL RIGHT:  PRO FEE ADD ON,78001756P,CDM,960,RC,64490,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,386.88,93,,,percent of total billed charges,93% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,403.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.52,97,,,percent of total billed charges,97% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,399.36,96,,,percent of total billed charges,96% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312,75,,,percent of total billed charges,75% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,8.5,403.52,
PF INJECT CERVICAL/THORACIC 2ND LEVEL LEFT:  PRO FEE ADD ON,78001758P,CDM,960,RC,64491,HCPCS,Outpatient,,,191,143.25,,175.72,92,,,percent of total billed charges,92% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.63,93,,,percent of total billed charges,93% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,185.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.27,97,,,percent of total billed charges,97% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,183.36,96,,,percent of total billed charges,96% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.25,75,,,percent of total billed charges,75% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,5.28,185.27,
PF INJECT CERVICAL/THORACIC 2ND LEVEL RIGHT:  PRO FEE ADD ON,78001758P,CDM,960,RC,64491,HCPCS,Outpatient,,,191,143.25,,175.72,92,,,percent of total billed charges,92% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.63,93,,,percent of total billed charges,93% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,185.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.27,97,,,percent of total billed charges,97% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,183.36,96,,,percent of total billed charges,96% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.25,75,,,percent of total billed charges,75% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,5.28,185.27,
PF INJECTION LUMBRAL/SACRAL 1ST LEVEL LEFT:  PRO FEE ADD ON,78001762P,CDM,960,RC,64493,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,7.18,343.38,
PF INJECTION LUMBRAL/SACRAL 1ST LEVEL RIGHT:  PRO FEE ADD ON,78001762P,CDM,960,RC,64493,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,7.18,343.38,
PF INJECTION LUMBRAL/SACRAL 2ND LEVEL LEFT:  PRO FEE ADD ON,78001764P,CDM,960,RC,64494,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.55,93,,,percent of total billed charges,93% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,130.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.95,97,,,percent of total billed charges,97% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,129.6,96,,,percent of total billed charges,96% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.25,75,,,percent of total billed charges,75% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,4.45,130.95,
PF INJECTION LUMBRAL/SACRAL 2ND LEVEL RIGHT:  PRO FEE ADD ON,78001764P,CDM,960,RC,64494,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.55,93,,,percent of total billed charges,93% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,130.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.95,97,,,percent of total billed charges,97% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,129.6,96,,,percent of total billed charges,96% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.25,75,,,percent of total billed charges,75% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,4.45,130.95,
XR FLUOROC GUIDANCE NEEDLE PLACEMENT:  PRO FEE ADD ON (PC/TC,71800466G,CDM,972,RC,77002,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.33,93,,,percent of total billed charges,93% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,175.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.57,97,,,percent of total billed charges,97% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,173.76,96,,,percent of total billed charges,96% of total billed charges,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.75,75,,,percent of total billed charges,75% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,3.36,175.57,
PF-AS REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM,78000216A,CDM,975,RC,12047,HCPCS,Outpatient,,,137,102.75,,126.04,92,,,percent of total billed charges,92% of total billed charges,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.41,93,,,percent of total billed charges,93% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,132.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.89,97,,,percent of total billed charges,97% of total billed charges,102.75,75,,,percent of total billed charges,75% of total billed charges,131.52,96,,,percent of total billed charges,96% of total billed charges,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102.75,75,,,percent of total billed charges,75% of total billed charges,102.75,75,,,percent of total billed charges,75% of total billed charges,46.68,132.89,
PF-AS REPAIR INTERMEDIATE F/E/E/N/L and /MUC >30.0 CM,78000230A,CDM,975,RC,12057,HCPCS,Outpatient,,,167,125.25,,153.64,92,,,percent of total billed charges,92% of total billed charges,44.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,155.31,93,,,percent of total billed charges,93% of total billed charges,150.3,90,,,percent of total billed charges,90% of total billed charges,150.3,90,,,percent of total billed charges,90% of total billed charges,161.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,44.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.99,97,,,percent of total billed charges,97% of total billed charges,125.25,75,,,percent of total billed charges,75% of total billed charges,160.32,96,,,percent of total billed charges,96% of total billed charges,44.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.25,75,,,percent of total billed charges,75% of total billed charges,125.25,75,,,percent of total billed charges,75% of total billed charges,44.85,161.99,
PF-AS REMOVAL IMPLANT DEEP,78000378A,CDM,975,RC,20680,HCPCS,Outpatient,,,187,140.25,,172.04,92,,,percent of total billed charges,92% of total billed charges,43.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,173.91,93,,,percent of total billed charges,93% of total billed charges,168.3,90,,,percent of total billed charges,90% of total billed charges,168.3,90,,,percent of total billed charges,90% of total billed charges,181.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.39,97,,,percent of total billed charges,97% of total billed charges,140.25,75,,,percent of total billed charges,75% of total billed charges,179.52,96,,,percent of total billed charges,96% of total billed charges,43.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,140.25,75,,,percent of total billed charges,75% of total billed charges,140.25,75,,,percent of total billed charges,75% of total billed charges,43.38,181.39,
PF-AS BONE GRAFT ANY DONOR AREA MINOR/SMALL,78000381A,CDM,975,RC,20900,HCPCS,Outpatient,,,177,132.75,,162.84,92,,,percent of total billed charges,92% of total billed charges,19.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.61,93,,,percent of total billed charges,93% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,171.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,171.69,97,,,percent of total billed charges,97% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,169.92,96,,,percent of total billed charges,96% of total billed charges,19.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.75,75,,,percent of total billed charges,75% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,19.77,171.69,
PF-AS BONE GRAFT ANY DONOR AREA MAJOR/LARGE,78000383A,CDM,975,RC,20902,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges,32.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.48,93,,,percent of total billed charges,93% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,228.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.92,97,,,percent of total billed charges,97% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,226.56,96,,,percent of total billed charges,96% of total billed charges,32.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177,75,,,percent of total billed charges,75% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,32.52,228.92,
PF-AS EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM,78000388A,CDM,975,RC,21011,HCPCS,Outpatient,,,131,98.25,,120.52,92,,,percent of total billed charges,92% of total billed charges,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,121.83,93,,,percent of total billed charges,93% of total billed charges,117.9,90,,,percent of total billed charges,90% of total billed charges,117.9,90,,,percent of total billed charges,90% of total billed charges,127.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.07,97,,,percent of total billed charges,97% of total billed charges,98.25,75,,,percent of total billed charges,75% of total billed charges,125.76,96,,,percent of total billed charges,96% of total billed charges,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,98.25,75,,,percent of total billed charges,75% of total billed charges,98.25,75,,,percent of total billed charges,75% of total billed charges,22.94,127.07,
PF-AS EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>,78000404A,CDM,975,RC,21931,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges,60.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,96.72,93,,,percent of total billed charges,93% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,100.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,60.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.88,97,,,percent of total billed charges,97% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges,99.84,96,,,percent of total billed charges,96% of total billed charges,60.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78,75,,,percent of total billed charges,75% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges,60.88,100.88,
PF-AS ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2,78000409A,CDM,975,RC,22554,HCPCS,Outpatient,,,856,642,,787.52,92,,,percent of total billed charges,92% of total billed charges,203.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,796.08,93,,,percent of total billed charges,93% of total billed charges,770.4,90,,,percent of total billed charges,90% of total billed charges,770.4,90,,,percent of total billed charges,90% of total billed charges,830.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,203.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,830.32,97,,,percent of total billed charges,97% of total billed charges,642,75,,,percent of total billed charges,75% of total billed charges,821.76,96,,,percent of total billed charges,96% of total billed charges,203.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,642,75,,,percent of total billed charges,75% of total billed charges,642,75,,,percent of total billed charges,75% of total billed charges,203.4,830.32,
PF-AS ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS,78000410A,CDM,975,RC,22845,HCPCS,Outpatient,,,695,521.25,,639.4,92,,,percent of total billed charges,92% of total billed charges,130.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,646.35,93,,,percent of total billed charges,93% of total billed charges,625.5,90,,,percent of total billed charges,90% of total billed charges,625.5,90,,,percent of total billed charges,90% of total billed charges,674.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,130.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,674.15,97,,,percent of total billed charges,97% of total billed charges,521.25,75,,,percent of total billed charges,75% of total billed charges,667.2,96,,,percent of total billed charges,96% of total billed charges,130.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,521.25,75,,,percent of total billed charges,75% of total billed charges,521.25,75,,,percent of total billed charges,75% of total billed charges,130.28,674.15,
PF-AS EXCISION TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM,78000411A,CDM,975,RC,22902,HCPCS,Outpatient,,,180,135,,165.6,92,,,percent of total billed charges,92% of total billed charges,40.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,167.4,93,,,percent of total billed charges,93% of total billed charges,162,90,,,percent of total billed charges,90% of total billed charges,162,90,,,percent of total billed charges,90% of total billed charges,174.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,174.6,97,,,percent of total billed charges,97% of total billed charges,135,75,,,percent of total billed charges,75% of total billed charges,172.8,96,,,percent of total billed charges,96% of total billed charges,40.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135,75,,,percent of total billed charges,75% of total billed charges,135,75,,,percent of total billed charges,75% of total billed charges,40.45,174.6,
PF-AS EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>,78000418A,CDM,975,RC,23071,HCPCS,Outpatient,,,157,117.75,,144.44,92,,,percent of total billed charges,92% of total billed charges,52.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.01,93,,,percent of total billed charges,93% of total billed charges,141.3,90,,,percent of total billed charges,90% of total billed charges,141.3,90,,,percent of total billed charges,90% of total billed charges,152.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,52.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,152.29,97,,,percent of total billed charges,97% of total billed charges,117.75,75,,,percent of total billed charges,75% of total billed charges,150.72,96,,,percent of total billed charges,96% of total billed charges,52.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117.75,75,,,percent of total billed charges,75% of total billed charges,117.75,75,,,percent of total billed charges,75% of total billed charges,52.13,152.29,
PF-AS CLAVICULECTOMY PARTIAL,78000421A,CDM,975,RC,23120,HCPCS,Outpatient,,,300,225,,276,92,,,percent of total billed charges,92% of total billed charges,61.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,279,93,,,percent of total billed charges,93% of total billed charges,270,90,,,percent of total billed charges,90% of total billed charges,270,90,,,percent of total billed charges,90% of total billed charges,291,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,291,97,,,percent of total billed charges,97% of total billed charges,225,75,,,percent of total billed charges,75% of total billed charges,288,96,,,percent of total billed charges,96% of total billed charges,61.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,225,75,,,percent of total billed charges,75% of total billed charges,225,75,,,percent of total billed charges,75% of total billed charges,61.68,291,
PF-AS OPEN REPAIR-AS OF ROTATOR CUFF ACUTE,78000432A,CDM,975,RC,23410,HCPCS,Outpatient,,,480,360,,441.6,92,,,percent of total billed charges,92% of total billed charges,90.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,446.4,93,,,percent of total billed charges,93% of total billed charges,432,90,,,percent of total billed charges,90% of total billed charges,432,90,,,percent of total billed charges,90% of total billed charges,465.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,90.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465.6,97,,,percent of total billed charges,97% of total billed charges,360,75,,,percent of total billed charges,75% of total billed charges,460.8,96,,,percent of total billed charges,96% of total billed charges,90.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,360,75,,,percent of total billed charges,75% of total billed charges,360,75,,,percent of total billed charges,75% of total billed charges,90.47,465.6,
PF-AS OPEN REPAIR OF ROTATOR CUFF CHRONIC,78000434A,CDM,975,RC,23412,HCPCS,Outpatient,,,503,377.25,,462.76,92,,,percent of total billed charges,92% of total billed charges,94.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,467.79,93,,,percent of total billed charges,93% of total billed charges,452.7,90,,,percent of total billed charges,90% of total billed charges,452.7,90,,,percent of total billed charges,90% of total billed charges,487.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,94.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,487.91,97,,,percent of total billed charges,97% of total billed charges,377.25,75,,,percent of total billed charges,75% of total billed charges,482.88,96,,,percent of total billed charges,96% of total billed charges,94.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,377.25,75,,,percent of total billed charges,75% of total billed charges,377.25,75,,,percent of total billed charges,75% of total billed charges,94.85,487.91,
PF-AS RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC,78000437A,CDM,975,RC,23420,HCPCS,Outpatient,,,565,423.75,,519.8,92,,,percent of total billed charges,92% of total billed charges,108.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,525.45,93,,,percent of total billed charges,93% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,548.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,108.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,548.05,97,,,percent of total billed charges,97% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,542.4,96,,,percent of total billed charges,96% of total billed charges,108.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,423.75,75,,,percent of total billed charges,75% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,108.86,548.05,
PF-AS TENODESIS LONG TENDON BICEPS,78000439A,CDM,975,RC,23430,HCPCS,Outpatient,,,382,286.5,,351.44,92,,,percent of total billed charges,92% of total billed charges,80.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,355.26,93,,,percent of total billed charges,93% of total billed charges,343.8,90,,,percent of total billed charges,90% of total billed charges,343.8,90,,,percent of total billed charges,90% of total billed charges,370.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,80.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,370.54,97,,,percent of total billed charges,97% of total billed charges,286.5,75,,,percent of total billed charges,75% of total billed charges,366.72,96,,,percent of total billed charges,96% of total billed charges,80.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,286.5,75,,,percent of total billed charges,75% of total billed charges,286.5,75,,,percent of total billed charges,75% of total billed charges,80.57,370.54,
PF-AS CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TRANSFER,78000441A,CDM,975,RC,23462,HCPCS,Outpatient,,,553,414.75,,508.76,92,,,percent of total billed charges,92% of total billed charges,125.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,514.29,93,,,percent of total billed charges,93% of total billed charges,497.7,90,,,percent of total billed charges,90% of total billed charges,497.7,90,,,percent of total billed charges,90% of total billed charges,536.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,125.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.41,97,,,percent of total billed charges,97% of total billed charges,414.75,75,,,percent of total billed charges,75% of total billed charges,530.88,96,,,percent of total billed charges,96% of total billed charges,125.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,414.75,75,,,percent of total billed charges,75% of total billed charges,414.75,75,,,percent of total billed charges,75% of total billed charges,125.28,536.41,
PF-AS ARTHROPLASTY GLENOHUMRL JOINT TOTAL SHOULDER,78000443A,CDM,975,RC,23472,HCPCS,Outpatient,,,983,737.25,,904.36,92,,,percent of total billed charges,92% of total billed charges,168.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,914.19,93,,,percent of total billed charges,93% of total billed charges,884.7,90,,,percent of total billed charges,90% of total billed charges,884.7,90,,,percent of total billed charges,90% of total billed charges,953.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,168.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,953.51,97,,,percent of total billed charges,97% of total billed charges,737.25,75,,,percent of total billed charges,75% of total billed charges,943.68,96,,,percent of total billed charges,96% of total billed charges,168.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,737.25,75,,,percent of total billed charges,75% of total billed charges,737.25,75,,,percent of total billed charges,75% of total billed charges,168.81,953.51,
PF-AS REVISION TOTAL SHOULD ARTHROPLASTY HUMERAL OR GLENOID,78002857A,CDM,975,RC,23473,HCPCS,Outpatient,,,399,299.25,,367.08,92,,,percent of total billed charges,92% of total billed charges,189.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,371.07,93,,,percent of total billed charges,93% of total billed charges,359.1,90,,,percent of total billed charges,90% of total billed charges,359.1,90,,,percent of total billed charges,90% of total billed charges,387.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,189.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,387.03,97,,,percent of total billed charges,97% of total billed charges,299.25,75,,,percent of total billed charges,75% of total billed charges,383.04,96,,,percent of total billed charges,96% of total billed charges,189.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,299.25,75,,,percent of total billed charges,75% of total billed charges,299.25,75,,,percent of total billed charges,75% of total billed charges,189.06,387.03,
PF-AS REVIS SHOULDER ARTHROPLASTY HUMERAL  and  GLENOID COMPONEN,78000445A,CDM,975,RC,23474,HCPCS,Outpatient,,,688,516,,632.96,92,,,percent of total billed charges,92% of total billed charges,205.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,639.84,93,,,percent of total billed charges,93% of total billed charges,619.2,90,,,percent of total billed charges,90% of total billed charges,619.2,90,,,percent of total billed charges,90% of total billed charges,667.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,205.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,667.36,97,,,percent of total billed charges,97% of total billed charges,516,75,,,percent of total billed charges,75% of total billed charges,660.48,96,,,percent of total billed charges,96% of total billed charges,205.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,516,75,,,percent of total billed charges,75% of total billed charges,516,75,,,percent of total billed charges,75% of total billed charges,205.95,667.36,
PF-AS OSTEOTOMY CLAVICLE W/BONE GRAFT FOR NON/MALUNION,78000447A,CDM,975,RC,23485,HCPCS,Outpatient,,,439,329.25,,403.88,92,,,percent of total billed charges,92% of total billed charges,109.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,408.27,93,,,percent of total billed charges,93% of total billed charges,395.1,90,,,percent of total billed charges,90% of total billed charges,395.1,90,,,percent of total billed charges,90% of total billed charges,425.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,425.83,97,,,percent of total billed charges,97% of total billed charges,329.25,75,,,percent of total billed charges,75% of total billed charges,421.44,96,,,percent of total billed charges,96% of total billed charges,109.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.25,75,,,percent of total billed charges,75% of total billed charges,329.25,75,,,percent of total billed charges,75% of total billed charges,109.44,425.83,
PF-AS OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATN,78000453A,CDM,975,RC,23515,HCPCS,Outpatient,,,285,213.75,,262.2,92,,,percent of total billed charges,92% of total billed charges,77.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.05,93,,,percent of total billed charges,93% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,256.5,90,,,percent of total billed charges,90% of total billed charges,276.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,77.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,276.45,97,,,percent of total billed charges,97% of total billed charges,213.75,75,,,percent of total billed charges,75% of total billed charges,273.6,96,,,percent of total billed charges,96% of total billed charges,77.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.75,75,,,percent of total billed charges,75% of total billed charges,213.75,75,,,percent of total billed charges,75% of total billed charges,77.6,276.45,
PF-AS OPEN TX ACROMIOCLAVICULAR DISLOCATION ACUTE/CHRONIC,78000457A,CDM,975,RC,23550,HCPCS,Outpatient,,,311,233.25,,286.12,92,,,percent of total billed charges,92% of total billed charges,61.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.23,93,,,percent of total billed charges,93% of total billed charges,279.9,90,,,percent of total billed charges,90% of total billed charges,279.9,90,,,percent of total billed charges,90% of total billed charges,301.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,301.67,97,,,percent of total billed charges,97% of total billed charges,233.25,75,,,percent of total billed charges,75% of total billed charges,298.56,96,,,percent of total billed charges,96% of total billed charges,61.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.25,75,,,percent of total billed charges,75% of total billed charges,233.25,75,,,percent of total billed charges,75% of total billed charges,61.07,301.67,
PF-AS OPEN TX ACROMCLAVICLE DISLOCATION W/FASCIAL GRAFT,78000459A,CDM,975,RC,23552,HCPCS,Outpatient,,,364,273,,334.88,92,,,percent of total billed charges,92% of total billed charges,69.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,338.52,93,,,percent of total billed charges,93% of total billed charges,327.6,90,,,percent of total billed charges,90% of total billed charges,327.6,90,,,percent of total billed charges,90% of total billed charges,353.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,69.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,353.08,97,,,percent of total billed charges,97% of total billed charges,273,75,,,percent of total billed charges,75% of total billed charges,349.44,96,,,percent of total billed charges,96% of total billed charges,69.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,273,75,,,percent of total billed charges,75% of total billed charges,273,75,,,percent of total billed charges,75% of total billed charges,69.17,353.08,
PF-AS OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PERFORMED,78000464A,CDM,975,RC,23585,HCPCS,Outpatient,,,398,298.5,,366.16,92,,,percent of total billed charges,92% of total billed charges,109.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,370.14,93,,,percent of total billed charges,93% of total billed charges,358.2,90,,,percent of total billed charges,90% of total billed charges,358.2,90,,,percent of total billed charges,90% of total billed charges,386.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,386.06,97,,,percent of total billed charges,97% of total billed charges,298.5,75,,,percent of total billed charges,75% of total billed charges,382.08,96,,,percent of total billed charges,96% of total billed charges,109.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,298.5,75,,,percent of total billed charges,75% of total billed charges,298.5,75,,,percent of total billed charges,75% of total billed charges,109.92,386.06,
PF-AS OPEN TREATMENT PROXIMAL HUMERAL FRACTURE,78002265A,CDM,975,RC,23615,HCPCS,Outpatient,,,396,297,,364.32,92,,,percent of total billed charges,92% of total billed charges,97.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,368.28,93,,,percent of total billed charges,93% of total billed charges,356.4,90,,,percent of total billed charges,90% of total billed charges,356.4,90,,,percent of total billed charges,90% of total billed charges,384.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,97.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,384.12,97,,,percent of total billed charges,97% of total billed charges,297,75,,,percent of total billed charges,75% of total billed charges,380.16,96,,,percent of total billed charges,96% of total billed charges,97.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297,75,,,percent of total billed charges,75% of total billed charges,297,75,,,percent of total billed charges,75% of total billed charges,97.84,384.12,
PF-AS OPEN TREATMNT GREATER HUMERAL TUBEROSITY FRACTURE,78000475A,CDM,975,RC,23630,HCPCS,Outpatient,,,299,224.25,,275.08,92,,,percent of total billed charges,92% of total billed charges,84.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,278.07,93,,,percent of total billed charges,93% of total billed charges,269.1,90,,,percent of total billed charges,90% of total billed charges,269.1,90,,,percent of total billed charges,90% of total billed charges,290.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,84.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,290.03,97,,,percent of total billed charges,97% of total billed charges,224.25,75,,,percent of total billed charges,75% of total billed charges,287.04,96,,,percent of total billed charges,96% of total billed charges,84.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,224.25,75,,,percent of total billed charges,75% of total billed charges,224.25,75,,,percent of total billed charges,75% of total billed charges,84.86,290.03,
PF-AS REMOVAL OF ELBOW JOINT,78002420A,CDM,975,RC,24130,HCPCS,Outpatient,,,216,162,,198.72,92,,,percent of total billed charges,92% of total billed charges,51.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,200.88,93,,,percent of total billed charges,93% of total billed charges,194.4,90,,,percent of total billed charges,90% of total billed charges,194.4,90,,,percent of total billed charges,90% of total billed charges,209.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,51.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,209.52,97,,,percent of total billed charges,97% of total billed charges,162,75,,,percent of total billed charges,75% of total billed charges,207.36,96,,,percent of total billed charges,96% of total billed charges,51.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162,75,,,percent of total billed charges,75% of total billed charges,162,75,,,percent of total billed charges,75% of total billed charges,51.38,209.52,
PF-AS REPAIR TENDON/MUSCLE UPPER ARM OR ELBOW EACH,78000507A,CDM,975,RC,24341,HCPCS,Outpatient,,,356,267,,327.52,92,,,percent of total billed charges,92% of total billed charges,76.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,331.08,93,,,percent of total billed charges,93% of total billed charges,320.4,90,,,percent of total billed charges,90% of total billed charges,320.4,90,,,percent of total billed charges,90% of total billed charges,345.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.32,97,,,percent of total billed charges,97% of total billed charges,267,75,,,percent of total billed charges,75% of total billed charges,341.76,96,,,percent of total billed charges,96% of total billed charges,76.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,267,75,,,percent of total billed charges,75% of total billed charges,267,75,,,percent of total billed charges,75% of total billed charges,76.52,345.32,
PF-AS REINSERT RUPTUREDD BICEPS OR TRICEPS TENDON DISTAL,78000508A,CDM,975,RC,24342,HCPCS,Outpatient,,,419,314.25,,385.48,92,,,percent of total billed charges,92% of total billed charges,84.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,389.67,93,,,percent of total billed charges,93% of total billed charges,377.1,90,,,percent of total billed charges,90% of total billed charges,377.1,90,,,percent of total billed charges,90% of total billed charges,406.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,84.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,406.43,97,,,percent of total billed charges,97% of total billed charges,314.25,75,,,percent of total billed charges,75% of total billed charges,402.24,96,,,percent of total billed charges,96% of total billed charges,84.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,314.25,75,,,percent of total billed charges,75% of total billed charges,314.25,75,,,percent of total billed charges,75% of total billed charges,84.57,406.43,
PF-AS REPAIR LATERAL COLLATERAL LIGAMENT ELBOW,78000510A,CDM,975,RC,24343,HCPCS,Outpatient,,,361,270.75,,332.12,92,,,percent of total billed charges,92% of total billed charges,73.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,335.73,93,,,percent of total billed charges,93% of total billed charges,324.9,90,,,percent of total billed charges,90% of total billed charges,324.9,90,,,percent of total billed charges,90% of total billed charges,350.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,73.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,350.17,97,,,percent of total billed charges,97% of total billed charges,270.75,75,,,percent of total billed charges,75% of total billed charges,346.56,96,,,percent of total billed charges,96% of total billed charges,73.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,270.75,75,,,percent of total billed charges,75% of total billed charges,270.75,75,,,percent of total billed charges,75% of total billed charges,73.66,350.17,
PF-AS TENOTOMY ELBOW LATERAL/MEDIAL DEBRIDE OPEN TENDON REPA,78000514A,CDM,975,RC,24359,HCPCS,Outpatient,,,313,234.75,,287.96,92,,,percent of total billed charges,92% of total billed charges,70.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,291.09,93,,,percent of total billed charges,93% of total billed charges,281.7,90,,,percent of total billed charges,90% of total billed charges,281.7,90,,,percent of total billed charges,90% of total billed charges,303.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,303.61,97,,,percent of total billed charges,97% of total billed charges,234.75,75,,,percent of total billed charges,75% of total billed charges,300.48,96,,,percent of total billed charges,96% of total billed charges,70.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,234.75,75,,,percent of total billed charges,75% of total billed charges,234.75,75,,,percent of total billed charges,75% of total billed charges,70.77,303.61,
PF-AS OPEN TX HUMERAL SHAFT FX W/PLATE SCREWS,78000520A,CDM,975,RC,24515,HCPCS,Outpatient,,,394,295.5,,362.48,92,,,percent of total billed charges,92% of total billed charges,96.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,366.42,93,,,percent of total billed charges,93% of total billed charges,354.6,90,,,percent of total billed charges,90% of total billed charges,354.6,90,,,percent of total billed charges,90% of total billed charges,382.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,96.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,382.18,97,,,percent of total billed charges,97% of total billed charges,295.5,75,,,percent of total billed charges,75% of total billed charges,378.24,96,,,percent of total billed charges,96% of total billed charges,96.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,295.5,75,,,percent of total billed charges,75% of total billed charges,295.5,75,,,percent of total billed charges,75% of total billed charges,96.95,382.18,
PF-AS TX HUMERAL SHAFT FX W/INSERT INTRAMEDULLARY IMPLANT,78000522A,CDM,975,RC,24516,HCPCS,Outpatient,,,409,306.75,,376.28,92,,,percent of total billed charges,92% of total billed charges,96.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,380.37,93,,,percent of total billed charges,93% of total billed charges,368.1,90,,,percent of total billed charges,90% of total billed charges,368.1,90,,,percent of total billed charges,90% of total billed charges,396.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,96.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,396.73,97,,,percent of total billed charges,97% of total billed charges,306.75,75,,,percent of total billed charges,75% of total billed charges,392.64,96,,,percent of total billed charges,96% of total billed charges,96.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.75,75,,,percent of total billed charges,75% of total billed charges,306.75,75,,,percent of total billed charges,75% of total billed charges,96.97,396.73,
PF-AS OP TX HUMERAL SUPRACONDYLAR FX W/O EXTENSION,78002895A,CDM,975,RC,24545,HCPCS,Outpatient,,,179.8,134.85,,165.42,92,,,percent of total billed charges,92% of total billed charges,104.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,167.21,93,,,percent of total billed charges,93% of total billed charges,161.82,90,,,percent of total billed charges,90% of total billed charges,161.82,90,,,percent of total billed charges,90% of total billed charges,174.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,104.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,174.41,97,,,percent of total billed charges,97% of total billed charges,134.85,75,,,percent of total billed charges,75% of total billed charges,172.61,96,,,percent of total billed charges,96% of total billed charges,104.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,134.85,75,,,percent of total billed charges,75% of total billed charges,134.85,75,,,percent of total billed charges,75% of total billed charges,104.28,174.41,
PF-AS OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/INTERNAL FIXA,78000529A,CDM,975,RC,24546,HCPCS,Outpatient,,,525,393.75,,483,92,,,percent of total billed charges,92% of total billed charges,116.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,488.25,93,,,percent of total billed charges,93% of total billed charges,472.5,90,,,percent of total billed charges,90% of total billed charges,472.5,90,,,percent of total billed charges,90% of total billed charges,509.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,116.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,509.25,97,,,percent of total billed charges,97% of total billed charges,393.75,75,,,percent of total billed charges,75% of total billed charges,504,96,,,percent of total billed charges,96% of total billed charges,116.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,393.75,75,,,percent of total billed charges,75% of total billed charges,393.75,75,,,percent of total billed charges,75% of total billed charges,116.95,509.25,
PF-AS OPEN TX HUMERAL EPICONDYLAR FRACTURE W/INTERNAL FIXATI,78000533A,CDM,975,RC,24575,HCPCS,Outpatient,,,331,248.25,,304.52,92,,,percent of total billed charges,92% of total billed charges,78.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,307.83,93,,,percent of total billed charges,93% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,321.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,78.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321.07,97,,,percent of total billed charges,97% of total billed charges,248.25,75,,,percent of total billed charges,75% of total billed charges,317.76,96,,,percent of total billed charges,96% of total billed charges,78.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,248.25,75,,,percent of total billed charges,75% of total billed charges,248.25,75,,,percent of total billed charges,75% of total billed charges,78.07,321.07,
PF-AS OPEN TREATMENT HUMERAL CONDYLAR FRACTURE,78000537A,CDM,975,RC,24579,HCPCS,Outpatient,,,378,283.5,,347.76,92,,,percent of total billed charges,92% of total billed charges,90.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,351.54,93,,,percent of total billed charges,93% of total billed charges,340.2,90,,,percent of total billed charges,90% of total billed charges,340.2,90,,,percent of total billed charges,90% of total billed charges,366.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,90.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,366.66,97,,,percent of total billed charges,97% of total billed charges,283.5,75,,,percent of total billed charges,75% of total billed charges,362.88,96,,,percent of total billed charges,96% of total billed charges,90.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,283.5,75,,,percent of total billed charges,75% of total billed charges,283.5,75,,,percent of total billed charges,75% of total billed charges,90.78,366.66,
PF-AS OPEN TX PERIARTICULAR FX  and /DISLOCATION ELBOW,78000539A,CDM,975,RC,24586,HCPCS,Outpatient,,,508,381,,467.36,92,,,percent of total billed charges,92% of total billed charges,123.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,472.44,93,,,percent of total billed charges,93% of total billed charges,457.2,90,,,percent of total billed charges,90% of total billed charges,457.2,90,,,percent of total billed charges,90% of total billed charges,492.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,123.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,492.76,97,,,percent of total billed charges,97% of total billed charges,381,75,,,percent of total billed charges,75% of total billed charges,487.68,96,,,percent of total billed charges,96% of total billed charges,123.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,381,75,,,percent of total billed charges,75% of total billed charges,381,75,,,percent of total billed charges,75% of total billed charges,123.51,492.76,
PF-AS OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW,78000546A,CDM,975,RC,24635,HCPCS,Outpatient,,,411,308.25,,378.12,92,,,percent of total billed charges,92% of total billed charges,70.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,382.23,93,,,percent of total billed charges,93% of total billed charges,369.9,90,,,percent of total billed charges,90% of total billed charges,369.9,90,,,percent of total billed charges,90% of total billed charges,398.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,398.67,97,,,percent of total billed charges,97% of total billed charges,308.25,75,,,percent of total billed charges,75% of total billed charges,394.56,96,,,percent of total billed charges,96% of total billed charges,70.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,308.25,75,,,percent of total billed charges,75% of total billed charges,308.25,75,,,percent of total billed charges,75% of total billed charges,70.92,398.67,
PF-AS OPEN TX RADIAL HEAD/NECK FRACTURE,78000554A,CDM,975,RC,24665,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges,67.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,267.84,93,,,percent of total billed charges,93% of total billed charges,259.2,90,,,percent of total billed charges,90% of total billed charges,259.2,90,,,percent of total billed charges,90% of total billed charges,279.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,67.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,279.36,97,,,percent of total billed charges,97% of total billed charges,216,75,,,percent of total billed charges,75% of total billed charges,276.48,96,,,percent of total billed charges,96% of total billed charges,67.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,216,75,,,percent of total billed charges,75% of total billed charges,216,75,,,percent of total billed charges,75% of total billed charges,67.6,279.36,
PF-AS OPEN TREATMENT ULNAR FRACTURE PROXIMAL END,78000560A,CDM,975,RC,24685,HCPCS,Outpatient,,,320,240,,294.4,92,,,percent of total billed charges,92% of total billed charges,68.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297.6,93,,,percent of total billed charges,93% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,310.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,68.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,310.4,97,,,percent of total billed charges,97% of total billed charges,240,75,,,percent of total billed charges,75% of total billed charges,307.2,96,,,percent of total billed charges,96% of total billed charges,68.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,240,75,,,percent of total billed charges,75% of total billed charges,240,75,,,percent of total billed charges,75% of total billed charges,68.29,310.4,
PF-AS ARTHROTOMY DISTAL RADIOULNAR JOINT REPAIR CARTILAGE,78000573A,CDM,975,RC,25107,HCPCS,Outpatient,,,337,252.75,,310.04,92,,,percent of total billed charges,92% of total billed charges,60.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,313.41,93,,,percent of total billed charges,93% of total billed charges,303.3,90,,,percent of total billed charges,90% of total billed charges,303.3,90,,,percent of total billed charges,90% of total billed charges,326.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,60.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,326.89,97,,,percent of total billed charges,97% of total billed charges,252.75,75,,,percent of total billed charges,75% of total billed charges,323.52,96,,,percent of total billed charges,96% of total billed charges,60.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,252.75,75,,,percent of total billed charges,75% of total billed charges,252.75,75,,,percent of total billed charges,75% of total billed charges,60.84,326.89,
PF-AS EXCISION CURETTAGE BONE CYST/TUMOR CARPL BONES W/AUTOG,78000580A,CDM,975,RC,25135,HCPCS,Outpatient,,,296,222,,272.32,92,,,percent of total billed charges,92% of total billed charges,59.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.28,93,,,percent of total billed charges,93% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,287.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,59.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,287.12,97,,,percent of total billed charges,97% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,284.16,96,,,percent of total billed charges,96% of total billed charges,59.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222,75,,,percent of total billed charges,75% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,59.69,287.12,
PF-AS OSTEOTOMY RADIUS DISTAL THIRD,78000594A,CDM,975,RC,25350,HCPCS,Outpatient,,,360,270,,331.2,92,,,percent of total billed charges,92% of total billed charges,70.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,334.8,93,,,percent of total billed charges,93% of total billed charges,324,90,,,percent of total billed charges,90% of total billed charges,324,90,,,percent of total billed charges,90% of total billed charges,349.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,349.2,97,,,percent of total billed charges,97% of total billed charges,270,75,,,percent of total billed charges,75% of total billed charges,345.6,96,,,percent of total billed charges,96% of total billed charges,70.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,270,75,,,percent of total billed charges,75% of total billed charges,270,75,,,percent of total billed charges,75% of total billed charges,70.32,349.2,
PF-AS REPAIR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT,78000596A,CDM,975,RC,25405,HCPCS,Outpatient,,,514,385.5,,472.88,92,,,percent of total billed charges,92% of total billed charges,114.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,478.02,93,,,percent of total billed charges,93% of total billed charges,462.6,90,,,percent of total billed charges,90% of total billed charges,462.6,90,,,percent of total billed charges,90% of total billed charges,498.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,114.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,498.58,97,,,percent of total billed charges,97% of total billed charges,385.5,75,,,percent of total billed charges,75% of total billed charges,493.44,96,,,percent of total billed charges,96% of total billed charges,114.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,385.5,75,,,percent of total billed charges,75% of total billed charges,385.5,75,,,percent of total billed charges,75% of total billed charges,114.47,498.58,
PF-AS ARTHROPLASTY INTERPOSPOSITION INTERCARPAL/METACARPAL J,78000600A,CDM,975,RC,25447,HCPCS,Outpatient,,,396,297,,364.32,92,,,percent of total billed charges,92% of total billed charges,86.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,368.28,93,,,percent of total billed charges,93% of total billed charges,356.4,90,,,percent of total billed charges,90% of total billed charges,356.4,90,,,percent of total billed charges,90% of total billed charges,384.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,86.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,384.12,97,,,percent of total billed charges,97% of total billed charges,297,75,,,percent of total billed charges,75% of total billed charges,380.16,96,,,percent of total billed charges,96% of total billed charges,86.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297,75,,,percent of total billed charges,75% of total billed charges,297,75,,,percent of total billed charges,75% of total billed charges,86.38,384.12,
PF-AS OPEN TREATMENT RADIAL SHAFT FRACTURE,78000605A,CDM,975,RC,25515,HCPCS,Outpatient,,,307,230.25,,282.44,92,,,percent of total billed charges,92% of total billed charges,70.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,285.51,93,,,percent of total billed charges,93% of total billed charges,276.3,90,,,percent of total billed charges,90% of total billed charges,276.3,90,,,percent of total billed charges,90% of total billed charges,297.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297.79,97,,,percent of total billed charges,97% of total billed charges,230.25,75,,,percent of total billed charges,75% of total billed charges,294.72,96,,,percent of total billed charges,96% of total billed charges,70.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,230.25,75,,,percent of total billed charges,75% of total billed charges,230.25,75,,,percent of total billed charges,75% of total billed charges,70.79,297.79,
PF-AS OPEN RADIAL SHAFT FX CLOSED RADIAL/ULNAR JOINT DISLOCA,78000608A,CDM,975,RC,25525,HCPCS,Outpatient,,,384,288,,353.28,92,,,percent of total billed charges,92% of total billed charges,84.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,357.12,93,,,percent of total billed charges,93% of total billed charges,345.6,90,,,percent of total billed charges,90% of total billed charges,345.6,90,,,percent of total billed charges,90% of total billed charges,372.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,84.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,372.48,97,,,percent of total billed charges,97% of total billed charges,288,75,,,percent of total billed charges,75% of total billed charges,368.64,96,,,percent of total billed charges,96% of total billed charges,84.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288,75,,,percent of total billed charges,75% of total billed charges,288,75,,,percent of total billed charges,75% of total billed charges,84.68,372.48,
PF-AS OPEN TREATMENT OF ULNAR SHAFT FRACTURE,78000614A,CDM,975,RC,25545,HCPCS,Outpatient,,,297,222.75,,273.24,92,,,percent of total billed charges,92% of total billed charges,64.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,276.21,93,,,percent of total billed charges,93% of total billed charges,267.3,90,,,percent of total billed charges,90% of total billed charges,267.3,90,,,percent of total billed charges,90% of total billed charges,288.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,64.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.09,97,,,percent of total billed charges,97% of total billed charges,222.75,75,,,percent of total billed charges,75% of total billed charges,285.12,96,,,percent of total billed charges,96% of total billed charges,64.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222.75,75,,,percent of total billed charges,75% of total billed charges,222.75,75,,,percent of total billed charges,75% of total billed charges,64.33,288.09,
PF-AS OPEN TX RADIAL  and  ULNAR SHAFT FX W/FIXATION,78000620A,CDM,975,RC,25574,HCPCS,Outpatient,,,297,222.75,,273.24,92,,,percent of total billed charges,92% of total billed charges,71.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,276.21,93,,,percent of total billed charges,93% of total billed charges,267.3,90,,,percent of total billed charges,90% of total billed charges,267.3,90,,,percent of total billed charges,90% of total billed charges,288.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,71.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.09,97,,,percent of total billed charges,97% of total billed charges,222.75,75,,,percent of total billed charges,75% of total billed charges,285.12,96,,,percent of total billed charges,96% of total billed charges,71.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222.75,75,,,percent of total billed charges,75% of total billed charges,222.75,75,,,percent of total billed charges,75% of total billed charges,71.48,288.09,
PF-AS OPEN TX RADIAL  and  ULNAR SHAFT FX W/FIXATION,78000622A,CDM,975,RC,25575,HCPCS,Outpatient,,,415,311.25,,381.8,92,,,percent of total billed charges,92% of total billed charges,98.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,385.95,93,,,percent of total billed charges,93% of total billed charges,373.5,90,,,percent of total billed charges,90% of total billed charges,373.5,90,,,percent of total billed charges,90% of total billed charges,402.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,98.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,402.55,97,,,percent of total billed charges,97% of total billed charges,311.25,75,,,percent of total billed charges,75% of total billed charges,398.4,96,,,percent of total billed charges,96% of total billed charges,98.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,311.25,75,,,percent of total billed charges,75% of total billed charges,311.25,75,,,percent of total billed charges,75% of total billed charges,98.36,402.55,
PF-AS OP TX DISTAL RADIAL EXTRA-ARTICULAR FX OR EPIPHYSEAL S,78000629A,CDM,975,RC,25607,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges,76.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.11,93,,,percent of total billed charges,93% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,317.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,317.19,97,,,percent of total billed charges,97% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,313.92,96,,,percent of total billed charges,96% of total billed charges,76.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.25,75,,,percent of total billed charges,75% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,76.74,317.19,
PF-AS OP TX DISTAL RADIAL EXTRA-ARTICULAR FX EPIPHYSEAL 2 FR,78000631A,CDM,975,RC,25608,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges,88.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.6,93,,,percent of total billed charges,93% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,213.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,88.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.4,97,,,percent of total billed charges,97% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,211.2,96,,,percent of total billed charges,96% of total billed charges,88.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165,75,,,percent of total billed charges,75% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,88.18,213.4,
PF-AS OP TX DISTAL RADIAL EXTRA-ARTICULAR FX EPIPHYSEAL 3 FR,78000633A,CDM,975,RC,25609,HCPCS,Outpatient,,,397,297.75,,365.24,92,,,percent of total billed charges,92% of total billed charges,112.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,369.21,93,,,percent of total billed charges,93% of total billed charges,357.3,90,,,percent of total billed charges,90% of total billed charges,357.3,90,,,percent of total billed charges,90% of total billed charges,385.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,112.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,385.09,97,,,percent of total billed charges,97% of total billed charges,297.75,75,,,percent of total billed charges,75% of total billed charges,381.12,96,,,percent of total billed charges,96% of total billed charges,112.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297.75,75,,,percent of total billed charges,75% of total billed charges,297.75,75,,,percent of total billed charges,75% of total billed charges,112.18,385.09,
PF-AS EXCISION TUMOR HAND/FINGER SUBQ 1.5CM/>,78000665A,CDM,975,RC,26111,HCPCS,Outpatient,,,230,172.5,,211.6,92,,,percent of total billed charges,92% of total billed charges,43.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.9,93,,,percent of total billed charges,93% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,223.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.1,97,,,percent of total billed charges,97% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,220.8,96,,,percent of total billed charges,96% of total billed charges,43.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.5,75,,,percent of total billed charges,75% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,43.11,223.1,
PF-AS REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH,78000685A,CDM,975,RC,26420,HCPCS,Outpatient,,,334,250.5,,307.28,92,,,percent of total billed charges,92% of total billed charges,61.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,310.62,93,,,percent of total billed charges,93% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,323.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,323.98,97,,,percent of total billed charges,97% of total billed charges,250.5,75,,,percent of total billed charges,75% of total billed charges,320.64,96,,,percent of total billed charges,96% of total billed charges,61.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,250.5,75,,,percent of total billed charges,75% of total billed charges,250.5,75,,,percent of total billed charges,75% of total billed charges,61.79,323.98,
PF-AS REPAIR NON-UNION METACARPAL OR PHALANX,78000696A,CDM,975,RC,26546,HCPCS,Outpatient,,,408,306,,375.36,92,,,percent of total billed charges,92% of total billed charges,91.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,379.44,93,,,percent of total billed charges,93% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,395.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,91.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,395.76,97,,,percent of total billed charges,97% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,391.68,96,,,percent of total billed charges,96% of total billed charges,91.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306,75,,,percent of total billed charges,75% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,91.88,395.76,
PF-AS OSTEOTOMY METACARPAL EACH,78000698A,CDM,975,RC,26565,HCPCS,Outpatient,,,323,242.25,,297.16,92,,,percent of total billed charges,92% of total billed charges,60.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.39,93,,,percent of total billed charges,93% of total billed charges,290.7,90,,,percent of total billed charges,90% of total billed charges,290.7,90,,,percent of total billed charges,90% of total billed charges,313.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,60.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,313.31,97,,,percent of total billed charges,97% of total billed charges,242.25,75,,,percent of total billed charges,75% of total billed charges,310.08,96,,,percent of total billed charges,96% of total billed charges,60.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,242.25,75,,,percent of total billed charges,75% of total billed charges,242.25,75,,,percent of total billed charges,75% of total billed charges,60.14,313.31,
PF-AS OSTEOPLASTY LENGTHENING METACARPAL/PHALANX,78000701A,CDM,975,RC,26568,HCPCS,Outpatient,,,400,300,,368,92,,,percent of total billed charges,92% of total billed charges,84.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,372,93,,,percent of total billed charges,93% of total billed charges,360,90,,,percent of total billed charges,90% of total billed charges,360,90,,,percent of total billed charges,90% of total billed charges,388,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,84.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388,97,,,percent of total billed charges,97% of total billed charges,300,75,,,percent of total billed charges,75% of total billed charges,384,96,,,percent of total billed charges,96% of total billed charges,84.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300,75,,,percent of total billed charges,75% of total billed charges,300,75,,,percent of total billed charges,75% of total billed charges,84.02,388,
PF-AS REMOVAL FOREIGN BODY PELVIS/HIP DEEP,78000760A,CDM,975,RC,27087,HCPCS,Outpatient,,,242,181.5,,222.64,92,,,percent of total billed charges,92% of total billed charges,76.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,225.06,93,,,percent of total billed charges,93% of total billed charges,217.8,90,,,percent of total billed charges,90% of total billed charges,217.8,90,,,percent of total billed charges,90% of total billed charges,234.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,234.74,97,,,percent of total billed charges,97% of total billed charges,181.5,75,,,percent of total billed charges,75% of total billed charges,232.32,96,,,percent of total billed charges,96% of total billed charges,76.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.5,75,,,percent of total billed charges,75% of total billed charges,181.5,75,,,percent of total billed charges,75% of total billed charges,76.85,234.74,
PF-AS HEMIARTHROPLASTY HIP PARTIAL,78000768A,CDM,975,RC,27125,HCPCS,Outpatient,,,659,494.25,,606.28,92,,,percent of total billed charges,92% of total billed charges,131.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,612.87,93,,,percent of total billed charges,93% of total billed charges,593.1,90,,,percent of total billed charges,90% of total billed charges,593.1,90,,,percent of total billed charges,90% of total billed charges,639.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,131.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,639.23,97,,,percent of total billed charges,97% of total billed charges,494.25,75,,,percent of total billed charges,75% of total billed charges,632.64,96,,,percent of total billed charges,96% of total billed charges,131.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,494.25,75,,,percent of total billed charges,75% of total billed charges,494.25,75,,,percent of total billed charges,75% of total billed charges,131.79,639.23,
PF-AS ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT,78000770A,CDM,975,RC,27130,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,153.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,153.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,153.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,153.8,938.96,
PF-AS OPTX FEM FX PROX END NCK INT FIX/PROST RPLMT,78000782A,CDM,975,RC,27236,HCPCS,Outpatient,,,633,474.75,,582.36,92,,,percent of total billed charges,92% of total billed charges,139.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,588.69,93,,,percent of total billed charges,93% of total billed charges,569.7,90,,,percent of total billed charges,90% of total billed charges,569.7,90,,,percent of total billed charges,90% of total billed charges,614.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,139.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,614.01,97,,,percent of total billed charges,97% of total billed charges,474.75,75,,,percent of total billed charges,75% of total billed charges,607.68,96,,,percent of total billed charges,96% of total billed charges,139.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,474.75,75,,,percent of total billed charges,75% of total billed charges,474.75,75,,,percent of total billed charges,75% of total billed charges,139.09,614.01,
PF-AS TX FEMORAL FRACTURE WITH SCREW/PLATE IMPLANT,78000787A,CDM,975,RC,27244,HCPCS,Outpatient,,,612,459,,563.04,92,,,percent of total billed charges,92% of total billed charges,143.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,569.16,93,,,percent of total billed charges,93% of total billed charges,550.8,90,,,percent of total billed charges,90% of total billed charges,550.8,90,,,percent of total billed charges,90% of total billed charges,593.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,143.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,593.64,97,,,percent of total billed charges,97% of total billed charges,459,75,,,percent of total billed charges,75% of total billed charges,587.52,96,,,percent of total billed charges,96% of total billed charges,143.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,459,75,,,percent of total billed charges,75% of total billed charges,459,75,,,percent of total billed charges,75% of total billed charges,143.51,593.64,
PF-AS TX FEMORAL FRACTURE W/INTRAMEDULLARY IMPLANT,78000789A,CDM,975,RC,27245,HCPCS,Outpatient,,,706,529.5,,649.52,92,,,percent of total billed charges,92% of total billed charges,142.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,656.58,93,,,percent of total billed charges,93% of total billed charges,635.4,90,,,percent of total billed charges,90% of total billed charges,635.4,90,,,percent of total billed charges,90% of total billed charges,684.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,142.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,684.82,97,,,percent of total billed charges,97% of total billed charges,529.5,75,,,percent of total billed charges,75% of total billed charges,677.76,96,,,percent of total billed charges,96% of total billed charges,142.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,529.5,75,,,percent of total billed charges,75% of total billed charges,529.5,75,,,percent of total billed charges,75% of total billed charges,142.91,684.82,
PF-AS OPEN TREATMENT GREATER TROCHANTERIC FRACTURE,78000793A,CDM,975,RC,27248,HCPCS,Outpatient,,,364,273,,334.88,92,,,percent of total billed charges,92% of total billed charges,85.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,338.52,93,,,percent of total billed charges,93% of total billed charges,327.6,90,,,percent of total billed charges,90% of total billed charges,327.6,90,,,percent of total billed charges,90% of total billed charges,353.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,85.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,353.08,97,,,percent of total billed charges,97% of total billed charges,273,75,,,percent of total billed charges,75% of total billed charges,349.44,96,,,percent of total billed charges,96% of total billed charges,85.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,273,75,,,percent of total billed charges,75% of total billed charges,273,75,,,percent of total billed charges,75% of total billed charges,85.9,353.08,
PF-AS INCISION DEEP W/OPENING OF BONE CORTEX FEMUR OR KNEE,78000809A,CDM,975,RC,27303,HCPCS,Outpatient,,,319,239.25,,293.48,92,,,percent of total billed charges,92% of total billed charges,70.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.67,93,,,percent of total billed charges,93% of total billed charges,287.1,90,,,percent of total billed charges,90% of total billed charges,287.1,90,,,percent of total billed charges,90% of total billed charges,309.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,309.43,97,,,percent of total billed charges,97% of total billed charges,239.25,75,,,percent of total billed charges,75% of total billed charges,306.24,96,,,percent of total billed charges,96% of total billed charges,70.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,239.25,75,,,percent of total billed charges,75% of total billed charges,239.25,75,,,percent of total billed charges,75% of total billed charges,70.5,309.43,
PF-AS ARTHROTOMY KNEE W/EXPLORE DRAINAGE OR REMOVAL OF FB,78000811A,CDM,975,RC,27310,HCPCS,Outpatient,,,378,283.5,,347.76,92,,,percent of total billed charges,92% of total billed charges,81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,351.54,93,,,percent of total billed charges,93% of total billed charges,340.2,90,,,percent of total billed charges,90% of total billed charges,340.2,90,,,percent of total billed charges,90% of total billed charges,366.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,366.66,97,,,percent of total billed charges,97% of total billed charges,283.5,75,,,percent of total billed charges,75% of total billed charges,362.88,96,,,percent of total billed charges,96% of total billed charges,81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,283.5,75,,,percent of total billed charges,75% of total billed charges,283.5,75,,,percent of total billed charges,75% of total billed charges,81,366.66,
PF-AS ARTHROTOMY KNEE W/JOINT EXPLORE OR REMOVAL OF FB,78000821A,CDM,975,RC,27331,HCPCS,Outpatient,,,109,81.75,,100.28,92,,,percent of total billed charges,92% of total billed charges,50.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.37,93,,,percent of total billed charges,93% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,105.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,105.73,97,,,percent of total billed charges,97% of total billed charges,81.75,75,,,percent of total billed charges,75% of total billed charges,104.64,96,,,percent of total billed charges,96% of total billed charges,50.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.75,75,,,percent of total billed charges,75% of total billed charges,81.75,75,,,percent of total billed charges,75% of total billed charges,50.18,105.73,
PF-AS SUTURE INFRAPATELLAR TENDON PRIMARY,78000839A,CDM,975,RC,27380,HCPCS,Outpatient,,,306,229.5,,281.52,92,,,percent of total billed charges,92% of total billed charges,62.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.58,93,,,percent of total billed charges,93% of total billed charges,275.4,90,,,percent of total billed charges,90% of total billed charges,275.4,90,,,percent of total billed charges,90% of total billed charges,296.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,62.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.82,97,,,percent of total billed charges,97% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges,293.76,96,,,percent of total billed charges,96% of total billed charges,62.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,229.5,75,,,percent of total billed charges,75% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges,62.82,296.82,
PF-AS SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY,78000842A,CDM,975,RC,27385,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,58.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,58.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,58.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,58.76,343.38,
PF-AS SUTURE QUADRICEPS/HAMSTRING MUSCLE RUPTURE RCNSTJ,78000844A,CDM,975,RC,27386,HCPCS,Outpatient,,,443,332.25,,407.56,92,,,percent of total billed charges,92% of total billed charges,90.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.99,93,,,percent of total billed charges,93% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,429.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,90.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,429.71,97,,,percent of total billed charges,97% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,425.28,96,,,percent of total billed charges,96% of total billed charges,90.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,332.25,75,,,percent of total billed charges,75% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,90.42,429.71,
PF-AS ARTHROTOMY W/MENISCUS REPAIR KNEE,78000847A,CDM,975,RC,27403,HCPCS,Outpatient,,,369,276.75,,339.48,92,,,percent of total billed charges,92% of total billed charges,70.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.17,93,,,percent of total billed charges,93% of total billed charges,332.1,90,,,percent of total billed charges,90% of total billed charges,332.1,90,,,percent of total billed charges,90% of total billed charges,357.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,357.93,97,,,percent of total billed charges,97% of total billed charges,276.75,75,,,percent of total billed charges,75% of total billed charges,354.24,96,,,percent of total billed charges,96% of total billed charges,70.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,276.75,75,,,percent of total billed charges,75% of total billed charges,276.75,75,,,percent of total billed charges,75% of total billed charges,70.4,357.93,
PF-AS REPAIR PRIMARY TORN LIGAMENT CAPSULE KNEE COLLATERAL,78000849A,CDM,975,RC,27405,HCPCS,Outpatient,,,368,276,,338.56,92,,,percent of total billed charges,92% of total billed charges,73.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,342.24,93,,,percent of total billed charges,93% of total billed charges,331.2,90,,,percent of total billed charges,90% of total billed charges,331.2,90,,,percent of total billed charges,90% of total billed charges,356.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,73.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,356.96,97,,,percent of total billed charges,97% of total billed charges,276,75,,,percent of total billed charges,75% of total billed charges,353.28,96,,,percent of total billed charges,96% of total billed charges,73.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,276,75,,,percent of total billed charges,75% of total billed charges,276,75,,,percent of total billed charges,75% of total billed charges,73.1,356.96,
AS REPAIR PRIMARY TORN LIGAMENT AND/OR CAPSULE KNEE CRUCIATE,78002834A,CDM,975,RC,27407,HCPCS,Outpatient,,,399.2,299.4,,367.26,92,,,percent of total billed charges,92% of total billed charges,88.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,371.26,93,,,percent of total billed charges,93% of total billed charges,359.28,90,,,percent of total billed charges,90% of total billed charges,359.28,90,,,percent of total billed charges,90% of total billed charges,387.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,88.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,387.22,97,,,percent of total billed charges,97% of total billed charges,299.4,75,,,percent of total billed charges,75% of total billed charges,383.23,96,,,percent of total billed charges,96% of total billed charges,88.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,299.4,75,,,percent of total billed charges,75% of total billed charges,299.4,75,,,percent of total billed charges,75% of total billed charges,88.39,387.22,
PF-AS RPR PRIMARY TORN LIGAMENT CAPSULE KNEE COLLTRL/CRUCTE,78000851A,CDM,975,RC,27409,HCPCS,Outpatient,,,556,417,,511.52,92,,,percent of total billed charges,92% of total billed charges,109.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,517.08,93,,,percent of total billed charges,93% of total billed charges,500.4,90,,,percent of total billed charges,90% of total billed charges,500.4,90,,,percent of total billed charges,90% of total billed charges,539.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,539.32,97,,,percent of total billed charges,97% of total billed charges,417,75,,,percent of total billed charges,75% of total billed charges,533.76,96,,,percent of total billed charges,96% of total billed charges,109.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,417,75,,,percent of total billed charges,75% of total billed charges,417,75,,,percent of total billed charges,75% of total billed charges,109.93,539.32,
PF-AS ANTERIOR TIBIAL TUBERCLEPLASTY,78000853A,CDM,975,RC,27418,HCPCS,Outpatient,,,457,342.75,,420.44,92,,,percent of total billed charges,92% of total billed charges,87.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,425.01,93,,,percent of total billed charges,93% of total billed charges,411.3,90,,,percent of total billed charges,90% of total billed charges,411.3,90,,,percent of total billed charges,90% of total billed charges,443.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,87.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,443.29,97,,,percent of total billed charges,97% of total billed charges,342.75,75,,,percent of total billed charges,75% of total billed charges,438.72,96,,,percent of total billed charges,96% of total billed charges,87.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,342.75,75,,,percent of total billed charges,75% of total billed charges,342.75,75,,,percent of total billed charges,75% of total billed charges,87.83,443.29,
PF-AS RECONSTRUCT DISLOCATED PATELLA W/EXTENSOR REALIGN,78000855A,CDM,975,RC,27422,HCPCS,Outpatient,,,452,339,,415.84,92,,,percent of total billed charges,92% of total billed charges,81.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,420.36,93,,,percent of total billed charges,93% of total billed charges,406.8,90,,,percent of total billed charges,90% of total billed charges,406.8,90,,,percent of total billed charges,90% of total billed charges,438.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,81.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,438.44,97,,,percent of total billed charges,97% of total billed charges,339,75,,,percent of total billed charges,75% of total billed charges,433.92,96,,,percent of total billed charges,96% of total billed charges,81.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,339,75,,,percent of total billed charges,75% of total billed charges,339,75,,,percent of total billed charges,75% of total billed charges,81.85,438.44,
PF-AS LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR,78000858A,CDM,975,RC,27427,HCPCS,Outpatient,,,436,327,,401.12,92,,,percent of total billed charges,92% of total billed charges,76.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,405.48,93,,,percent of total billed charges,93% of total billed charges,392.4,90,,,percent of total billed charges,90% of total billed charges,392.4,90,,,percent of total billed charges,90% of total billed charges,422.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,422.92,97,,,percent of total billed charges,97% of total billed charges,327,75,,,percent of total billed charges,75% of total billed charges,418.56,96,,,percent of total billed charges,96% of total billed charges,76.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,327,75,,,percent of total billed charges,75% of total billed charges,327,75,,,percent of total billed charges,75% of total billed charges,76.62,422.92,
PF-AS QUADRICEPSPLASTY,78000860A,CDM,975,RC,27430,HCPCS,Outpatient,,,421,315.75,,387.32,92,,,percent of total billed charges,92% of total billed charges,82.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,391.53,93,,,percent of total billed charges,93% of total billed charges,378.9,90,,,percent of total billed charges,90% of total billed charges,378.9,90,,,percent of total billed charges,90% of total billed charges,408.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,82.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,408.37,97,,,percent of total billed charges,97% of total billed charges,315.75,75,,,percent of total billed charges,75% of total billed charges,404.16,96,,,percent of total billed charges,96% of total billed charges,82.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,315.75,75,,,percent of total billed charges,75% of total billed charges,315.75,75,,,percent of total billed charges,75% of total billed charges,82.43,408.37,
PF-AS ARTHROPLASTY KNEE CONDYLE  PLATEAU MED/LAT COMPARTMENT,78000862A,CDM,975,RC,27446,HCPCS,Outpatient,,,983,737.25,,904.36,92,,,percent of total billed charges,92% of total billed charges,135.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,914.19,93,,,percent of total billed charges,93% of total billed charges,884.7,90,,,percent of total billed charges,90% of total billed charges,884.7,90,,,percent of total billed charges,90% of total billed charges,953.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,135.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,953.51,97,,,percent of total billed charges,97% of total billed charges,737.25,75,,,percent of total billed charges,75% of total billed charges,943.68,96,,,percent of total billed charges,96% of total billed charges,135.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,737.25,75,,,percent of total billed charges,75% of total billed charges,737.25,75,,,percent of total billed charges,75% of total billed charges,135.04,953.51,
PF-AS ARTHROPLASTY KNEE CONDYLE  and  PLATEAU MEDIAL/LATERAL,78000864A,CDM,975,RC,27447,HCPCS,Outpatient,,,983,737.25,,904.36,92,,,percent of total billed charges,92% of total billed charges,153.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,914.19,93,,,percent of total billed charges,93% of total billed charges,884.7,90,,,percent of total billed charges,90% of total billed charges,884.7,90,,,percent of total billed charges,90% of total billed charges,953.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,153.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,953.51,97,,,percent of total billed charges,97% of total billed charges,737.25,75,,,percent of total billed charges,75% of total billed charges,943.68,96,,,percent of total billed charges,96% of total billed charges,153.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,737.25,75,,,percent of total billed charges,75% of total billed charges,737.25,75,,,percent of total billed charges,75% of total billed charges,153.18,953.51,
PF-AS REVISION TOTAL KNEE ARTHROPLASTY,78002860A,CDM,975,RC,27487,HCPCS,Outpatient,,,433,324.75,,398.36,92,,,percent of total billed charges,92% of total billed charges,211.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,402.69,93,,,percent of total billed charges,93% of total billed charges,389.7,90,,,percent of total billed charges,90% of total billed charges,389.7,90,,,percent of total billed charges,90% of total billed charges,420.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,211.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,420.01,97,,,percent of total billed charges,97% of total billed charges,324.75,75,,,percent of total billed charges,75% of total billed charges,415.68,96,,,percent of total billed charges,96% of total billed charges,211.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,324.75,75,,,percent of total billed charges,75% of total billed charges,324.75,75,,,percent of total billed charges,75% of total billed charges,211.94,420.01,
PF-AS REMOVAL OF TOTAL KNEE PROSTHESIS,78002852A,CDM,975,RC,27488,HCPCS,Outpatient,,,358,268.5,,329.36,92,,,percent of total billed charges,92% of total billed charges,139.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,332.94,93,,,percent of total billed charges,93% of total billed charges,322.2,90,,,percent of total billed charges,90% of total billed charges,322.2,90,,,percent of total billed charges,90% of total billed charges,347.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,139.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,347.26,97,,,percent of total billed charges,97% of total billed charges,268.5,75,,,percent of total billed charges,75% of total billed charges,343.68,96,,,percent of total billed charges,96% of total billed charges,139.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,268.5,75,,,percent of total billed charges,75% of total billed charges,268.5,75,,,percent of total billed charges,75% of total billed charges,139.61,347.26,
PF-AS OPEN TX FEMORAL SHAFT FX W/INSERT INTRAMED IMPLANT,78000880A,CDM,975,RC,27506,HCPCS,Outpatient,,,620,465,,570.4,92,,,percent of total billed charges,92% of total billed charges,155.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,576.6,93,,,percent of total billed charges,93% of total billed charges,558,90,,,percent of total billed charges,90% of total billed charges,558,90,,,percent of total billed charges,90% of total billed charges,601.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,155.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,601.4,97,,,percent of total billed charges,97% of total billed charges,465,75,,,percent of total billed charges,75% of total billed charges,595.2,96,,,percent of total billed charges,96% of total billed charges,155.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,75,,,percent of total billed charges,75% of total billed charges,465,75,,,percent of total billed charges,75% of total billed charges,155.49,601.4,
PF-AS OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ,78000901A,CDM,975,RC,27536,HCPCS,Outpatient,,,556,417,,511.52,92,,,percent of total billed charges,92% of total billed charges,138.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,517.08,93,,,percent of total billed charges,93% of total billed charges,500.4,90,,,percent of total billed charges,90% of total billed charges,500.4,90,,,percent of total billed charges,90% of total billed charges,539.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,138.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,539.32,97,,,percent of total billed charges,97% of total billed charges,417,75,,,percent of total billed charges,75% of total billed charges,533.76,96,,,percent of total billed charges,96% of total billed charges,138.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,417,75,,,percent of total billed charges,75% of total billed charges,417,75,,,percent of total billed charges,75% of total billed charges,138.1,539.32,
PF-AS UNLISTED PROCEDURE FEMUR/KNEE,78000917A,CDM,975,RC,27599,HCPCS,Outpatient,,,340,255,,312.8,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,316.2,93,,,percent of total billed charges,93% of total billed charges,306,90,,,percent of total billed charges,90% of total billed charges,306,90,,,percent of total billed charges,90% of total billed charges,329.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,329.8,97,,,percent of total billed charges,97% of total billed charges,255,75,,,percent of total billed charges,75% of total billed charges,326.4,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,255,75,,,percent of total billed charges,75% of total billed charges,255,75,,,percent of total billed charges,75% of total billed charges,255,329.8,
PF-AS REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE,78000951A,CDM,975,RC,27698,HCPCS,Outpatient,,,445,333.75,,409.4,92,,,percent of total billed charges,92% of total billed charges,62.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.85,93,,,percent of total billed charges,93% of total billed charges,400.5,90,,,percent of total billed charges,90% of total billed charges,400.5,90,,,percent of total billed charges,90% of total billed charges,431.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,62.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,431.65,97,,,percent of total billed charges,97% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges,427.2,96,,,percent of total billed charges,96% of total billed charges,62.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333.75,75,,,percent of total billed charges,75% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges,62.64,431.65,
PF-AS AMPUTATION LEG THROUGH TIBIA & FIBULA,78001025A,CDM,975,RC,27880,HCPCS,Outpatient,,,411,308.25,,378.12,92,,,percent of total billed charges,92% of total billed charges,130.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,382.23,93,,,percent of total billed charges,93% of total billed charges,369.9,90,,,percent of total billed charges,90% of total billed charges,369.9,90,,,percent of total billed charges,90% of total billed charges,398.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,130.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,398.67,97,,,percent of total billed charges,97% of total billed charges,308.25,75,,,percent of total billed charges,75% of total billed charges,394.56,96,,,percent of total billed charges,96% of total billed charges,130.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,308.25,75,,,percent of total billed charges,75% of total billed charges,308.25,75,,,percent of total billed charges,75% of total billed charges,130.2,398.67,
PF-AS EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>,78001038A,CDM,975,RC,28039,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges,28.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186,93,,,percent of total billed charges,93% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,194,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194,97,,,percent of total billed charges,97% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,192,96,,,percent of total billed charges,96% of total billed charges,28.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150,75,,,percent of total billed charges,75% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,28.32,194,
PF-AS EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS,78001048A,CDM,975,RC,28100,HCPCS,Outpatient,,,221,165.75,,203.32,92,,,percent of total billed charges,92% of total billed charges,36.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,205.53,93,,,percent of total billed charges,93% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,214.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,36.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.37,97,,,percent of total billed charges,97% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,212.16,96,,,percent of total billed charges,96% of total billed charges,36.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.75,75,,,percent of total billed charges,75% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,36.82,214.37,
PF-AS EXCISE BONE CYST OR BENIGN TUMOR TARSAL/METATARSAL,78001050A,CDM,975,RC,28104,HCPCS,Outpatient,,,202,151.5,,185.84,92,,,percent of total billed charges,92% of total billed charges,29.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,187.86,93,,,percent of total billed charges,93% of total billed charges,181.8,90,,,percent of total billed charges,90% of total billed charges,181.8,90,,,percent of total billed charges,90% of total billed charges,195.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.94,97,,,percent of total billed charges,97% of total billed charges,151.5,75,,,percent of total billed charges,75% of total billed charges,193.92,96,,,percent of total billed charges,96% of total billed charges,29.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,151.5,75,,,percent of total billed charges,75% of total billed charges,151.5,75,,,percent of total billed charges,75% of total billed charges,29.19,195.94,
PF-AS OSTECTOMY CALCANEUS,78001057A,CDM,975,RC,28118,HCPCS,Outpatient,,,223,167.25,,205.16,92,,,percent of total billed charges,92% of total billed charges,37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,207.39,93,,,percent of total billed charges,93% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,200.7,90,,,percent of total billed charges,90% of total billed charges,216.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,216.31,97,,,percent of total billed charges,97% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges,214.08,96,,,percent of total billed charges,96% of total billed charges,37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,167.25,75,,,percent of total billed charges,75% of total billed charges,167.25,75,,,percent of total billed charges,75% of total billed charges,37,216.31,
PF-AS PARTIAL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS,78001060A,CDM,975,RC,28122,HCPCS,Outpatient,,,245,183.75,,225.4,92,,,percent of total billed charges,92% of total billed charges,35.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,227.85,93,,,percent of total billed charges,93% of total billed charges,220.5,90,,,percent of total billed charges,90% of total billed charges,220.5,90,,,percent of total billed charges,90% of total billed charges,237.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,35.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237.65,97,,,percent of total billed charges,97% of total billed charges,183.75,75,,,percent of total billed charges,75% of total billed charges,235.2,96,,,percent of total billed charges,96% of total billed charges,35.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,183.75,75,,,percent of total billed charges,75% of total billed charges,183.75,75,,,percent of total billed charges,75% of total billed charges,35.11,237.65,
PF-AS PARTICAL EXCISION BONE PHALANX TOE,78001062A,CDM,975,RC,28124,HCPCS,Outpatient,,,166,124.5,,152.72,92,,,percent of total billed charges,92% of total billed charges,23.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.38,93,,,percent of total billed charges,93% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,161.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.02,97,,,percent of total billed charges,97% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,159.36,96,,,percent of total billed charges,96% of total billed charges,23.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,124.5,75,,,percent of total billed charges,75% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,23.87,161.02,
PF-AS REPAIR TENDON FLEXOR FOOT SEC W/FREE GRAFT EA TENDON,78001074A,CDM,975,RC,28202,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges,33.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,229.71,93,,,percent of total billed charges,93% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,239.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,239.59,97,,,percent of total billed charges,97% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,237.12,96,,,percent of total billed charges,96% of total billed charges,33.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.25,75,,,percent of total billed charges,75% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,33.61,239.59,
PF-AS KELLER/MCBRIDE/MAYO PROCEDURE,78001083A,CDM,975,RC,28292,HCPCS,Outpatient,,,344,258,,316.48,92,,,percent of total billed charges,92% of total billed charges,37.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,319.92,93,,,percent of total billed charges,93% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,333.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333.68,97,,,percent of total billed charges,97% of total billed charges,258,75,,,percent of total billed charges,75% of total billed charges,330.24,96,,,percent of total billed charges,96% of total billed charges,37.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,258,75,,,percent of total billed charges,75% of total billed charges,258,75,,,percent of total billed charges,75% of total billed charges,37.01,333.68,
PF-AS CORRJ HALLUX VALGUS W/WO SESMDC W/METAR OSTE,78001085A,CDM,975,RC,28296,HCPCS,Outpatient,,,380,285,,349.6,92,,,percent of total billed charges,92% of total billed charges,38.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,353.4,93,,,percent of total billed charges,93% of total billed charges,342,90,,,percent of total billed charges,90% of total billed charges,342,90,,,percent of total billed charges,90% of total billed charges,368.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,38.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,368.6,97,,,percent of total billed charges,97% of total billed charges,285,75,,,percent of total billed charges,75% of total billed charges,364.8,96,,,percent of total billed charges,96% of total billed charges,38.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,285,75,,,percent of total billed charges,75% of total billed charges,285,75,,,percent of total billed charges,75% of total billed charges,38.76,368.6,
PF-AS CORRJ HALLUX VALGUS W/WO SESMDC PHALANX OSTE,78001087A,CDM,975,RC,28298,HCPCS,Outpatient,,,307,230.25,,282.44,92,,,percent of total billed charges,92% of total billed charges,43.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,285.51,93,,,percent of total billed charges,93% of total billed charges,276.3,90,,,percent of total billed charges,90% of total billed charges,276.3,90,,,percent of total billed charges,90% of total billed charges,297.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297.79,97,,,percent of total billed charges,97% of total billed charges,230.25,75,,,percent of total billed charges,75% of total billed charges,294.72,96,,,percent of total billed charges,96% of total billed charges,43.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,230.25,75,,,percent of total billed charges,75% of total billed charges,230.25,75,,,percent of total billed charges,75% of total billed charges,43.2,297.79,
PF-AS CORRJ HALLUX VALGUS W/WO SESMDC 2 OSTEOT,78001089A,CDM,975,RC,28299,HCPCS,Outpatient,,,429,321.75,,394.68,92,,,percent of total billed charges,92% of total billed charges,50.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,398.97,93,,,percent of total billed charges,93% of total billed charges,386.1,90,,,percent of total billed charges,90% of total billed charges,386.1,90,,,percent of total billed charges,90% of total billed charges,416.13,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,416.13,97,,,percent of total billed charges,97% of total billed charges,321.75,75,,,percent of total billed charges,75% of total billed charges,411.84,96,,,percent of total billed charges,96% of total billed charges,50.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321.75,75,,,percent of total billed charges,75% of total billed charges,321.75,75,,,percent of total billed charges,75% of total billed charges,50.02,416.13,
PF-AS RPR NON/MALUNION METARSAL W/WO BONE GRAFT,78001093A,CDM,975,RC,28322,HCPCS,Outpatient,,,296,222,,272.32,92,,,percent of total billed charges,92% of total billed charges,55.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.28,93,,,percent of total billed charges,93% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,287.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,55.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,287.12,97,,,percent of total billed charges,97% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,284.16,96,,,percent of total billed charges,96% of total billed charges,55.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222,75,,,percent of total billed charges,75% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,55.71,287.12,
PF-AS PERCUT SKELETAL FIXATION OF CALCANEAL FX W/MANIP,78002883A,CDM,975,RC,28406,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges,57.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.02,93,,,percent of total billed charges,93% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,110.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,57.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.58,97,,,percent of total billed charges,97% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,109.44,96,,,percent of total billed charges,96% of total billed charges,57.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.5,75,,,percent of total billed charges,75% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,57.42,110.58,
PF-AS OPEN TREATMENT CALCANEAL FRACTURE,78001097A,CDM,975,RC,28415,HCPCS,Outpatient,,,508,381,,467.36,92,,,percent of total billed charges,92% of total billed charges,111.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,472.44,93,,,percent of total billed charges,93% of total billed charges,457.2,90,,,percent of total billed charges,90% of total billed charges,457.2,90,,,percent of total billed charges,90% of total billed charges,492.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,111.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,492.76,97,,,percent of total billed charges,97% of total billed charges,381,75,,,percent of total billed charges,75% of total billed charges,487.68,96,,,percent of total billed charges,96% of total billed charges,111.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,381,75,,,percent of total billed charges,75% of total billed charges,381,75,,,percent of total billed charges,75% of total billed charges,111.68,492.76,
PF-AS OPEN TREATMENT TALUS FRACTURE,78001103A,CDM,975,RC,28445,HCPCS,Outpatient,,,464,348,,426.88,92,,,percent of total billed charges,92% of total billed charges,110,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,431.52,93,,,percent of total billed charges,93% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,450.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,110,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,450.08,97,,,percent of total billed charges,97% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,445.44,96,,,percent of total billed charges,96% of total billed charges,110,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,348,75,,,percent of total billed charges,75% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,110,450.08,
PF-AS ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT,78001138A,CDM,975,RC,28740,HCPCS,Outpatient,,,217,162.75,,199.64,92,,,percent of total billed charges,92% of total billed charges,55.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.81,93,,,percent of total billed charges,93% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,210.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,55.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,210.49,97,,,percent of total billed charges,97% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,208.32,96,,,percent of total billed charges,96% of total billed charges,55.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.75,75,,,percent of total billed charges,75% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,55.91,210.49,
PF-AS AMPUTATION FOOT MIDTARSAL,78001141A,CDM,975,RC,28800,HCPCS,Outpatient,,,296,222,,272.32,92,,,percent of total billed charges,92% of total billed charges,45.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.28,93,,,percent of total billed charges,93% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,287.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,287.12,97,,,percent of total billed charges,97% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,284.16,96,,,percent of total billed charges,96% of total billed charges,45.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222,75,,,percent of total billed charges,75% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,45.13,287.12,
PF-AS AMPUTATION METATARSAL W/TOE SINGLE,78001143A,CDM,975,RC,28810,HCPCS,Outpatient,,,215,161.25,,197.8,92,,,percent of total billed charges,92% of total billed charges,41.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,199.95,93,,,percent of total billed charges,93% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,208.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,208.55,97,,,percent of total billed charges,97% of total billed charges,161.25,75,,,percent of total billed charges,75% of total billed charges,206.4,96,,,percent of total billed charges,96% of total billed charges,41.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.25,75,,,percent of total billed charges,75% of total billed charges,161.25,75,,,percent of total billed charges,75% of total billed charges,41.52,208.55,
PF-AS AMPUTATION TOE INTERPHALANGEAL JOINT,78001145A,CDM,975,RC,28825,HCPCS,Outpatient,,,501,375.75,,460.92,92,,,percent of total billed charges,92% of total billed charges,16.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465.93,93,,,percent of total billed charges,93% of total billed charges,450.9,90,,,percent of total billed charges,90% of total billed charges,450.9,90,,,percent of total billed charges,90% of total billed charges,485.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485.97,97,,,percent of total billed charges,97% of total billed charges,375.75,75,,,percent of total billed charges,75% of total billed charges,480.96,96,,,percent of total billed charges,96% of total billed charges,16.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375.75,75,,,percent of total billed charges,75% of total billed charges,375.75,75,,,percent of total billed charges,75% of total billed charges,16.8,485.97,
PF-AS UNLISTED PROCEDURE FOOT/TOES,78001146A,CDM,975,RC,28899,HCPCS,Outpatient,,,279,209.25,,256.68,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,259.47,93,,,percent of total billed charges,93% of total billed charges,251.1,90,,,percent of total billed charges,90% of total billed charges,251.1,90,,,percent of total billed charges,90% of total billed charges,270.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,270.63,97,,,percent of total billed charges,97% of total billed charges,209.25,75,,,percent of total billed charges,75% of total billed charges,267.84,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,209.25,75,,,percent of total billed charges,75% of total billed charges,209.25,75,,,percent of total billed charges,75% of total billed charges,209.25,270.63,
PF-AS ARTHROSCOPY SHOULDR SURG DEBRIDEMENT LIMITED,78001214A,CDM,975,RC,29822,HCPCS,Outpatient,,,675,506.25,,621,92,,,percent of total billed charges,92% of total billed charges,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,627.75,93,,,percent of total billed charges,93% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,654.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,654.75,97,,,percent of total billed charges,97% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,648,96,,,percent of total billed charges,96% of total billed charges,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,506.25,75,,,percent of total billed charges,75% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,56.97,654.75,
PF-AS ARTHROSCOPY SHOULDER SURG DEBRIDE EXTENSIVE,78001216A,CDM,975,RC,29823,HCPCS,Outpatient,,,481,360.75,,442.52,92,,,percent of total billed charges,92% of total billed charges,63.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.33,93,,,percent of total billed charges,93% of total billed charges,432.9,90,,,percent of total billed charges,90% of total billed charges,432.9,90,,,percent of total billed charges,90% of total billed charges,466.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,63.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,466.57,97,,,percent of total billed charges,97% of total billed charges,360.75,75,,,percent of total billed charges,75% of total billed charges,461.76,96,,,percent of total billed charges,96% of total billed charges,63.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,360.75,75,,,percent of total billed charges,75% of total billed charges,360.75,75,,,percent of total billed charges,75% of total billed charges,63.35,466.57,
PF-AS ARTHROSCOPY SHOULDER AHESIOLYSIS W/WO MANIP,78001220A,CDM,975,RC,29825,HCPCS,Outpatient,,,422,316.5,,388.24,92,,,percent of total billed charges,92% of total billed charges,61.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,392.46,93,,,percent of total billed charges,93% of total billed charges,379.8,90,,,percent of total billed charges,90% of total billed charges,379.8,90,,,percent of total billed charges,90% of total billed charges,409.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,409.34,97,,,percent of total billed charges,97% of total billed charges,316.5,75,,,percent of total billed charges,75% of total billed charges,405.12,96,,,percent of total billed charges,96% of total billed charges,61.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,316.5,75,,,percent of total billed charges,75% of total billed charges,316.5,75,,,percent of total billed charges,75% of total billed charges,61.76,409.34,
PF-AS ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RLS,78001222A,CDM,975,RC,29826,HCPCS,Outpatient,,,675,506.25,,621,92,,,percent of total billed charges,92% of total billed charges,21.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,627.75,93,,,percent of total billed charges,93% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,654.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,654.75,97,,,percent of total billed charges,97% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,648,96,,,percent of total billed charges,96% of total billed charges,21.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,506.25,75,,,percent of total billed charges,75% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,21.61,654.75,
PF-AS ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR,78001224A,CDM,975,RC,29827,HCPCS,Outpatient,,,675,506.25,,621,92,,,percent of total billed charges,92% of total billed charges,120.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,627.75,93,,,percent of total billed charges,93% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,654.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,120.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,654.75,97,,,percent of total billed charges,97% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,648,96,,,percent of total billed charges,96% of total billed charges,120.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,506.25,75,,,percent of total billed charges,75% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,120.42,654.75,
PF-AS ARTHROSCOPY SHOULDER BICEPS TENODESIS,78001226A,CDM,975,RC,29828,HCPCS,Outpatient,,,675,506.25,,621,92,,,percent of total billed charges,92% of total billed charges,102.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,627.75,93,,,percent of total billed charges,93% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,654.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,102.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,654.75,97,,,percent of total billed charges,97% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,648,96,,,percent of total billed charges,96% of total billed charges,102.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,506.25,75,,,percent of total billed charges,75% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,102.16,654.75,
PF-AS ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX,78001234A,CDM,975,RC,29875,HCPCS,Outpatient,,,675,506.25,,621,92,,,percent of total billed charges,92% of total billed charges,52.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,627.75,93,,,percent of total billed charges,93% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,654.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,52.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,654.75,97,,,percent of total billed charges,97% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,648,96,,,percent of total billed charges,96% of total billed charges,52.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,506.25,75,,,percent of total billed charges,75% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,52.7,654.75,
PF-AS ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG,78001239A,CDM,975,RC,29881,HCPCS,Outpatient,,,675,506.25,,621,92,,,percent of total billed charges,92% of total billed charges,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,627.75,93,,,percent of total billed charges,93% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,654.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,654.75,97,,,percent of total billed charges,97% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,648,96,,,percent of total billed charges,96% of total billed charges,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,506.25,75,,,percent of total billed charges,75% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,56.97,654.75,
PF-AS ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ,78001242A,CDM,975,RC,29884,HCPCS,Outpatient,,,435,326.25,,400.2,92,,,percent of total billed charges,92% of total billed charges,66.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,404.55,93,,,percent of total billed charges,93% of total billed charges,391.5,90,,,percent of total billed charges,90% of total billed charges,391.5,90,,,percent of total billed charges,90% of total billed charges,421.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,66.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,421.95,97,,,percent of total billed charges,97% of total billed charges,326.25,75,,,percent of total billed charges,75% of total billed charges,417.6,96,,,percent of total billed charges,96% of total billed charges,66.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,326.25,75,,,percent of total billed charges,75% of total billed charges,326.25,75,,,percent of total billed charges,75% of total billed charges,66.74,421.95,
PF-AS ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ,78001245A,CDM,975,RC,29888,HCPCS,Outpatient,,,800,600,,736,92,,,percent of total billed charges,92% of total billed charges,109.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,744,93,,,percent of total billed charges,93% of total billed charges,720,90,,,percent of total billed charges,90% of total billed charges,720,90,,,percent of total billed charges,90% of total billed charges,776,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,776,97,,,percent of total billed charges,97% of total billed charges,600,75,,,percent of total billed charges,75% of total billed charges,768,96,,,percent of total billed charges,96% of total billed charges,109.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,600,75,,,percent of total billed charges,75% of total billed charges,600,75,,,percent of total billed charges,75% of total billed charges,109.01,776,
PF-AS ARTHROSCOPY ANKLE SURGICAL,78002750A,CDM,975,RC,29891,HCPCS,Outpatient,,,170,127.5,,156.4,92,,,percent of total billed charges,92% of total billed charges,66.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.1,93,,,percent of total billed charges,93% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,164.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,66.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.9,97,,,percent of total billed charges,97% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,163.2,96,,,percent of total billed charges,96% of total billed charges,66.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.5,75,,,percent of total billed charges,75% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,66.39,164.9,
PF-AS ARTHROSCOPY ANKLE W/REMOVAL OF FOREIGN BODY,78002884A,CDM,975,RC,29894,HCPCS,Outpatient,,,99.4,74.55,,91.45,92,,,percent of total billed charges,92% of total billed charges,50.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,92.44,93,,,percent of total billed charges,93% of total billed charges,89.46,90,,,percent of total billed charges,90% of total billed charges,89.46,90,,,percent of total billed charges,90% of total billed charges,96.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,96.42,97,,,percent of total billed charges,97% of total billed charges,74.55,75,,,percent of total billed charges,75% of total billed charges,95.42,96,,,percent of total billed charges,96% of total billed charges,50.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.55,75,,,percent of total billed charges,75% of total billed charges,74.55,75,,,percent of total billed charges,75% of total billed charges,50.16,96.42,
PF-AS ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL,78002832A,CDM,975,RC,29895,HCPCS,Outpatient,,,113.3,84.98,,104.24,92,,,percent of total billed charges,92% of total billed charges,43.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,105.37,93,,,percent of total billed charges,93% of total billed charges,101.97,90,,,percent of total billed charges,90% of total billed charges,101.97,90,,,percent of total billed charges,90% of total billed charges,109.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,109.9,97,,,percent of total billed charges,97% of total billed charges,84.98,75,,,percent of total billed charges,75% of total billed charges,108.77,96,,,percent of total billed charges,96% of total billed charges,43.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.98,75,,,percent of total billed charges,75% of total billed charges,84.98,75,,,percent of total billed charges,75% of total billed charges,43.82,109.9,
PF-AS ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED,78002831A,CDM,975,RC,29897,HCPCS,Outpatient,,,124.5,93.38,,114.54,92,,,percent of total billed charges,92% of total billed charges,49.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,115.79,93,,,percent of total billed charges,93% of total billed charges,112.05,90,,,percent of total billed charges,90% of total billed charges,112.05,90,,,percent of total billed charges,90% of total billed charges,120.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,49.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,120.77,97,,,percent of total billed charges,97% of total billed charges,93.38,75,,,percent of total billed charges,75% of total billed charges,119.52,96,,,percent of total billed charges,96% of total billed charges,49.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.38,75,,,percent of total billed charges,75% of total billed charges,93.38,75,,,percent of total billed charges,75% of total billed charges,49.03,120.77,
PF-AS ARTHROSCOPY OF JOINT UNLISTED,78002829A,CDM,975,RC,29999,HCPCS,Outpatient,,,161.5,121.13,,148.58,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,150.2,93,,,percent of total billed charges,93% of total billed charges,145.35,90,,,percent of total billed charges,90% of total billed charges,145.35,90,,,percent of total billed charges,90% of total billed charges,156.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,156.66,97,,,percent of total billed charges,97% of total billed charges,121.13,75,,,percent of total billed charges,75% of total billed charges,155.04,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,121.13,75,,,percent of total billed charges,75% of total billed charges,121.13,75,,,percent of total billed charges,75% of total billed charges,121.13,156.66,
PF-AS THORACOTOMY WITH EXPLORATION,78001271A,CDM,975,RC,32100,HCPCS,Outpatient,,,317,237.75,,291.64,92,,,percent of total billed charges,92% of total billed charges,116.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,294.81,93,,,percent of total billed charges,93% of total billed charges,285.3,90,,,percent of total billed charges,90% of total billed charges,285.3,90,,,percent of total billed charges,90% of total billed charges,307.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,116.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,307.49,97,,,percent of total billed charges,97% of total billed charges,237.75,75,,,percent of total billed charges,75% of total billed charges,304.32,96,,,percent of total billed charges,96% of total billed charges,116.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237.75,75,,,percent of total billed charges,75% of total billed charges,237.75,75,,,percent of total billed charges,75% of total billed charges,116.43,307.49,
PF-AS APPENDECOMY FOR RUPTURED APPENDIX,78001442A,CDM,975,RC,44960,HCPCS,Outpatient,,,211,158.25,,194.12,92,,,percent of total billed charges,92% of total billed charges,128.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,196.23,93,,,percent of total billed charges,93% of total billed charges,189.9,90,,,percent of total billed charges,90% of total billed charges,189.9,90,,,percent of total billed charges,90% of total billed charges,204.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,128.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.67,97,,,percent of total billed charges,97% of total billed charges,158.25,75,,,percent of total billed charges,75% of total billed charges,202.56,96,,,percent of total billed charges,96% of total billed charges,128.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.25,75,,,percent of total billed charges,75% of total billed charges,158.25,75,,,percent of total billed charges,75% of total billed charges,128.82,204.67,
PF-AS TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY,78001611A,CDM,975,RC,58150,HCPCS,Outpatient,,,542,406.5,,498.64,92,,,percent of total billed charges,92% of total billed charges,114.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,504.06,93,,,percent of total billed charges,93% of total billed charges,487.8,90,,,percent of total billed charges,90% of total billed charges,487.8,90,,,percent of total billed charges,90% of total billed charges,525.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,114.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,525.74,97,,,percent of total billed charges,97% of total billed charges,406.5,75,,,percent of total billed charges,75% of total billed charges,520.32,96,,,percent of total billed charges,96% of total billed charges,114.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,406.5,75,,,percent of total billed charges,75% of total billed charges,406.5,75,,,percent of total billed charges,75% of total billed charges,114.19,525.74,
PF-AS SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX,78001652A,CDM,975,RC,58700,HCPCS,Outpatient,,,308,231,,283.36,92,,,percent of total billed charges,92% of total billed charges,93.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,286.44,93,,,percent of total billed charges,93% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,298.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,93.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,298.76,97,,,percent of total billed charges,97% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,295.68,96,,,percent of total billed charges,96% of total billed charges,93.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231,75,,,percent of total billed charges,75% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,93.21,298.76,
PF-AS LAPS TX ECTOPIC PREG W/O SALPING and /OOPHORECT,78001665A,CDM,975,RC,59150,HCPCS,Outpatient,,,565,423.75,,519.8,92,,,percent of total billed charges,92% of total billed charges,129.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,525.45,93,,,percent of total billed charges,93% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,548.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,129.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,548.05,97,,,percent of total billed charges,97% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,542.4,96,,,percent of total billed charges,96% of total billed charges,129.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,423.75,75,,,percent of total billed charges,75% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,129.67,548.05,
PF-AS LAPS TX ECTOPIC PREG W/SALPING and /OOPHORECTOMY,78001667A,CDM,975,RC,59151,HCPCS,Outpatient,,,565,423.75,,519.8,92,,,percent of total billed charges,92% of total billed charges,127.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,525.45,93,,,percent of total billed charges,93% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,548.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,127.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,548.05,97,,,percent of total billed charges,97% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,542.4,96,,,percent of total billed charges,96% of total billed charges,127.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,423.75,75,,,percent of total billed charges,75% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,127.71,548.05,
PF-AS CESAREAN DELIVERY ONLY,78001687A,CDM,975,RC,59514,HCPCS,Outpatient,,,738,553.5,,678.96,92,,,percent of total billed charges,92% of total billed charges,161.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,686.34,93,,,percent of total billed charges,93% of total billed charges,664.2,90,,,percent of total billed charges,90% of total billed charges,664.2,90,,,percent of total billed charges,90% of total billed charges,715.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,161.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.86,97,,,percent of total billed charges,97% of total billed charges,553.5,75,,,percent of total billed charges,75% of total billed charges,708.48,96,,,percent of total billed charges,96% of total billed charges,161.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.5,75,,,percent of total billed charges,75% of total billed charges,553.5,75,,,percent of total billed charges,75% of total billed charges,161.04,715.86,
PF-AS HYSTERECTOMY AFTER CESAREAN DELIVERY,78001692A,CDM,975,RC,59525,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,87.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,87.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,87.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,87.71,255.11,
PF-AS TOTAL THYROID LOBECTOMY UNI W/CONTRALAT SUB TOTAL LOBE,78001700A,CDM,975,RC,60225,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges,109.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,93,,,percent of total billed charges,93% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,485,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485,97,,,percent of total billed charges,97% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,480,96,,,percent of total billed charges,96% of total billed charges,109.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375,75,,,percent of total billed charges,75% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,109.57,485,
PF-AS EXCISION THYROGLOSSAL DUCT CYST/SINUS,78001701A,CDM,975,RC,60280,HCPCS,Outpatient,,,349,261.75,,321.08,92,,,percent of total billed charges,92% of total billed charges,41.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,324.57,93,,,percent of total billed charges,93% of total billed charges,314.1,90,,,percent of total billed charges,90% of total billed charges,314.1,90,,,percent of total billed charges,90% of total billed charges,338.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,338.53,97,,,percent of total billed charges,97% of total billed charges,261.75,75,,,percent of total billed charges,75% of total billed charges,335.04,96,,,percent of total billed charges,96% of total billed charges,41.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,261.75,75,,,percent of total billed charges,75% of total billed charges,261.75,75,,,percent of total billed charges,75% of total billed charges,41.63,338.53,
PF-AS PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS,78001702A,CDM,975,RC,60500,HCPCS,Outpatient,,,550,412.5,,506,92,,,percent of total billed charges,92% of total billed charges,126.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,511.5,93,,,percent of total billed charges,93% of total billed charges,495,90,,,percent of total billed charges,90% of total billed charges,495,90,,,percent of total billed charges,90% of total billed charges,533.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,126.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.5,97,,,percent of total billed charges,97% of total billed charges,412.5,75,,,percent of total billed charges,75% of total billed charges,528,96,,,percent of total billed charges,96% of total billed charges,126.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,412.5,75,,,percent of total billed charges,75% of total billed charges,412.5,75,,,percent of total billed charges,75% of total billed charges,126.13,533.5,
PF-AS LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LMBR,78001719A,CDM,975,RC,63030,HCPCS,Outpatient,,,1150,862.5,,1058,92,,,percent of total billed charges,92% of total billed charges,137.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1069.5,93,,,percent of total billed charges,93% of total billed charges,1035,90,,,percent of total billed charges,90% of total billed charges,1035,90,,,percent of total billed charges,90% of total billed charges,1115.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,137.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1115.5,97,,,percent of total billed charges,97% of total billed charges,862.5,75,,,percent of total billed charges,75% of total billed charges,1104,96,,,percent of total billed charges,96% of total billed charges,137.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,862.5,75,,,percent of total billed charges,75% of total billed charges,862.5,75,,,percent of total billed charges,75% of total billed charges,137.87,1115.5,
PF-AS NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW,78001788A,CDM,975,RC,64718,HCPCS,Outpatient,,,428,321,,393.76,92,,,percent of total billed charges,92% of total billed charges,61.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,398.04,93,,,percent of total billed charges,93% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,415.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,415.16,97,,,percent of total billed charges,97% of total billed charges,321,75,,,percent of total billed charges,75% of total billed charges,410.88,96,,,percent of total billed charges,96% of total billed charges,61.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321,75,,,percent of total billed charges,75% of total billed charges,321,75,,,percent of total billed charges,75% of total billed charges,61.34,415.16,
PF-AS DECOMPRESSION UNSPECIFIED NERVE,78001791A,CDM,975,RC,64722,HCPCS,Outpatient,,,428,321,,393.76,92,,,percent of total billed charges,92% of total billed charges,41.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,398.04,93,,,percent of total billed charges,93% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,415.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,415.16,97,,,percent of total billed charges,97% of total billed charges,321,75,,,percent of total billed charges,75% of total billed charges,410.88,96,,,percent of total billed charges,96% of total billed charges,41.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321,75,,,percent of total billed charges,75% of total billed charges,321,75,,,percent of total billed charges,75% of total billed charges,41.76,415.16,
PF-AS SUTURE 1 NERVE MEDIAN MOTOR THENAR,78001794A,CDM,975,RC,64835,HCPCS,Outpatient,,,819,614.25,,753.48,92,,,percent of total billed charges,92% of total billed charges,93.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,761.67,93,,,percent of total billed charges,93% of total billed charges,737.1,90,,,percent of total billed charges,90% of total billed charges,737.1,90,,,percent of total billed charges,90% of total billed charges,794.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,93.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,794.43,97,,,percent of total billed charges,97% of total billed charges,614.25,75,,,percent of total billed charges,75% of total billed charges,786.24,96,,,percent of total billed charges,96% of total billed charges,93.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,614.25,75,,,percent of total billed charges,75% of total billed charges,614.25,75,,,percent of total billed charges,75% of total billed charges,93.8,794.43,
DEBRIDEMENT OPEN WOUND 20 SQ CM/<,78001862G,CDM,960,RC,97597,HCPCS,Outpatient,,,198,148.5,,182.16,92,,,percent of total billed charges,92% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.14,93,,,percent of total billed charges,93% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,192.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,192.06,97,,,percent of total billed charges,97% of total billed charges,148.5,75,,,percent of total billed charges,75% of total billed charges,190.08,96,,,percent of total billed charges,96% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,148.5,75,,,percent of total billed charges,75% of total billed charges,148.5,75,,,percent of total billed charges,75% of total billed charges,2.84,192.06,
PF-CRNA INJECTION INTRALESIONAL UP TO  INCLUD 7 LESION,78000156P,CDM,964,RC,11900,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.65,2.65,
PF-CRNA INJECTION THERAPEUTIC CARPAL TUNNEL,78000346P,CDM,964,RC,20526,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.57,6.57,
PF-CRNA INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,78000348P,CDM,964,RC,20550,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.05,4.05,
PF-CRNA INJECTION SINGLE TENDON ORIGIN/INSERTION,78000350P,CDM,964,RC,20551,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.77,3.77,
PF-CRNA INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,78000352P,CDM,964,RC,20552,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,3.44,
PF-CRNA INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,78000354P,CDM,964,RC,20553,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,3.88,
PF-CRNA ARTHROCENTESIS ASPIR/INJ SMALL JT/BURSA W/O US,78000356P,CDM,964,RC,20600,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.67,3.67,
PF-CRNA ARTHROCNT ASPIR/INJ SML JT/BURSAW/US REC RPRT,78000360P,CDM,964,RC,20604,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,4.28,
PF-CRNA ARTHROCENTESIS ASPIR/INJ INTERM JT/BURS W/O US,78000362P,CDM,964,RC,20605,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.71,3.71,
PF-CRNA ARTHROCENTESIS ASPIR and /INJ INTERM JT/BURS W/US,78000366P,CDM,964,RC,20606,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.31,5.31,
PF-CRNA ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA W/O US,78000368P,CDM,964,RC,20610,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.09,5.09,
PF-CRNA ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA W/US,78000372P,CDM,964,RC,20611,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.09,6.09,
PF-CRNA INJECTION SI JOINT ARTHRGRPHY/ANES/STEROID W/IMA,78000764P,CDM,964,RC,27096,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.64,6.64,
PF-CRNA INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,78001263P,CDM,964,RC,31500,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,16.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.47,16.47,
PF-CRNA INTRO NEEDLE OR INTRACATHETER EXTREMITY ARTERY,78002255P,CDM,964,RC,36140,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,12.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.76,12.76,
PF-CRNA VENIPUNCTURE <3 YRS PHY/QHP SKILL FEMRL/JGLR VN,78001293P,CDM,964,RC,36400,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,1.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.45,1.45,
PF-CRNA VENIPNCTURE 3 YEARS/> REQUIRING SKILL OF MD OR QHP,78001295P,CDM,964,RC,36410,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.85,0.85,
PF-CRNA INSJ NON-TUNNELD CENTRAL VENOUS CATH AGE 5 YR/>,78001313P,CDM,964,RC,36556,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,9.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.11,9.11,
PF-CRNA INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>,78001315P,CDM,964,RC,36558,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,26.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.14,26.14,
PF-CRNA INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION  A,78001319P,CDM,964,RC,36569,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.08,11.08,
PF-CRNA INSERTION PICC W/RS and I 5 YR/>,78001323P,CDM,964,RC,36573,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,7.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.42,7.42,
PF-CRNA INSERTION PICC W/RS and I 5 YR/>,78001323P,CDM,964,RC,36573,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,7.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.42,7.42,
PF-CRNA REPLACE PICC W/O PORT/PUMP THROUGH ACCESS SITE,78002251P,CDM,964,RC,36584,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.22,5.22,
PF-CRNA REPLACE PICC VAD CATH W/PORT THROUGH ACCESS SITE,78002253P,CDM,964,RC,36585,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,28.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.21,28.21,
PF-CRNA INSERT ARTERIAL CATHETER FOR BLOOD SAMPLE OR INFUSIO,78001342P,CDM,964,RC,36620,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.94,3.94,
PF-CRNA INSERT ARTERIAL CATHETER FOR BLOOD SAMPLING OR INFUS,78002266P,CDM,964,RC,36625,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,12.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.52,12.52,
PF-CRNA SPINAL PUNCTURE LUMBAR DIAGNOSTIC,78001703P,CDM,964,RC,62270,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,9.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.51,9.51,
PF-CRNA INJECTION EPIDURAL BLOOD/CLOT PATCH,78001705P,CDM,964,RC,62273,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,9.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.85,9.85,
PF-CRNA INJECTION DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN,78001709P,CDM,964,RC,62320,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.21,10.21,
PF-CRNA INJECTION DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN,78001711P,CDM,964,RC,62321,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,8.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.84,8.84,
PF-CRNA INJECTION DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN,78001713P,CDM,964,RC,62322,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.33,7.33,
PF-CRNA INJECTION DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN,78001715P,CDM,964,RC,62323,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,8.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.29,8.29,
PF-CRNA INJECTION INTERLAMINAR CERVICAL/THORACIC W/O GUIDE,78002160P,CDM,964,RC,62324,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,7.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.38,7.38,
PF-CRNA INJECT INTERLAMINAR SUBARACHNOID LUMBAR OR SACRAL W/,78002873P,CDM,964,RC,62326,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.25,7.25,
"PF-CRNA IMPLANT, REVISE TUNNELED INTRATHECAL CATHETER",78002874P,CDM,964,RC,62350,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.68,46.68,
PF-CRNA INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE,78001722P,CDM,964,RC,64405,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.79,7.79,
PF-CRNA SINGLE NERVE BLOCK INJECTION ARM NERVE,78001724P,CDM,964,RC,64415,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,5.9,
PF-CRNA INJ ANESTHETIC/STEROID BRACHIAL PLEXUS W/GUIDANCE,78002875P,CDM,964,RC,64416,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.69,6.69,
PF-CRNA INJECTION ANESTHETIC OR STEROID AXILLARY NERVE,78200007P,CDM,964,RC,64417,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.71,5.71,
PF-CRNA INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE,78001726P,CDM,964,RC,64418,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.15,5.15,
PF-CRNA INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE,78001728P,CDM,964,RC,64420,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,4.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.7,4.7,
PF-CRNA MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES,78001730P,CDM,964,RC,64421,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,2.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.21,2.21,
PF-CRNA INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRV,78001732P,CDM,964,RC,64425,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.58,4.58,
PF-CRNA INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE,78001736P,CDM,964,RC,64445,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.26,6.26,
PF-CRNA INJECTION ANESTHETIC AGENT/STEROID SCIATIC NERVE,78002840P,CDM,964,RC,64446,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.64,6.64,
PF-CRNA INJECTION(S) ANESTH AGENT/STEROID FEMORAL NERVE,78002257P,CDM,964,RC,64447,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.14,5.14,
PF-CRNA INJECTION ANESTHETIC AGENT/STEROID FEMORAL NERVE,78002841P,CDM,964,RC,64448,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,6.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.25,6.25,
PF-CRNA INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,78001738P,CDM,964,RC,64450,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,3.88,
PF-CRNA INJECTION AA/STRD NERVES NRVTG SI JOINT W/IMG,78001740P,CDM,964,RC,64451,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.59,6.59,
PF-CRNA INJECTION AA/STRD GENICULAR NRV BRANCHES W/IMG,78001742P,CDM,964,RC,64454,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.62,6.62,
PF-CRNA PVB THORACIC SINGLE INJECTION SITE W/IMG GUIDE,78001744P,CDM,964,RC,64461,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7,7,
PF-CRNA INJECTION ANES/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL,78001748P,CDM,964,RC,64483,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,8.7,
PF-CRNA INJECTION ANES/STRD W/IMG TFRML EDRL LMBR/SAC EA LV,78001750P,CDM,964,RC,64484,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.47,4.47,
PF-CRNA TRANSVERSUS ABDIMINIS PLANE BLOCK W/GUIDANCE,78001752P,CDM,964,RC,64486,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,4.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.86,4.86,
PF-CRNA TAP BLOCK BILATERAL BY INJECTION(S),78001754P,CDM,964,RC,64488,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.86,5.86,
PF-CRNA INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL,78001756P,CDM,964,RC,64490,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,8.5,
PF-CRNA INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 2ND LVL,78001758P,CDM,964,RC,64491,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.28,5.28,
PF-CRNA INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVE,78001760P,CDM,964,RC,64492,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.32,5.32,
PF-CRNA INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL,78001762P,CDM,964,RC,64493,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.18,7.18,
PF-CRNA INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LVL,78001764P,CDM,964,RC,64494,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.45,4.45,
PF-CRNA INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVE,78001766P,CDM,964,RC,64495,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.48,4.48,
PF-CRNA INJECTION ANES AGENT SPHENOPALATINE GANGLION,78001768P,CDM,964,RC,64505,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,13.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.69,13.69,
PF-CRNA INJECTION ANESTH AGENT STELLATE GANGLION CERV SYMPAT,78002802P,CDM,964,RC,64510,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,5.9,
PF-CRNA INJECTION ANES LUMBAR/THORACIC PARAVERTBRL SYMPATHET,78001770P,CDM,964,RC,64520,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.45,6.45,
PF-CRNA DESTRUCTION NEUROLYTIC AGT GENICULAR NRVE W/IMG,78001774P,CDM,964,RC,64624,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.26,11.26,
PF-CRNA DESTRUCTION NEUROLYTIC AGENT PARVERTEB FCT SNGL CRVC,78001776P,CDM,964,RC,64633,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,15.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.29,15.29,
PF-CRNA DESTRUCTION NEUROLYTIC AGENT PARVERTEB FCT ADDL CRVC,78001778P,CDM,964,RC,64634,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.82,5.82,
PF-CRNA DESTRUCTION NEUROLYTIC AGENT PARVERTEB FCT SNGL LMBR,78001780P,CDM,964,RC,64635,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,15.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.3,15.3,
PF-CRNA DESTRUCTION NEUROLYTIC AGENT PARVERTEB FCT ADDL LUMB,78001784P,CDM,964,RC,64636,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,4.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.99,4.99,
PF-CRNA DESTRUCTION NEUROLYTIC AGENT OTHER PERIPHERAL NERVE,78001786P,CDM,964,RC,64640,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.79,9.79,
PF-CRNA US GUIDANCE NEEDLE PLACEMENT IMG SI,72600031P,CDM,964,RC,76942,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,1.25,
PF-CRNA XR FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,71800466P,CDM,964,RC,77002,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.36,3.36,
PF-CRNA XR FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,71800468P,CDM,964,RC,77003,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.93,2.93,
PF-CRNA INSERT & PLACE FLOW DIRECTED CATHETER,78002231P,CDM,964,RC,93503,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.84,7.84,
INSERT NON-INDWELLING BLADDER CATHETER,78001532G,CDM,960,RC,51701,HCPCS,Outpatient,,,68,51,,62.56,92,,,percent of total billed charges,92% of total billed charges,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63.24,93,,,percent of total billed charges,93% of total billed charges,61.2,90,,,percent of total billed charges,90% of total billed charges,61.2,90,,,percent of total billed charges,90% of total billed charges,65.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.96,97,,,percent of total billed charges,97% of total billed charges,51,75,,,percent of total billed charges,75% of total billed charges,65.28,96,,,percent of total billed charges,96% of total billed charges,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,51,75,,,percent of total billed charges,75% of total billed charges,51,75,,,percent of total billed charges,75% of total billed charges,2.77,65.96,
PF ECG ROUTINE ECG W/LEAST 12 LDS IR ONLY,78001841P,CDM,985,RC,93010,HCPCS,Outpatient,,,197,147.75,,181.24,92,,,percent of total billed charges,92% of total billed charges,0.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,183.21,93,,,percent of total billed charges,93% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,191.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.09,97,,,percent of total billed charges,97% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,189.12,96,,,percent of total billed charges,96% of total billed charges,0.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.75,75,,,percent of total billed charges,75% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,0.55,191.09,
PF CLOSED TX FINGER DISLOCATION W/MANIP W/O ANESTH,78002888P,CDM,981,RC,26770,HCPCS,Outpatient,,,592.4,444.3,,545.01,92,,,percent of total billed charges,92% of total billed charges,26.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,550.93,93,,,percent of total billed charges,93% of total billed charges,533.16,90,,,percent of total billed charges,90% of total billed charges,533.16,90,,,percent of total billed charges,90% of total billed charges,574.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,574.63,97,,,percent of total billed charges,97% of total billed charges,444.3,75,,,percent of total billed charges,75% of total billed charges,568.7,96,,,percent of total billed charges,96% of total billed charges,26.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,444.3,75,,,percent of total billed charges,75% of total billed charges,444.3,75,,,percent of total billed charges,75% of total billed charges,26.31,574.63,
PF CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA,78001018P,CDM,981,RC,27840,HCPCS,Outpatient,,,1477,1107.75,,1358.84,92,,,percent of total billed charges,92% of total billed charges,40.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1373.61,93,,,percent of total billed charges,93% of total billed charges,1329.3,90,,,percent of total billed charges,90% of total billed charges,1329.3,90,,,percent of total billed charges,90% of total billed charges,1432.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1432.69,97,,,percent of total billed charges,97% of total billed charges,1107.75,75,,,percent of total billed charges,75% of total billed charges,1417.92,96,,,percent of total billed charges,96% of total billed charges,40.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1107.75,75,,,percent of total billed charges,75% of total billed charges,1107.75,75,,,percent of total billed charges,75% of total billed charges,40.13,1432.69,
CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA,78001018G,CDM,981,RC,27840,HCPCS,Outpatient,,,1477,1107.75,,1358.84,92,,,percent of total billed charges,92% of total billed charges,40.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1373.61,93,,,percent of total billed charges,93% of total billed charges,1329.3,90,,,percent of total billed charges,90% of total billed charges,1329.3,90,,,percent of total billed charges,90% of total billed charges,1432.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1432.69,97,,,percent of total billed charges,97% of total billed charges,1107.75,75,,,percent of total billed charges,75% of total billed charges,1417.92,96,,,percent of total billed charges,96% of total billed charges,40.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1107.75,75,,,percent of total billed charges,75% of total billed charges,1107.75,75,,,percent of total billed charges,75% of total billed charges,40.13,1432.69,
PF REMOVAL INTRAUTERINE DEVICE IUD,78001621P,CDM,981,RC,58301,HCPCS,Outpatient,,,175,131.25,,161,92,,,percent of total billed charges,92% of total billed charges,7.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.75,93,,,percent of total billed charges,93% of total billed charges,157.5,90,,,percent of total billed charges,90% of total billed charges,157.5,90,,,percent of total billed charges,90% of total billed charges,169.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,169.75,97,,,percent of total billed charges,97% of total billed charges,131.25,75,,,percent of total billed charges,75% of total billed charges,168,96,,,percent of total billed charges,96% of total billed charges,7.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.25,75,,,percent of total billed charges,75% of total billed charges,131.25,75,,,percent of total billed charges,75% of total billed charges,7.98,169.75,
PF VAGINAL DELIVERY ONLY,78001673P,CDM,981,RC,59409,HCPCS,Outpatient,,,3943,2957.25,,3627.56,92,,,percent of total billed charges,92% of total billed charges,133.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3666.99,93,,,percent of total billed charges,93% of total billed charges,3548.7,90,,,percent of total billed charges,90% of total billed charges,3548.7,90,,,percent of total billed charges,90% of total billed charges,3824.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,133.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3824.71,97,,,percent of total billed charges,97% of total billed charges,2957.25,75,,,percent of total billed charges,75% of total billed charges,3785.28,96,,,percent of total billed charges,96% of total billed charges,133.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2957.25,75,,,percent of total billed charges,75% of total billed charges,2957.25,75,,,percent of total billed charges,75% of total billed charges,133.73,3824.71,
PF CONSCIOUS SEDATION SAME MD <5 YRS INIT 15 MIN,68500062P,CDM,981,RC,99151,HCPCS,Outpatient,,,91,68.25,,83.72,92,,,percent of total billed charges,92% of total billed charges,1.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.63,93,,,percent of total billed charges,93% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,88.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,88.27,97,,,percent of total billed charges,97% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,87.36,96,,,percent of total billed charges,96% of total billed charges,1.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,68.25,75,,,percent of total billed charges,75% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,1.63,88.27,
PF CONSCIOUS SEDATION SAME MD 5+ YRS INIT 15 MIN,68500013P,CDM,981,RC,99152,HCPCS,Outpatient,,,591,443.25,,543.72,92,,,percent of total billed charges,92% of total billed charges,1.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,549.63,93,,,percent of total billed charges,93% of total billed charges,531.9,90,,,percent of total billed charges,90% of total billed charges,531.9,90,,,percent of total billed charges,90% of total billed charges,573.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,573.27,97,,,percent of total billed charges,97% of total billed charges,443.25,75,,,percent of total billed charges,75% of total billed charges,567.36,96,,,percent of total billed charges,96% of total billed charges,1.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,443.25,75,,,percent of total billed charges,75% of total billed charges,443.25,75,,,percent of total billed charges,75% of total billed charges,1.23,573.27,
PF CONSCIOUS SEDATION SAME MD EA ADDL 15 MIN,68500015P,CDM,981,RC,99153,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges,0.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,39.06,93,,,percent of total billed charges,93% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,40.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,40.74,97,,,percent of total billed charges,97% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,40.32,96,,,percent of total billed charges,96% of total billed charges,0.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,31.5,75,,,percent of total billed charges,75% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,0.95,40.74,
PF CONSCIOUS SEDATION DIFF MD <5 YRS INIT 15 MIN,68500017P,CDM,981,RC,99155,HCPCS,Outpatient,,,331,248.25,,304.52,92,,,percent of total billed charges,92% of total billed charges,8.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,307.83,93,,,percent of total billed charges,93% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,321.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321.07,97,,,percent of total billed charges,97% of total billed charges,248.25,75,,,percent of total billed charges,75% of total billed charges,317.76,96,,,percent of total billed charges,96% of total billed charges,8.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,248.25,75,,,percent of total billed charges,75% of total billed charges,248.25,75,,,percent of total billed charges,75% of total billed charges,8.52,321.07,
PF CONSCIOUS SEDATION DIFF MD 5+ YRS INIT 15 MIN,68500019P,CDM,981,RC,99156,HCPCS,Outpatient,,,303,227.25,,278.76,92,,,percent of total billed charges,92% of total billed charges,7.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,281.79,93,,,percent of total billed charges,93% of total billed charges,272.7,90,,,percent of total billed charges,90% of total billed charges,272.7,90,,,percent of total billed charges,90% of total billed charges,293.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,293.91,97,,,percent of total billed charges,97% of total billed charges,227.25,75,,,percent of total billed charges,75% of total billed charges,290.88,96,,,percent of total billed charges,96% of total billed charges,7.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,227.25,75,,,percent of total billed charges,75% of total billed charges,227.25,75,,,percent of total billed charges,75% of total billed charges,7.17,293.91,
PF CONSCIOUS SEDATION DIFF MD EA ADDL 15 MIN,68500021P,CDM,981,RC,99157,HCPCS,Outpatient,,,248,186,,228.16,92,,,percent of total billed charges,92% of total billed charges,5.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,230.64,93,,,percent of total billed charges,93% of total billed charges,223.2,90,,,percent of total billed charges,90% of total billed charges,223.2,90,,,percent of total billed charges,90% of total billed charges,240.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,240.56,97,,,percent of total billed charges,97% of total billed charges,186,75,,,percent of total billed charges,75% of total billed charges,238.08,96,,,percent of total billed charges,96% of total billed charges,5.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186,75,,,percent of total billed charges,75% of total billed charges,186,75,,,percent of total billed charges,75% of total billed charges,5.01,240.56,
PF EMER DEPARTMENT VISIT LEVEL 1 TRIAGE,68500030P,CDM,981,RC,99281,HCPCS,Outpatient,,,57,42.75,,52.44,92,,,percent of total billed charges,92% of total billed charges,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.01,93,,,percent of total billed charges,93% of total billed charges,51.3,90,,,percent of total billed charges,90% of total billed charges,51.3,90,,,percent of total billed charges,90% of total billed charges,55.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,55.29,97,,,percent of total billed charges,97% of total billed charges,42.75,75,,,percent of total billed charges,75% of total billed charges,54.72,96,,,percent of total billed charges,96% of total billed charges,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,42.75,75,,,percent of total billed charges,75% of total billed charges,42.75,75,,,percent of total billed charges,75% of total billed charges,1.21,55.29,
PF ER VISIT LEVEL 2 EXPANDED PROBLEM FOCUSED,68500033P,CDM,981,RC,99282,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,4.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,4.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,4.14,107.67,
PF ER VISIT LEVEL 3 MOD SEVERITY,68500036P,CDM,981,RC,99283,HCPCS,Outpatient,,,189,141.75,,173.88,92,,,percent of total billed charges,92% of total billed charges,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.77,93,,,percent of total billed charges,93% of total billed charges,170.1,90,,,percent of total billed charges,90% of total billed charges,170.1,90,,,percent of total billed charges,90% of total billed charges,183.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,183.33,97,,,percent of total billed charges,97% of total billed charges,141.75,75,,,percent of total billed charges,75% of total billed charges,181.44,96,,,percent of total billed charges,96% of total billed charges,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.75,75,,,percent of total billed charges,75% of total billed charges,141.75,75,,,percent of total billed charges,75% of total billed charges,7.04,183.33,
PF ER VISIT LEVEL 4 HIGH SEVERITY,68500039P,CDM,981,RC,99284,HCPCS,Outpatient,,,319,239.25,,293.48,92,,,percent of total billed charges,92% of total billed charges,12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.67,93,,,percent of total billed charges,93% of total billed charges,287.1,90,,,percent of total billed charges,90% of total billed charges,287.1,90,,,percent of total billed charges,90% of total billed charges,309.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,309.43,97,,,percent of total billed charges,97% of total billed charges,239.25,75,,,percent of total billed charges,75% of total billed charges,306.24,96,,,percent of total billed charges,96% of total billed charges,12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,239.25,75,,,percent of total billed charges,75% of total billed charges,239.25,75,,,percent of total billed charges,75% of total billed charges,12,309.43,
PF ER VISIT LEVEL 5 HIGH SEVERITY,68500042P,CDM,981,RC,99285,HCPCS,Outpatient,,,464,348,,426.88,92,,,percent of total billed charges,92% of total billed charges,17.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,431.52,93,,,percent of total billed charges,93% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,450.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,450.08,97,,,percent of total billed charges,97% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,445.44,96,,,percent of total billed charges,96% of total billed charges,17.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,348,75,,,percent of total billed charges,75% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,17.38,450.08,
PF MD/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS,68500045P,CDM,981,RC,99288,HCPCS,Outpatient,,,482,361.5,,443.44,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,448.26,93,,,percent of total billed charges,93% of total billed charges,433.8,90,,,percent of total billed charges,90% of total billed charges,433.8,90,,,percent of total billed charges,90% of total billed charges,467.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,467.54,97,,,percent of total billed charges,97% of total billed charges,361.5,75,,,percent of total billed charges,75% of total billed charges,462.72,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,361.5,75,,,percent of total billed charges,75% of total billed charges,361.5,75,,,percent of total billed charges,75% of total billed charges,361.5,467.54,
PF CRITICAL CARE FIRST 30-74 MIN,68500046P,CDM,981,RC,99291,HCPCS,Outpatient,,,569,426.75,,523.48,92,,,percent of total billed charges,92% of total billed charges,18.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,529.17,93,,,percent of total billed charges,93% of total billed charges,512.1,90,,,percent of total billed charges,90% of total billed charges,512.1,90,,,percent of total billed charges,90% of total billed charges,551.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,551.93,97,,,percent of total billed charges,97% of total billed charges,426.75,75,,,percent of total billed charges,75% of total billed charges,546.24,96,,,percent of total billed charges,96% of total billed charges,18.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,426.75,75,,,percent of total billed charges,75% of total billed charges,426.75,75,,,percent of total billed charges,75% of total billed charges,18.66,551.93,
PF CRITICAL CARE EA ADDL 30 MIN,68500049P,CDM,981,RC,99292,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges,9.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.98,93,,,percent of total billed charges,93% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,277.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.42,97,,,percent of total billed charges,97% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,274.56,96,,,percent of total billed charges,96% of total billed charges,9.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.5,75,,,percent of total billed charges,75% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,9.9,277.42,
PF CRITICAL CARE EA ADDL 30 MIN,68500049P,CDM,981,RC,99292,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges,9.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.98,93,,,percent of total billed charges,93% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,277.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.42,97,,,percent of total billed charges,97% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,274.56,96,,,percent of total billed charges,96% of total billed charges,9.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.5,75,,,percent of total billed charges,75% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,9.9,277.42,
ED FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESN,78000003G,CDM,981,RC,10021,HCPCS,Outpatient,,,642,481.5,,590.64,92,,,percent of total billed charges,92% of total billed charges,5.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,597.06,93,,,percent of total billed charges,93% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,622.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,622.74,97,,,percent of total billed charges,97% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,616.32,96,,,percent of total billed charges,96% of total billed charges,5.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,481.5,75,,,percent of total billed charges,75% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,5.67,622.74,
ED INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE,78000005G,CDM,981,RC,10060,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,7.23,289.06,
ED INCISION  and  DRAINAGE ABSCESS COMPLICATED/MULT,78000007G,CDM,981,RC,10061,HCPCS,Outpatient,,,712,534,,655.04,92,,,percent of total billed charges,92% of total billed charges,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,662.16,93,,,percent of total billed charges,93% of total billed charges,640.8,90,,,percent of total billed charges,90% of total billed charges,640.8,90,,,percent of total billed charges,90% of total billed charges,690.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,690.64,97,,,percent of total billed charges,97% of total billed charges,534,75,,,percent of total billed charges,75% of total billed charges,683.52,96,,,percent of total billed charges,96% of total billed charges,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534,75,,,percent of total billed charges,75% of total billed charges,534,75,,,percent of total billed charges,75% of total billed charges,15.08,690.64,
ED INCISION AND DRAINAGE PILONIDAL CYST SIMPLE,78000009G,CDM,981,RC,10080,HCPCS,Outpatient,,,403,302.25,,370.76,92,,,percent of total billed charges,92% of total billed charges,9.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,374.79,93,,,percent of total billed charges,93% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,390.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,390.91,97,,,percent of total billed charges,97% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,386.88,96,,,percent of total billed charges,96% of total billed charges,9.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,302.25,75,,,percent of total billed charges,75% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,9.08,390.91,
ED INCISION AND DRAINAGE PILONIDAL CYST COMPLICATED,78000011G,CDM,981,RC,10081,HCPCS,Outpatient,,,453,339.75,,416.76,92,,,percent of total billed charges,92% of total billed charges,18.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,421.29,93,,,percent of total billed charges,93% of total billed charges,407.7,90,,,percent of total billed charges,90% of total billed charges,407.7,90,,,percent of total billed charges,90% of total billed charges,439.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,439.41,97,,,percent of total billed charges,97% of total billed charges,339.75,75,,,percent of total billed charges,75% of total billed charges,434.88,96,,,percent of total billed charges,96% of total billed charges,18.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,339.75,75,,,percent of total billed charges,75% of total billed charges,339.75,75,,,percent of total billed charges,75% of total billed charges,18.68,439.41,
ED INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,78000013G,CDM,981,RC,10120,HCPCS,Outpatient,,,403,302.25,,370.76,92,,,percent of total billed charges,92% of total billed charges,7.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,374.79,93,,,percent of total billed charges,93% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,390.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,390.91,97,,,percent of total billed charges,97% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,386.88,96,,,percent of total billed charges,96% of total billed charges,7.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,302.25,75,,,percent of total billed charges,75% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,7.74,390.91,
ED INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPLETE,78000015G,CDM,981,RC,10121,HCPCS,Outpatient,,,728,546,,669.76,92,,,percent of total billed charges,92% of total billed charges,17.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,677.04,93,,,percent of total billed charges,93% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,706.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,706.16,97,,,percent of total billed charges,97% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,698.88,96,,,percent of total billed charges,96% of total billed charges,17.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546,75,,,percent of total billed charges,75% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,17.2,706.16,
ED I & D HEMATOMA SEROMA/FLUID COLLECTION,78000017G,CDM,981,RC,10140,HCPCS,Outpatient,,,410,307.5,,377.2,92,,,percent of total billed charges,92% of total billed charges,9.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,381.3,93,,,percent of total billed charges,93% of total billed charges,369,90,,,percent of total billed charges,90% of total billed charges,369,90,,,percent of total billed charges,90% of total billed charges,397.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,397.7,97,,,percent of total billed charges,97% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges,393.6,96,,,percent of total billed charges,96% of total billed charges,9.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,307.5,75,,,percent of total billed charges,75% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges,9.8,397.7,
ED PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,78000019G,CDM,981,RC,10160,HCPCS,Outpatient,,,487,365.25,,448.04,92,,,percent of total billed charges,92% of total billed charges,7.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,452.91,93,,,percent of total billed charges,93% of total billed charges,438.3,90,,,percent of total billed charges,90% of total billed charges,438.3,90,,,percent of total billed charges,90% of total billed charges,472.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,472.39,97,,,percent of total billed charges,97% of total billed charges,365.25,75,,,percent of total billed charges,75% of total billed charges,467.52,96,,,percent of total billed charges,96% of total billed charges,7.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,365.25,75,,,percent of total billed charges,75% of total billed charges,365.25,75,,,percent of total billed charges,75% of total billed charges,7.69,472.39,
ED INCISION & DRAIN POST OP WOUND INFECTION COMPLEX,78000021G,CDM,981,RC,10180,HCPCS,Outpatient,,,907,680.25,,834.44,92,,,percent of total billed charges,92% of total billed charges,20.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,843.51,93,,,percent of total billed charges,93% of total billed charges,816.3,90,,,percent of total billed charges,90% of total billed charges,816.3,90,,,percent of total billed charges,90% of total billed charges,879.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,879.79,97,,,percent of total billed charges,97% of total billed charges,680.25,75,,,percent of total billed charges,75% of total billed charges,870.72,96,,,percent of total billed charges,96% of total billed charges,20.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,680.25,75,,,percent of total billed charges,75% of total billed charges,680.25,75,,,percent of total billed charges,75% of total billed charges,20.04,879.79,
ED DEBRIDE W/FOREIGN BODY REMOVAL SKIN & SUBC TISS,78000026G,CDM,981,RC,11010,HCPCS,Outpatient,,,728,546,,669.76,92,,,percent of total billed charges,92% of total billed charges,29.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,677.04,93,,,percent of total billed charges,93% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,706.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,706.16,97,,,percent of total billed charges,97% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,698.88,96,,,percent of total billed charges,96% of total billed charges,29.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546,75,,,percent of total billed charges,75% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,29.58,706.16,
ED DEBRIDE W/FOREIGN BODY RMVL SKIN SUBQ TISS MUSC,78000028G,CDM,981,RC,11011,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,36.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,36.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,36.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,36.54,729.44,
ED DEBRIDEMENT WFB REMOVAL AT OPEN FX/DISLOCATION,78000030G,CDM,981,RC,11012,HCPCS,Outpatient,,,2546,1909.5,,2342.32,92,,,percent of total billed charges,92% of total billed charges,50.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2367.78,93,,,percent of total billed charges,93% of total billed charges,2291.4,90,,,percent of total billed charges,90% of total billed charges,2291.4,90,,,percent of total billed charges,90% of total billed charges,2469.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2469.62,97,,,percent of total billed charges,97% of total billed charges,1909.5,75,,,percent of total billed charges,75% of total billed charges,2444.16,96,,,percent of total billed charges,96% of total billed charges,50.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1909.5,75,,,percent of total billed charges,75% of total billed charges,1909.5,75,,,percent of total billed charges,75% of total billed charges,50.63,2469.62,
ED DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,78000032G,CDM,981,RC,11042,HCPCS,Outpatient,,,239,179.25,,219.88,92,,,percent of total billed charges,92% of total billed charges,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222.27,93,,,percent of total billed charges,93% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,231.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.83,97,,,percent of total billed charges,97% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,229.44,96,,,percent of total billed charges,96% of total billed charges,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.25,75,,,percent of total billed charges,75% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,5.61,231.83,
ED DEBRIDE MUSCLE AND/OR FASCIA FIRST 20 SQCM OR <,78000034G,CDM,981,RC,11043,HCPCS,Outpatient,,,608,456,,559.36,92,,,percent of total billed charges,92% of total billed charges,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,565.44,93,,,percent of total billed charges,93% of total billed charges,547.2,90,,,percent of total billed charges,90% of total billed charges,547.2,90,,,percent of total billed charges,90% of total billed charges,589.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,589.76,97,,,percent of total billed charges,97% of total billed charges,456,75,,,percent of total billed charges,75% of total billed charges,583.68,96,,,percent of total billed charges,96% of total billed charges,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,456,75,,,percent of total billed charges,75% of total billed charges,456,75,,,percent of total billed charges,75% of total billed charges,16.12,589.76,
ED DEBRIDEMENT BONE FIRST 20 SQ CM OR LESS,78000036G,CDM,981,RC,11044,HCPCS,Outpatient,,,893,669.75,,821.56,92,,,percent of total billed charges,92% of total billed charges,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,830.49,93,,,percent of total billed charges,93% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,866.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,866.21,97,,,percent of total billed charges,97% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,857.28,96,,,percent of total billed charges,96% of total billed charges,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,669.75,75,,,percent of total billed charges,75% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,25.64,866.21,
ED DEBRIDE SUBCUTANEOUS TISSUE EACH ADDL 20 SQ CM,78000038G,CDM,981,RC,11045,HCPCS,Outpatient,,,105,78.75,,96.6,92,,,percent of total billed charges,92% of total billed charges,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.65,93,,,percent of total billed charges,93% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,101.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.85,97,,,percent of total billed charges,97% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges,100.8,96,,,percent of total billed charges,96% of total billed charges,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.75,75,,,percent of total billed charges,75% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges,3.03,101.85,
ED DEBRIDE MUSCLE AND/OR FASCIA EACH ADDL 20 SQ CM,78000040G,CDM,981,RC,11046,HCPCS,Outpatient,,,219,164.25,,201.48,92,,,percent of total billed charges,92% of total billed charges,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.67,93,,,percent of total billed charges,93% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,212.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,212.43,97,,,percent of total billed charges,97% of total billed charges,164.25,75,,,percent of total billed charges,75% of total billed charges,210.24,96,,,percent of total billed charges,96% of total billed charges,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.25,75,,,percent of total billed charges,75% of total billed charges,164.25,75,,,percent of total billed charges,75% of total billed charges,7.03,212.43,
ED DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM,78000042G,CDM,981,RC,11047,HCPCS,Outpatient,,,387,290.25,,356.04,92,,,percent of total billed charges,92% of total billed charges,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,359.91,93,,,percent of total billed charges,93% of total billed charges,348.3,90,,,percent of total billed charges,90% of total billed charges,348.3,90,,,percent of total billed charges,90% of total billed charges,375.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375.39,97,,,percent of total billed charges,97% of total billed charges,290.25,75,,,percent of total billed charges,75% of total billed charges,371.52,96,,,percent of total billed charges,96% of total billed charges,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,290.25,75,,,percent of total billed charges,75% of total billed charges,290.25,75,,,percent of total billed charges,75% of total billed charges,12.81,375.39,
ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,78000044G,CDM,981,RC,11055,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,39.06,93,,,percent of total billed charges,93% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,40.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,40.74,97,,,percent of total billed charges,97% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,40.32,96,,,percent of total billed charges,96% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,31.5,75,,,percent of total billed charges,75% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,1.34,40.74,
ED PARING/CUTTING BENIGN HYPERKERATOTC LESIONS 2-4,78000046G,CDM,981,RC,11056,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.94,93,,,percent of total billed charges,93% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,56.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.26,97,,,percent of total billed charges,97% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,55.68,96,,,percent of total billed charges,96% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.5,75,,,percent of total billed charges,75% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,1.83,56.26,
ED PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,78000048G,CDM,981,RC,11057,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,2.33,73.72,
ED TANGENTIAL BIOPSY SKIN SINGLE LESION,78000050G,CDM,981,RC,11102,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.15,93,,,percent of total billed charges,93% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,150.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.35,97,,,percent of total billed charges,97% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,148.8,96,,,percent of total billed charges,96% of total billed charges,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,75,,,percent of total billed charges,75% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,3.19,150.35,
ED PUNCH BIOPSY SKIN SINGLE LESION,78000054G,CDM,981,RC,11104,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.56,93,,,percent of total billed charges,93% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,186.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.24,97,,,percent of total billed charges,97% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,184.32,96,,,percent of total billed charges,96% of total billed charges,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144,75,,,percent of total billed charges,75% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,4.31,186.24,
ED PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000056G,CDM,981,RC,11105,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.7,93,,,percent of total billed charges,93% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,87.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,87.3,97,,,percent of total billed charges,97% of total billed charges,67.5,75,,,percent of total billed charges,75% of total billed charges,86.4,96,,,percent of total billed charges,96% of total billed charges,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,67.5,75,,,percent of total billed charges,75% of total billed charges,67.5,75,,,percent of total billed charges,75% of total billed charges,2.5,87.3,
ED INCISIONAL BIOPSY SKIN SINGLE LESION,78000058G,CDM,981,RC,11106,HCPCS,Outpatient,,,238,178.5,,218.96,92,,,percent of total billed charges,92% of total billed charges,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,221.34,93,,,percent of total billed charges,93% of total billed charges,214.2,90,,,percent of total billed charges,90% of total billed charges,214.2,90,,,percent of total billed charges,90% of total billed charges,230.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,230.86,97,,,percent of total billed charges,97% of total billed charges,178.5,75,,,percent of total billed charges,75% of total billed charges,228.48,96,,,percent of total billed charges,96% of total billed charges,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.5,75,,,percent of total billed charges,75% of total billed charges,178.5,75,,,percent of total billed charges,75% of total billed charges,5.46,230.86,
ED INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000060G,CDM,981,RC,11107,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,2.95,104.76,
ED REMOVAL OF SKIN TAGS UP TO 15 LESIONS,78000062G,CDM,981,RC,11200,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges,5.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.55,93,,,percent of total billed charges,93% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,130.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.95,97,,,percent of total billed charges,97% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,129.6,96,,,percent of total billed charges,96% of total billed charges,5.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.25,75,,,percent of total billed charges,75% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,5.1,130.95,
ED REMOVAL OF SKIN TAGS ANY AREA EACH ADD 10 LESN,78000064G,CDM,981,RC,11201,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges,1.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,39.99,93,,,percent of total billed charges,93% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,41.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,41.71,97,,,percent of total billed charges,97% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,41.28,96,,,percent of total billed charges,96% of total billed charges,1.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,32.25,75,,,percent of total billed charges,75% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,1.37,41.71,
ED SHAVING SKIN LESN 1 TRUNK/ARM/LEG DIAM 0.5CM/<,78000066G,CDM,981,RC,11300,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges,3.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.15,93,,,percent of total billed charges,93% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,150.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.35,97,,,percent of total billed charges,97% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,148.8,96,,,percent of total billed charges,96% of total billed charges,3.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,75,,,percent of total billed charges,75% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,3.06,150.35,
ED SHAVE SKIN LESN 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,78000068G,CDM,981,RC,11301,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges,4.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.05,93,,,percent of total billed charges,93% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,179.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.45,97,,,percent of total billed charges,97% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,177.6,96,,,percent of total billed charges,96% of total billed charges,4.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,4.46,179.45,
ED SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<,78000072G,CDM,981,RC,11310,HCPCS,Outpatient,,,177,132.75,,162.84,92,,,percent of total billed charges,92% of total billed charges,4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.61,93,,,percent of total billed charges,93% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,171.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,171.69,97,,,percent of total billed charges,97% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,169.92,96,,,percent of total billed charges,96% of total billed charges,4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.75,75,,,percent of total billed charges,75% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,4,171.69,
ED EXCISE BENIGN LESION MRGN XCP SK TG T/A/L 0.5 CM/<,78000076G,CDM,981,RC,11400,HCPCS,Outpatient,,,221,165.75,,203.32,92,,,percent of total billed charges,92% of total billed charges,6.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,205.53,93,,,percent of total billed charges,93% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,214.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.37,97,,,percent of total billed charges,97% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,212.16,96,,,percent of total billed charges,96% of total billed charges,6.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.75,75,,,percent of total billed charges,75% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,6.19,214.37,
ED EXCISE BENIGN LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM,78000078G,CDM,981,RC,11401,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.48,93,,,percent of total billed charges,93% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,228.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.92,97,,,percent of total billed charges,97% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,226.56,96,,,percent of total billed charges,96% of total billed charges,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177,75,,,percent of total billed charges,75% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,8.01,228.92,
ED EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 1.1-2.0 CM,78000080G,CDM,981,RC,11402,HCPCS,Outpatient,,,260,195,,239.2,92,,,percent of total billed charges,92% of total billed charges,9.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,241.8,93,,,percent of total billed charges,93% of total billed charges,234,90,,,percent of total billed charges,90% of total billed charges,234,90,,,percent of total billed charges,90% of total billed charges,252.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,252.2,97,,,percent of total billed charges,97% of total billed charges,195,75,,,percent of total billed charges,75% of total billed charges,249.6,96,,,percent of total billed charges,96% of total billed charges,9.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195,75,,,percent of total billed charges,75% of total billed charges,195,75,,,percent of total billed charges,75% of total billed charges,9.17,252.2,
ED EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 2.1-3.0 CM,78000082G,CDM,981,RC,11403,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,12.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,12.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,12.53,289.06,
ED EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 3.1-4.0 CM,78000084G,CDM,981,RC,11404,HCPCS,Outpatient,,,338,253.5,,310.96,92,,,percent of total billed charges,92% of total billed charges,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,314.34,93,,,percent of total billed charges,93% of total billed charges,304.2,90,,,percent of total billed charges,90% of total billed charges,304.2,90,,,percent of total billed charges,90% of total billed charges,327.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,327.86,97,,,percent of total billed charges,97% of total billed charges,253.5,75,,,percent of total billed charges,75% of total billed charges,324.48,96,,,percent of total billed charges,96% of total billed charges,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,253.5,75,,,percent of total billed charges,75% of total billed charges,253.5,75,,,percent of total billed charges,75% of total billed charges,15.21,327.86,
ED EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS >4.0 CM,78000086G,CDM,981,RC,11406,HCPCS,Outpatient,,,479,359.25,,440.68,92,,,percent of total billed charges,92% of total billed charges,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,445.47,93,,,percent of total billed charges,93% of total billed charges,431.1,90,,,percent of total billed charges,90% of total billed charges,431.1,90,,,percent of total billed charges,90% of total billed charges,464.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,464.63,97,,,percent of total billed charges,97% of total billed charges,359.25,75,,,percent of total billed charges,75% of total billed charges,459.84,96,,,percent of total billed charges,96% of total billed charges,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,359.25,75,,,percent of total billed charges,75% of total billed charges,359.25,75,,,percent of total billed charges,75% of total billed charges,26.53,464.63,
ED EXCISE BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,78000088G,CDM,981,RC,11420,HCPCS,Outpatient,,,193,144.75,,177.56,92,,,percent of total billed charges,92% of total billed charges,5.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.49,93,,,percent of total billed charges,93% of total billed charges,173.7,90,,,percent of total billed charges,90% of total billed charges,173.7,90,,,percent of total billed charges,90% of total billed charges,187.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,187.21,97,,,percent of total billed charges,97% of total billed charges,144.75,75,,,percent of total billed charges,75% of total billed charges,185.28,96,,,percent of total billed charges,96% of total billed charges,5.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.75,75,,,percent of total billed charges,75% of total billed charges,144.75,75,,,percent of total billed charges,75% of total billed charges,5.57,187.21,
ED EXCISE BENIGN LESN MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM,78000090G,CDM,981,RC,11421,HCPCS,Outpatient,,,241,180.75,,221.72,92,,,percent of total billed charges,92% of total billed charges,8.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,224.13,93,,,percent of total billed charges,93% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,233.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.77,97,,,percent of total billed charges,97% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,231.36,96,,,percent of total billed charges,96% of total billed charges,8.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.75,75,,,percent of total billed charges,75% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,8.4,233.77,
ED EXCISE BENIGN LESN MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM,78000092G,CDM,981,RC,11422,HCPCS,Outpatient,,,270,202.5,,248.4,92,,,percent of total billed charges,92% of total billed charges,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,251.1,93,,,percent of total billed charges,93% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,261.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,261.9,97,,,percent of total billed charges,97% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,259.2,96,,,percent of total billed charges,96% of total billed charges,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,202.5,75,,,percent of total billed charges,75% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,10.41,261.9,
ED EXCISE BENIGN LESION MGN XCP SK TG S/N/H/F/G 2.1-3.0CM,78000094G,CDM,981,RC,11423,HCPCS,Outpatient,,,308,231,,283.36,92,,,percent of total billed charges,92% of total billed charges,12.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,286.44,93,,,percent of total billed charges,93% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,298.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,298.76,97,,,percent of total billed charges,97% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,295.68,96,,,percent of total billed charges,96% of total billed charges,12.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231,75,,,percent of total billed charges,75% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,12.78,298.76,
ED EXCISE BENIGN LESION MGN XCP SK TG S/N/H/F/G 3.1-4.0CM,78000096G,CDM,981,RC,11424,HCPCS,Outpatient,,,353,264.75,,324.76,92,,,percent of total billed charges,92% of total billed charges,16.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,328.29,93,,,percent of total billed charges,93% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,342.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,342.41,97,,,percent of total billed charges,97% of total billed charges,264.75,75,,,percent of total billed charges,75% of total billed charges,338.88,96,,,percent of total billed charges,96% of total billed charges,16.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,264.75,75,,,percent of total billed charges,75% of total billed charges,264.75,75,,,percent of total billed charges,75% of total billed charges,16.32,342.41,
ED EXCISE BENIGN LESION SCALP NECK HANDS FT GENIT > 4.0CM,78000098G,CDM,981,RC,11426,HCPCS,Outpatient,,,499,374.25,,459.08,92,,,percent of total billed charges,92% of total billed charges,26.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,464.07,93,,,percent of total billed charges,93% of total billed charges,449.1,90,,,percent of total billed charges,90% of total billed charges,449.1,90,,,percent of total billed charges,90% of total billed charges,484.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,484.03,97,,,percent of total billed charges,97% of total billed charges,374.25,75,,,percent of total billed charges,75% of total billed charges,479.04,96,,,percent of total billed charges,96% of total billed charges,26.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,374.25,75,,,percent of total billed charges,75% of total billed charges,374.25,75,,,percent of total billed charges,75% of total billed charges,26.37,484.03,
ED EXCISE BENIGN LESION FACE EAR EYELID NOSE LIP MOUTH 0.5CM,78000100G,CDM,981,RC,11440,HCPCS,Outpatient,,,217,162.75,,199.64,92,,,percent of total billed charges,92% of total billed charges,6.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.81,93,,,percent of total billed charges,93% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,210.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,210.49,97,,,percent of total billed charges,97% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,208.32,96,,,percent of total billed charges,96% of total billed charges,6.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.75,75,,,percent of total billed charges,75% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,6.71,210.49,
ED EXCISE BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM,78000102G,CDM,981,RC,11441,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,10.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,10.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,10.06,255.11,
ED EXCISE BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM,78000104G,CDM,981,RC,11442,HCPCS,Outpatient,,,291,218.25,,267.72,92,,,percent of total billed charges,92% of total billed charges,11.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,270.63,93,,,percent of total billed charges,93% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,282.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,282.27,97,,,percent of total billed charges,97% of total billed charges,218.25,75,,,percent of total billed charges,75% of total billed charges,279.36,96,,,percent of total billed charges,96% of total billed charges,11.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.25,75,,,percent of total billed charges,75% of total billed charges,218.25,75,,,percent of total billed charges,75% of total billed charges,11.62,282.27,
ED EXCISE BENIGN LESION MGN XCP SK TG F/E/E/N/L/M > 4.0CM,78000106G,CDM,981,RC,11446,HCPCS,Outpatient,,,843,632.25,,775.56,92,,,percent of total billed charges,92% of total billed charges,29.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,783.99,93,,,percent of total billed charges,93% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,817.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,817.71,97,,,percent of total billed charges,97% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,809.28,96,,,percent of total billed charges,96% of total billed charges,29.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,632.25,75,,,percent of total billed charges,75% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,29.41,817.71,
ED EXCISION MALIGNAT LESION TRUNK ARMS LEGS 0.5 CM/<,78000108G,CDM,981,RC,11600,HCPCS,Outpatient,,,322,241.5,,296.24,92,,,percent of total billed charges,92% of total billed charges,10.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,299.46,93,,,percent of total billed charges,93% of total billed charges,289.8,90,,,percent of total billed charges,90% of total billed charges,289.8,90,,,percent of total billed charges,90% of total billed charges,312.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312.34,97,,,percent of total billed charges,97% of total billed charges,241.5,75,,,percent of total billed charges,75% of total billed charges,309.12,96,,,percent of total billed charges,96% of total billed charges,10.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,241.5,75,,,percent of total billed charges,75% of total billed charges,241.5,75,,,percent of total billed charges,75% of total billed charges,10.2,312.34,
ED EXCISION MALIGNANT LESION TRUNK ARMS LEGS 0.6-1.0CM,78000110G,CDM,981,RC,11601,HCPCS,Outpatient,,,344,258,,316.48,92,,,percent of total billed charges,92% of total billed charges,11.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,319.92,93,,,percent of total billed charges,93% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,333.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333.68,97,,,percent of total billed charges,97% of total billed charges,258,75,,,percent of total billed charges,75% of total billed charges,330.24,96,,,percent of total billed charges,96% of total billed charges,11.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,258,75,,,percent of total billed charges,75% of total billed charges,258,75,,,percent of total billed charges,75% of total billed charges,11.9,333.68,
ED EXCISION MALIGNANT LESION TRUNK ARMS LEGS 1.1-2.0CM,78000112G,CDM,981,RC,11602,HCPCS,Outpatient,,,367,275.25,,337.64,92,,,percent of total billed charges,92% of total billed charges,12.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,341.31,93,,,percent of total billed charges,93% of total billed charges,330.3,90,,,percent of total billed charges,90% of total billed charges,330.3,90,,,percent of total billed charges,90% of total billed charges,355.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,355.99,97,,,percent of total billed charges,97% of total billed charges,275.25,75,,,percent of total billed charges,75% of total billed charges,352.32,96,,,percent of total billed charges,96% of total billed charges,12.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.25,75,,,percent of total billed charges,75% of total billed charges,275.25,75,,,percent of total billed charges,75% of total billed charges,12.34,355.99,
ED EXCISION MALIGNANT LESION TRUNK ARMS LEGS > 4.0CM,78000116G,CDM,981,RC,11606,HCPCS,Outpatient,,,835,626.25,,768.2,92,,,percent of total billed charges,92% of total billed charges,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,776.55,93,,,percent of total billed charges,93% of total billed charges,751.5,90,,,percent of total billed charges,90% of total billed charges,751.5,90,,,percent of total billed charges,90% of total billed charges,809.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,809.95,97,,,percent of total billed charges,97% of total billed charges,626.25,75,,,percent of total billed charges,75% of total billed charges,801.6,96,,,percent of total billed charges,96% of total billed charges,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,626.25,75,,,percent of total billed charges,75% of total billed charges,626.25,75,,,percent of total billed charges,75% of total billed charges,34.49,809.95,
ED EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT 0.6-1.0CM,78000118G,CDM,981,RC,11621,HCPCS,Outpatient,,,624,468,,574.08,92,,,percent of total billed charges,92% of total billed charges,12.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,580.32,93,,,percent of total billed charges,93% of total billed charges,561.6,90,,,percent of total billed charges,90% of total billed charges,561.6,90,,,percent of total billed charges,90% of total billed charges,605.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,605.28,97,,,percent of total billed charges,97% of total billed charges,468,75,,,percent of total billed charges,75% of total billed charges,599.04,96,,,percent of total billed charges,96% of total billed charges,12.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,468,75,,,percent of total billed charges,75% of total billed charges,468,75,,,percent of total billed charges,75% of total billed charges,12.2,605.28,
ED EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT 1.1-2.0CM,78000120G,CDM,981,RC,11622,HCPCS,Outpatient,,,444,333,,408.48,92,,,percent of total billed charges,92% of total billed charges,13.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,412.92,93,,,percent of total billed charges,93% of total billed charges,399.6,90,,,percent of total billed charges,90% of total billed charges,399.6,90,,,percent of total billed charges,90% of total billed charges,430.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.68,97,,,percent of total billed charges,97% of total billed charges,333,75,,,percent of total billed charges,75% of total billed charges,426.24,96,,,percent of total billed charges,96% of total billed charges,13.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333,75,,,percent of total billed charges,75% of total billed charges,333,75,,,percent of total billed charges,75% of total billed charges,13.7,430.68,
ED EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM,78000122G,CDM,981,RC,11623,HCPCS,Outpatient,,,549,411.75,,505.08,92,,,percent of total billed charges,92% of total billed charges,18.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,510.57,93,,,percent of total billed charges,93% of total billed charges,494.1,90,,,percent of total billed charges,90% of total billed charges,494.1,90,,,percent of total billed charges,90% of total billed charges,532.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,532.53,97,,,percent of total billed charges,97% of total billed charges,411.75,75,,,percent of total billed charges,75% of total billed charges,527.04,96,,,percent of total billed charges,96% of total billed charges,18.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.75,75,,,percent of total billed charges,75% of total billed charges,411.75,75,,,percent of total billed charges,75% of total billed charges,18.04,532.53,
ED EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT >4CM,78000124G,CDM,981,RC,11626,HCPCS,Outpatient,,,769,576.75,,707.48,92,,,percent of total billed charges,92% of total billed charges,30.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.17,93,,,percent of total billed charges,93% of total billed charges,692.1,90,,,percent of total billed charges,90% of total billed charges,692.1,90,,,percent of total billed charges,90% of total billed charges,745.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,745.93,97,,,percent of total billed charges,97% of total billed charges,576.75,75,,,percent of total billed charges,75% of total billed charges,738.24,96,,,percent of total billed charges,96% of total billed charges,30.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,576.75,75,,,percent of total billed charges,75% of total billed charges,576.75,75,,,percent of total billed charges,75% of total billed charges,30.89,745.93,
ED EXCISE MALIGNANT LESION FACE EAR EYELID NOSE LIP 0.5CM/<,78000126G,CDM,981,RC,11640,HCPCS,Outpatient,,,333,249.75,,306.36,92,,,percent of total billed charges,92% of total billed charges,10.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,309.69,93,,,percent of total billed charges,93% of total billed charges,299.7,90,,,percent of total billed charges,90% of total billed charges,299.7,90,,,percent of total billed charges,90% of total billed charges,323.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,323.01,97,,,percent of total billed charges,97% of total billed charges,249.75,75,,,percent of total billed charges,75% of total billed charges,319.68,96,,,percent of total billed charges,96% of total billed charges,10.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249.75,75,,,percent of total billed charges,75% of total billed charges,249.75,75,,,percent of total billed charges,75% of total billed charges,10.08,323.01,
ED EXCISE MALIGNANT LESN FACE EAR EYELID NOSE LIP 0.6-1.0CM,78000128G,CDM,981,RC,11641,HCPCS,Outpatient,,,408,306,,375.36,92,,,percent of total billed charges,92% of total billed charges,12.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,379.44,93,,,percent of total billed charges,93% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,395.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,395.76,97,,,percent of total billed charges,97% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,391.68,96,,,percent of total billed charges,96% of total billed charges,12.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306,75,,,percent of total billed charges,75% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,12.69,395.76,
ED EXCISE MALIGNANT LESN FACE EAR EYELID NOSE LIP 1.1-2.0CM,78000130G,CDM,981,RC,11642,HCPCS,Outpatient,,,478,358.5,,439.76,92,,,percent of total billed charges,92% of total billed charges,15.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,444.54,93,,,percent of total billed charges,93% of total billed charges,430.2,90,,,percent of total billed charges,90% of total billed charges,430.2,90,,,percent of total billed charges,90% of total billed charges,463.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,463.66,97,,,percent of total billed charges,97% of total billed charges,358.5,75,,,percent of total billed charges,75% of total billed charges,458.88,96,,,percent of total billed charges,96% of total billed charges,15.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,358.5,75,,,percent of total billed charges,75% of total billed charges,358.5,75,,,percent of total billed charges,75% of total billed charges,15.49,463.66,
ED EXCISE MALIGNANT LESN FACE EAR EYELID NOSE LIP 2.1-3.0CM,78000132G,CDM,981,RC,11643,HCPCS,Outpatient,,,597,447.75,,549.24,92,,,percent of total billed charges,92% of total billed charges,20.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,555.21,93,,,percent of total billed charges,93% of total billed charges,537.3,90,,,percent of total billed charges,90% of total billed charges,537.3,90,,,percent of total billed charges,90% of total billed charges,579.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,579.09,97,,,percent of total billed charges,97% of total billed charges,447.75,75,,,percent of total billed charges,75% of total billed charges,573.12,96,,,percent of total billed charges,96% of total billed charges,20.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.75,75,,,percent of total billed charges,75% of total billed charges,447.75,75,,,percent of total billed charges,75% of total billed charges,20.29,579.09,
ED TRIMMING NONDYSTROPHIC NAILS ANY NUMBER,78000136G,CDM,981,RC,11719,HCPCS,Outpatient,,,21,15.75,,19.32,92,,,percent of total billed charges,92% of total billed charges,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,19.53,93,,,percent of total billed charges,93% of total billed charges,18.9,90,,,percent of total billed charges,90% of total billed charges,18.9,90,,,percent of total billed charges,90% of total billed charges,20.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,20.37,97,,,percent of total billed charges,97% of total billed charges,15.75,75,,,percent of total billed charges,75% of total billed charges,20.16,96,,,percent of total billed charges,96% of total billed charges,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,15.75,75,,,percent of total billed charges,75% of total billed charges,15.75,75,,,percent of total billed charges,75% of total billed charges,0.52,20.37,
DEBRIDEMENT NAIL ANY METHOD 1-5,78000138G,CDM,981,RC,11720,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges,1.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.94,93,,,percent of total billed charges,93% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,56.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.26,97,,,percent of total billed charges,97% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,55.68,96,,,percent of total billed charges,96% of total billed charges,1.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.5,75,,,percent of total billed charges,75% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,1.3,56.26,
AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1,78000142G,CDM,981,RC,11730,HCPCS,Outpatient,,,215,161.25,,197.8,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,199.95,93,,,percent of total billed charges,93% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,208.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,208.55,97,,,percent of total billed charges,97% of total billed charges,161.25,75,,,percent of total billed charges,75% of total billed charges,206.4,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.25,75,,,percent of total billed charges,75% of total billed charges,161.25,75,,,percent of total billed charges,75% of total billed charges,4.28,208.55,
AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL,78000144G,CDM,981,RC,11732,HCPCS,Outpatient,,,69,51.75,,63.48,92,,,percent of total billed charges,92% of total billed charges,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.17,93,,,percent of total billed charges,93% of total billed charges,62.1,90,,,percent of total billed charges,90% of total billed charges,62.1,90,,,percent of total billed charges,90% of total billed charges,66.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.93,97,,,percent of total billed charges,97% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges,66.24,96,,,percent of total billed charges,96% of total billed charges,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,51.75,75,,,percent of total billed charges,75% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges,1.39,66.93,
EVACUATION SUBUNGUAL HEMATOMA,78000146G,CDM,981,RC,11740,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,115.32,93,,,percent of total billed charges,93% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,120.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,120.28,97,,,percent of total billed charges,97% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,119.04,96,,,percent of total billed charges,96% of total billed charges,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93,75,,,percent of total billed charges,75% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,1.93,120.28,
EXCISION NAIL MATRIX PERMANENT REMOVAL,78000148G,CDM,981,RC,11750,HCPCS,Outpatient,,,241,180.75,,221.72,92,,,percent of total billed charges,92% of total billed charges,7.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,224.13,93,,,percent of total billed charges,93% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,233.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.77,97,,,percent of total billed charges,97% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,231.36,96,,,percent of total billed charges,96% of total billed charges,7.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.75,75,,,percent of total billed charges,75% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,7.05,233.77,
REPAIR OF NAIL BED,78000150G,CDM,981,RC,11760,HCPCS,Outpatient,,,294,220.5,,270.48,92,,,percent of total billed charges,92% of total billed charges,8.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,273.42,93,,,percent of total billed charges,93% of total billed charges,264.6,90,,,percent of total billed charges,90% of total billed charges,264.6,90,,,percent of total billed charges,90% of total billed charges,285.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,285.18,97,,,percent of total billed charges,97% of total billed charges,220.5,75,,,percent of total billed charges,75% of total billed charges,282.24,96,,,percent of total billed charges,96% of total billed charges,8.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,220.5,75,,,percent of total billed charges,75% of total billed charges,220.5,75,,,percent of total billed charges,75% of total billed charges,8.94,285.18,
WEDGE EXCISION SKIN NAIL FOLD,78000152G,CDM,981,RC,11765,HCPCS,Outpatient,,,251,188.25,,230.92,92,,,percent of total billed charges,92% of total billed charges,5.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.43,93,,,percent of total billed charges,93% of total billed charges,225.9,90,,,percent of total billed charges,90% of total billed charges,225.9,90,,,percent of total billed charges,90% of total billed charges,243.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,243.47,97,,,percent of total billed charges,97% of total billed charges,188.25,75,,,percent of total billed charges,75% of total billed charges,240.96,96,,,percent of total billed charges,96% of total billed charges,5.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,188.25,75,,,percent of total billed charges,75% of total billed charges,188.25,75,,,percent of total billed charges,75% of total billed charges,5.93,243.47,
EXCISION PILONIDAL CYST/SINUS COMPLICATED,78000154G,CDM,981,RC,11772,HCPCS,Outpatient,,,1551,1163.25,,1426.92,92,,,percent of total billed charges,92% of total billed charges,65.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1442.43,93,,,percent of total billed charges,93% of total billed charges,1395.9,90,,,percent of total billed charges,90% of total billed charges,1395.9,90,,,percent of total billed charges,90% of total billed charges,1504.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,65.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1504.47,97,,,percent of total billed charges,97% of total billed charges,1163.25,75,,,percent of total billed charges,75% of total billed charges,1488.96,96,,,percent of total billed charges,96% of total billed charges,65.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1163.25,75,,,percent of total billed charges,75% of total billed charges,1163.25,75,,,percent of total billed charges,75% of total billed charges,65.19,1504.47,
INJECTION INTRALESIONAL UP TO  and  INCLUD 7 LESION,78000156G,CDM,981,RC,11900,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.61,93,,,percent of total billed charges,93% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,74.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.69,97,,,percent of total billed charges,97% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,73.92,96,,,percent of total billed charges,96% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.75,75,,,percent of total billed charges,75% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,2.65,74.69,
SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 2.5CM/<,78000166G,CDM,981,RC,12001,HCPCS,Outpatient,,,176,132,,161.92,92,,,percent of total billed charges,92% of total billed charges,5.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.68,93,,,percent of total billed charges,93% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,170.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,170.72,97,,,percent of total billed charges,97% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,168.96,96,,,percent of total billed charges,96% of total billed charges,5.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132,75,,,percent of total billed charges,75% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,5.88,170.72,
SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 2.6-7.5CM,78000168G,CDM,981,RC,12002,HCPCS,Outpatient,,,235,176.25,,216.2,92,,,percent of total billed charges,92% of total billed charges,7.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.55,93,,,percent of total billed charges,93% of total billed charges,211.5,90,,,percent of total billed charges,90% of total billed charges,211.5,90,,,percent of total billed charges,90% of total billed charges,227.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,227.95,97,,,percent of total billed charges,97% of total billed charges,176.25,75,,,percent of total billed charges,75% of total billed charges,225.6,96,,,percent of total billed charges,96% of total billed charges,7.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.25,75,,,percent of total billed charges,75% of total billed charges,176.25,75,,,percent of total billed charges,75% of total billed charges,7.99,227.95,
SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM,78000170G,CDM,981,RC,12004,HCPCS,Outpatient,,,292,219,,268.64,92,,,percent of total billed charges,92% of total billed charges,10.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,271.56,93,,,percent of total billed charges,93% of total billed charges,262.8,90,,,percent of total billed charges,90% of total billed charges,262.8,90,,,percent of total billed charges,90% of total billed charges,283.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,283.24,97,,,percent of total billed charges,97% of total billed charges,219,75,,,percent of total billed charges,75% of total billed charges,280.32,96,,,percent of total billed charges,96% of total billed charges,10.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219,75,,,percent of total billed charges,75% of total billed charges,219,75,,,percent of total billed charges,75% of total billed charges,10.4,283.24,
SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM,78000172G,CDM,981,RC,12005,HCPCS,Outpatient,,,379,284.25,,348.68,92,,,percent of total billed charges,92% of total billed charges,14.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.47,93,,,percent of total billed charges,93% of total billed charges,341.1,90,,,percent of total billed charges,90% of total billed charges,341.1,90,,,percent of total billed charges,90% of total billed charges,367.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.63,97,,,percent of total billed charges,97% of total billed charges,284.25,75,,,percent of total billed charges,75% of total billed charges,363.84,96,,,percent of total billed charges,96% of total billed charges,14.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.25,75,,,percent of total billed charges,75% of total billed charges,284.25,75,,,percent of total billed charges,75% of total billed charges,14.11,367.63,
SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM,78000174G,CDM,981,RC,12006,HCPCS,Outpatient,,,464,348,,426.88,92,,,percent of total billed charges,92% of total billed charges,16.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,431.52,93,,,percent of total billed charges,93% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,450.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,450.08,97,,,percent of total billed charges,97% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,445.44,96,,,percent of total billed charges,96% of total billed charges,16.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,348,75,,,percent of total billed charges,75% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,16.73,450.08,
SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM,78000176G,CDM,981,RC,12007,HCPCS,Outpatient,,,573,429.75,,527.16,92,,,percent of total billed charges,92% of total billed charges,20.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,532.89,93,,,percent of total billed charges,93% of total billed charges,515.7,90,,,percent of total billed charges,90% of total billed charges,515.7,90,,,percent of total billed charges,90% of total billed charges,555.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,555.81,97,,,percent of total billed charges,97% of total billed charges,429.75,75,,,percent of total billed charges,75% of total billed charges,550.08,96,,,percent of total billed charges,96% of total billed charges,20.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,429.75,75,,,percent of total billed charges,75% of total billed charges,429.75,75,,,percent of total billed charges,75% of total billed charges,20.69,555.81,
SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<,78000178G,CDM,981,RC,12011,HCPCS,Outpatient,,,221,165.75,,203.32,92,,,percent of total billed charges,92% of total billed charges,7.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,205.53,93,,,percent of total billed charges,93% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,214.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.37,97,,,percent of total billed charges,97% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,212.16,96,,,percent of total billed charges,96% of total billed charges,7.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.75,75,,,percent of total billed charges,75% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,7.61,214.37,
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM,78000180G,CDM,981,RC,12013,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,216.69,93,,,percent of total billed charges,93% of total billed charges,209.7,90,,,percent of total billed charges,90% of total billed charges,209.7,90,,,percent of total billed charges,90% of total billed charges,226.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,226.01,97,,,percent of total billed charges,97% of total billed charges,174.75,75,,,percent of total billed charges,75% of total billed charges,223.68,96,,,percent of total billed charges,96% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,174.75,75,,,percent of total billed charges,75% of total billed charges,174.75,75,,,percent of total billed charges,75% of total billed charges,8.5,226.01,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 5.1-7.5CM,78000182G,CDM,981,RC,12014,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,11.26,289.06,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 7.6-12.5CM,78000184G,CDM,981,RC,12015,HCPCS,Outpatient,,,376,282,,345.92,92,,,percent of total billed charges,92% of total billed charges,14.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,349.68,93,,,percent of total billed charges,93% of total billed charges,338.4,90,,,percent of total billed charges,90% of total billed charges,338.4,90,,,percent of total billed charges,90% of total billed charges,364.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,364.72,97,,,percent of total billed charges,97% of total billed charges,282,75,,,percent of total billed charges,75% of total billed charges,360.96,96,,,percent of total billed charges,96% of total billed charges,14.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,282,75,,,percent of total billed charges,75% of total billed charges,282,75,,,percent of total billed charges,75% of total billed charges,14.09,364.72,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 12.6-20CM,78000186G,CDM,981,RC,12016,HCPCS,Outpatient,,,510,382.5,,469.2,92,,,percent of total billed charges,92% of total billed charges,19.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,474.3,93,,,percent of total billed charges,93% of total billed charges,459,90,,,percent of total billed charges,90% of total billed charges,459,90,,,percent of total billed charges,90% of total billed charges,494.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,494.7,97,,,percent of total billed charges,97% of total billed charges,382.5,75,,,percent of total billed charges,75% of total billed charges,489.6,96,,,percent of total billed charges,96% of total billed charges,19.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,382.5,75,,,percent of total billed charges,75% of total billed charges,382.5,75,,,percent of total billed charges,75% of total billed charges,19.04,494.7,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 20.1-30CM,78000188G,CDM,981,RC,12017,HCPCS,Outpatient,,,400,300,,368,92,,,percent of total billed charges,92% of total billed charges,24.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,372,93,,,percent of total billed charges,93% of total billed charges,360,90,,,percent of total billed charges,90% of total billed charges,360,90,,,percent of total billed charges,90% of total billed charges,388,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388,97,,,percent of total billed charges,97% of total billed charges,300,75,,,percent of total billed charges,75% of total billed charges,384,96,,,percent of total billed charges,96% of total billed charges,24.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300,75,,,percent of total billed charges,75% of total billed charges,300,75,,,percent of total billed charges,75% of total billed charges,24.02,388,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE >30CM,78000190G,CDM,981,RC,12018,HCPCS,Outpatient,,,687,515.25,,632.04,92,,,percent of total billed charges,92% of total billed charges,26.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,638.91,93,,,percent of total billed charges,93% of total billed charges,618.3,90,,,percent of total billed charges,90% of total billed charges,618.3,90,,,percent of total billed charges,90% of total billed charges,666.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,666.39,97,,,percent of total billed charges,97% of total billed charges,515.25,75,,,percent of total billed charges,75% of total billed charges,659.52,96,,,percent of total billed charges,96% of total billed charges,26.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,515.25,75,,,percent of total billed charges,75% of total billed charges,515.25,75,,,percent of total billed charges,75% of total billed charges,26.85,666.39,
TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE,78000192G,CDM,981,RC,12020,HCPCS,Outpatient,,,657,492.75,,604.44,92,,,percent of total billed charges,92% of total billed charges,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,611.01,93,,,percent of total billed charges,93% of total billed charges,591.3,90,,,percent of total billed charges,90% of total billed charges,591.3,90,,,percent of total billed charges,90% of total billed charges,637.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,637.29,97,,,percent of total billed charges,97% of total billed charges,492.75,75,,,percent of total billed charges,75% of total billed charges,630.72,96,,,percent of total billed charges,96% of total billed charges,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,492.75,75,,,percent of total billed charges,75% of total billed charges,492.75,75,,,percent of total billed charges,75% of total billed charges,17.91,637.29,
REPAIR INTERMEDIATE SCALP UNDERARMS TRUNK ARM LEG 2.5 CM/<,78000194G,CDM,981,RC,12031,HCPCS,Outpatient,,,565,423.75,,519.8,92,,,percent of total billed charges,92% of total billed charges,12.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,525.45,93,,,percent of total billed charges,93% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,548.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,548.05,97,,,percent of total billed charges,97% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,542.4,96,,,percent of total billed charges,96% of total billed charges,12.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,423.75,75,,,percent of total billed charges,75% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,12.01,548.05,
REPAIR INTERMEDIATE SCALP UNDERARMS TRUNK ARM LEG 2.6-7.5CM,78000196G,CDM,981,RC,12032,HCPCS,Outpatient,,,748,561,,688.16,92,,,percent of total billed charges,92% of total billed charges,14.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,695.64,93,,,percent of total billed charges,93% of total billed charges,673.2,90,,,percent of total billed charges,90% of total billed charges,673.2,90,,,percent of total billed charges,90% of total billed charges,725.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,725.56,97,,,percent of total billed charges,97% of total billed charges,561,75,,,percent of total billed charges,75% of total billed charges,718.08,96,,,percent of total billed charges,96% of total billed charges,14.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,561,75,,,percent of total billed charges,75% of total billed charges,561,75,,,percent of total billed charges,75% of total billed charges,14.43,725.56,
REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES 7.6-12.5CM,78000198G,CDM,981,RC,12034,HCPCS,Outpatient,,,807,605.25,,742.44,92,,,percent of total billed charges,92% of total billed charges,17.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,750.51,93,,,percent of total billed charges,93% of total billed charges,726.3,90,,,percent of total billed charges,90% of total billed charges,726.3,90,,,percent of total billed charges,90% of total billed charges,782.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,782.79,97,,,percent of total billed charges,97% of total billed charges,605.25,75,,,percent of total billed charges,75% of total billed charges,774.72,96,,,percent of total billed charges,96% of total billed charges,17.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,605.25,75,,,percent of total billed charges,75% of total billed charges,605.25,75,,,percent of total billed charges,75% of total billed charges,17.93,782.79,
REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES 12.6-20CM,78000200G,CDM,981,RC,12035,HCPCS,Outpatient,,,946,709.5,,870.32,92,,,percent of total billed charges,92% of total billed charges,25.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,879.78,93,,,percent of total billed charges,93% of total billed charges,851.4,90,,,percent of total billed charges,90% of total billed charges,851.4,90,,,percent of total billed charges,90% of total billed charges,917.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,917.62,97,,,percent of total billed charges,97% of total billed charges,709.5,75,,,percent of total billed charges,75% of total billed charges,908.16,96,,,percent of total billed charges,96% of total billed charges,25.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,709.5,75,,,percent of total billed charges,75% of total billed charges,709.5,75,,,percent of total billed charges,75% of total billed charges,25.42,917.62,
REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES 20.1-30CM,78000202G,CDM,981,RC,12036,HCPCS,Outpatient,,,1109,831.75,,1020.28,92,,,percent of total billed charges,92% of total billed charges,33.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1031.37,93,,,percent of total billed charges,93% of total billed charges,998.1,90,,,percent of total billed charges,90% of total billed charges,998.1,90,,,percent of total billed charges,90% of total billed charges,1075.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1075.73,97,,,percent of total billed charges,97% of total billed charges,831.75,75,,,percent of total billed charges,75% of total billed charges,1064.64,96,,,percent of total billed charges,96% of total billed charges,33.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,831.75,75,,,percent of total billed charges,75% of total billed charges,831.75,75,,,percent of total billed charges,75% of total billed charges,33.62,1075.73,
REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES >30CM,78000204G,CDM,981,RC,12037,HCPCS,Outpatient,,,1295,971.25,,1191.4,92,,,percent of total billed charges,92% of total billed charges,40.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1204.35,93,,,percent of total billed charges,93% of total billed charges,1165.5,90,,,percent of total billed charges,90% of total billed charges,1165.5,90,,,percent of total billed charges,90% of total billed charges,1256.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1256.15,97,,,percent of total billed charges,97% of total billed charges,971.25,75,,,percent of total billed charges,75% of total billed charges,1243.2,96,,,percent of total billed charges,96% of total billed charges,40.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,971.25,75,,,percent of total billed charges,75% of total billed charges,971.25,75,,,percent of total billed charges,75% of total billed charges,40.08,1256.15,
REPAIR INTERMEDIATE NECK HAND FEET GENITALS 2.5CM/<,78000206G,CDM,981,RC,12041,HCPCS,Outpatient,,,576,432,,529.92,92,,,percent of total billed charges,92% of total billed charges,12.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,535.68,93,,,percent of total billed charges,93% of total billed charges,518.4,90,,,percent of total billed charges,90% of total billed charges,518.4,90,,,percent of total billed charges,90% of total billed charges,558.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,558.72,97,,,percent of total billed charges,97% of total billed charges,432,75,,,percent of total billed charges,75% of total billed charges,552.96,96,,,percent of total billed charges,96% of total billed charges,12.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,432,75,,,percent of total billed charges,75% of total billed charges,432,75,,,percent of total billed charges,75% of total billed charges,12.06,558.72,
REPAIR INTERMEDIATE NECK HAND FEET GENITALS 2.6-7.5CM,78000208G,CDM,981,RC,12042,HCPCS,Outpatient,,,772,579,,710.24,92,,,percent of total billed charges,92% of total billed charges,15.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717.96,93,,,percent of total billed charges,93% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,748.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,748.84,97,,,percent of total billed charges,97% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,741.12,96,,,percent of total billed charges,96% of total billed charges,15.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,579,75,,,percent of total billed charges,75% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,15.69,748.84,
REPAIR INTERMEDIATE NECK HAND FEET GENITALS 7.6-12.5CM,78000210G,CDM,981,RC,12044,HCPCS,Outpatient,,,841,630.75,,773.72,92,,,percent of total billed charges,92% of total billed charges,19.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,782.13,93,,,percent of total billed charges,93% of total billed charges,756.9,90,,,percent of total billed charges,90% of total billed charges,756.9,90,,,percent of total billed charges,90% of total billed charges,815.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,815.77,97,,,percent of total billed charges,97% of total billed charges,630.75,75,,,percent of total billed charges,75% of total billed charges,807.36,96,,,percent of total billed charges,96% of total billed charges,19.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,630.75,75,,,percent of total billed charges,75% of total billed charges,630.75,75,,,percent of total billed charges,75% of total billed charges,19.6,815.77,
REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM,78000212G,CDM,981,RC,12045,HCPCS,Outpatient,,,1058,793.5,,973.36,92,,,percent of total billed charges,92% of total billed charges,28.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,983.94,93,,,percent of total billed charges,93% of total billed charges,952.2,90,,,percent of total billed charges,90% of total billed charges,952.2,90,,,percent of total billed charges,90% of total billed charges,1026.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1026.26,97,,,percent of total billed charges,97% of total billed charges,793.5,75,,,percent of total billed charges,75% of total billed charges,1015.68,96,,,percent of total billed charges,96% of total billed charges,28.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,793.5,75,,,percent of total billed charges,75% of total billed charges,793.5,75,,,percent of total billed charges,75% of total billed charges,28.18,1026.26,
RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM,78000214G,CDM,981,RC,12046,HCPCS,Outpatient,,,1074,805.5,,988.08,92,,,percent of total billed charges,92% of total billed charges,41.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,998.82,93,,,percent of total billed charges,93% of total billed charges,966.6,90,,,percent of total billed charges,90% of total billed charges,966.6,90,,,percent of total billed charges,90% of total billed charges,1041.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1041.78,97,,,percent of total billed charges,97% of total billed charges,805.5,75,,,percent of total billed charges,75% of total billed charges,1031.04,96,,,percent of total billed charges,96% of total billed charges,41.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,805.5,75,,,percent of total billed charges,75% of total billed charges,805.5,75,,,percent of total billed charges,75% of total billed charges,41.41,1041.78,
REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM,78000216G,CDM,981,RC,12047,HCPCS,Outpatient,,,1373,1029.75,,1263.16,92,,,percent of total billed charges,92% of total billed charges,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1276.89,93,,,percent of total billed charges,93% of total billed charges,1235.7,90,,,percent of total billed charges,90% of total billed charges,1235.7,90,,,percent of total billed charges,90% of total billed charges,1331.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1331.81,97,,,percent of total billed charges,97% of total billed charges,1029.75,75,,,percent of total billed charges,75% of total billed charges,1318.08,96,,,percent of total billed charges,96% of total billed charges,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1029.75,75,,,percent of total billed charges,75% of total billed charges,1029.75,75,,,percent of total billed charges,75% of total billed charges,46.68,1331.81,
REPAIR INTERMEDIATE F/E/E/N/L and /MUC 2.5 CM/<,78000218G,CDM,981,RC,12051,HCPCS,Outpatient,,,445,333.75,,409.4,92,,,percent of total billed charges,92% of total billed charges,14.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.85,93,,,percent of total billed charges,93% of total billed charges,400.5,90,,,percent of total billed charges,90% of total billed charges,400.5,90,,,percent of total billed charges,90% of total billed charges,431.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,431.65,97,,,percent of total billed charges,97% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges,427.2,96,,,percent of total billed charges,96% of total billed charges,14.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333.75,75,,,percent of total billed charges,75% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges,14.26,431.65,
REPAIR INTERMEDIATE F/E/E/N/L and /MUC 2.6-5.0 CM,78000220G,CDM,981,RC,12052,HCPCS,Outpatient,,,785,588.75,,722.2,92,,,percent of total billed charges,92% of total billed charges,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,730.05,93,,,percent of total billed charges,93% of total billed charges,706.5,90,,,percent of total billed charges,90% of total billed charges,706.5,90,,,percent of total billed charges,90% of total billed charges,761.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,761.45,97,,,percent of total billed charges,97% of total billed charges,588.75,75,,,percent of total billed charges,75% of total billed charges,753.6,96,,,percent of total billed charges,96% of total billed charges,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,588.75,75,,,percent of total billed charges,75% of total billed charges,588.75,75,,,percent of total billed charges,75% of total billed charges,16.36,761.45,
REPAIR INTERMEDIATE F/E/E/N/L and /MUC 5.1-7.5 CM,78000222G,CDM,981,RC,12053,HCPCS,Outpatient,,,847,635.25,,779.24,92,,,percent of total billed charges,92% of total billed charges,18.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,787.71,93,,,percent of total billed charges,93% of total billed charges,762.3,90,,,percent of total billed charges,90% of total billed charges,762.3,90,,,percent of total billed charges,90% of total billed charges,821.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,821.59,97,,,percent of total billed charges,97% of total billed charges,635.25,75,,,percent of total billed charges,75% of total billed charges,813.12,96,,,percent of total billed charges,96% of total billed charges,18.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,635.25,75,,,percent of total billed charges,75% of total billed charges,635.25,75,,,percent of total billed charges,75% of total billed charges,18.26,821.59,
REPAIR INTERMEDIATE F/E/E/N/L and /MUC 7.6-12.5 CM,78000224G,CDM,981,RC,12054,HCPCS,Outpatient,,,866,649.5,,796.72,92,,,percent of total billed charges,92% of total billed charges,21.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,805.38,93,,,percent of total billed charges,93% of total billed charges,779.4,90,,,percent of total billed charges,90% of total billed charges,779.4,90,,,percent of total billed charges,90% of total billed charges,840.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.02,97,,,percent of total billed charges,97% of total billed charges,649.5,75,,,percent of total billed charges,75% of total billed charges,831.36,96,,,percent of total billed charges,96% of total billed charges,21.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,649.5,75,,,percent of total billed charges,75% of total billed charges,649.5,75,,,percent of total billed charges,75% of total billed charges,21.69,840.02,
REPAIR INTERM FACE EAR EYELD NOSE LIP MUCOUS MEMBR 12.6-20CM,78000226G,CDM,981,RC,12055,HCPCS,Outpatient,,,1179,884.25,,1084.68,92,,,percent of total billed charges,92% of total billed charges,32.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1096.47,93,,,percent of total billed charges,93% of total billed charges,1061.1,90,,,percent of total billed charges,90% of total billed charges,1061.1,90,,,percent of total billed charges,90% of total billed charges,1143.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1143.63,97,,,percent of total billed charges,97% of total billed charges,884.25,75,,,percent of total billed charges,75% of total billed charges,1131.84,96,,,percent of total billed charges,96% of total billed charges,32.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,884.25,75,,,percent of total billed charges,75% of total billed charges,884.25,75,,,percent of total billed charges,75% of total billed charges,32.39,1143.63,
REPAIR INTERM FACE EAR EYELID NOSE LIP MUCOUS MEMB 20.1-30CM,78000228G,CDM,981,RC,12056,HCPCS,Outpatient,,,1513,1134.75,,1391.96,92,,,percent of total billed charges,92% of total billed charges,39.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1407.09,93,,,percent of total billed charges,93% of total billed charges,1361.7,90,,,percent of total billed charges,90% of total billed charges,1361.7,90,,,percent of total billed charges,90% of total billed charges,1467.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,39.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1467.61,97,,,percent of total billed charges,97% of total billed charges,1134.75,75,,,percent of total billed charges,75% of total billed charges,1452.48,96,,,percent of total billed charges,96% of total billed charges,39.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1134.75,75,,,percent of total billed charges,75% of total billed charges,1134.75,75,,,percent of total billed charges,75% of total billed charges,39.84,1467.61,
REPAIR INTERM FACE EAR EYELID NOSE LIP MUCOUS MEMBR >30CM,78000230G,CDM,981,RC,12057,HCPCS,Outpatient,,,1674,1255.5,,1540.08,92,,,percent of total billed charges,92% of total billed charges,44.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1556.82,93,,,percent of total billed charges,93% of total billed charges,1506.6,90,,,percent of total billed charges,90% of total billed charges,1506.6,90,,,percent of total billed charges,90% of total billed charges,1623.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,44.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1623.78,97,,,percent of total billed charges,97% of total billed charges,1255.5,75,,,percent of total billed charges,75% of total billed charges,1607.04,96,,,percent of total billed charges,96% of total billed charges,44.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1255.5,75,,,percent of total billed charges,75% of total billed charges,1255.5,75,,,percent of total billed charges,75% of total billed charges,44.85,1623.78,
REPAIR COMPLEX WOUND TRUNK 1.1-2.5 CM,78000232G,CDM,981,RC,13100,HCPCS,Outpatient,,,795,596.25,,731.4,92,,,percent of total billed charges,92% of total billed charges,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,739.35,93,,,percent of total billed charges,93% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,771.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,771.15,97,,,percent of total billed charges,97% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,763.2,96,,,percent of total billed charges,96% of total billed charges,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,596.25,75,,,percent of total billed charges,75% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,17.19,771.15,
REPAIR COMPLEX WOUND TRUNK 2.6-7.5 CM,78000234G,CDM,981,RC,13101,HCPCS,Outpatient,,,978,733.5,,899.76,92,,,percent of total billed charges,92% of total billed charges,19.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,909.54,93,,,percent of total billed charges,93% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,948.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,948.66,97,,,percent of total billed charges,97% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,938.88,96,,,percent of total billed charges,96% of total billed charges,19.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,733.5,75,,,percent of total billed charges,75% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,19.86,948.66,
REPAIR COMPLEX WOUND TRUNK EACH ADDITIONAL 5 CM/<,78000236G,CDM,981,RC,13102,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges,7.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.98,93,,,percent of total billed charges,93% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,277.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.42,97,,,percent of total billed charges,97% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,274.56,96,,,percent of total billed charges,96% of total billed charges,7.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.5,75,,,percent of total billed charges,75% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,7.88,277.42,
REPAIR COMPLEX WOUND SCALP ARM LEG 1.1-2.5 CM,78000238G,CDM,981,RC,13120,HCPCS,Outpatient,,,914,685.5,,840.88,92,,,percent of total billed charges,92% of total billed charges,18.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,850.02,93,,,percent of total billed charges,93% of total billed charges,822.6,90,,,percent of total billed charges,90% of total billed charges,822.6,90,,,percent of total billed charges,90% of total billed charges,886.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,886.58,97,,,percent of total billed charges,97% of total billed charges,685.5,75,,,percent of total billed charges,75% of total billed charges,877.44,96,,,percent of total billed charges,96% of total billed charges,18.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,685.5,75,,,percent of total billed charges,75% of total billed charges,685.5,75,,,percent of total billed charges,75% of total billed charges,18.8,886.58,
REPAIR COMPLEX WOUND SCALP ARM LEG 2.6-7.5 CM,78000240G,CDM,981,RC,13121,HCPCS,Outpatient,,,675,506.25,,621,92,,,percent of total billed charges,92% of total billed charges,21.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,627.75,93,,,percent of total billed charges,93% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,654.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,654.75,97,,,percent of total billed charges,97% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,648,96,,,percent of total billed charges,96% of total billed charges,21.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,506.25,75,,,percent of total billed charges,75% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,21.59,654.75,
REPAIR COMPLEX WOUND SCALP ARM LEG EACH ADDL 5 CM/<,78000242G,CDM,981,RC,13122,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.9,93,,,percent of total billed charges,93% of total billed charges,297,90,,,percent of total billed charges,90% of total billed charges,297,90,,,percent of total billed charges,90% of total billed charges,320.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,320.1,97,,,percent of total billed charges,97% of total billed charges,247.5,75,,,percent of total billed charges,75% of total billed charges,316.8,96,,,percent of total billed charges,96% of total billed charges,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,247.5,75,,,percent of total billed charges,75% of total billed charges,247.5,75,,,percent of total billed charges,75% of total billed charges,8.79,320.1,
REPAIR COMP FOREHEAD CHEEK CHIN MOUTH NECK HAND 1.1-2.5CM,78000244G,CDM,981,RC,13131,HCPCS,Outpatient,,,963,722.25,,885.96,92,,,percent of total billed charges,92% of total billed charges,20.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,895.59,93,,,percent of total billed charges,93% of total billed charges,866.7,90,,,percent of total billed charges,90% of total billed charges,866.7,90,,,percent of total billed charges,90% of total billed charges,934.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,934.11,97,,,percent of total billed charges,97% of total billed charges,722.25,75,,,percent of total billed charges,75% of total billed charges,924.48,96,,,percent of total billed charges,96% of total billed charges,20.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,722.25,75,,,percent of total billed charges,75% of total billed charges,722.25,75,,,percent of total billed charges,75% of total billed charges,20.78,934.11,
REPAIR COMP FOREHEAD CHEEK CHIN MOUTH NECK HAND 2.6-7.5CM,78000246G,CDM,981,RC,13132,HCPCS,Outpatient,,,795,596.25,,731.4,92,,,percent of total billed charges,92% of total billed charges,25.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,739.35,93,,,percent of total billed charges,93% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,771.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,771.15,97,,,percent of total billed charges,97% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,763.2,96,,,percent of total billed charges,96% of total billed charges,25.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,596.25,75,,,percent of total billed charges,75% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,25.28,771.15,
REPAIR COMP FOREHEAD CHEEK CHIN MOUTH NECK HAND EA ADD 5CM,78000248G,CDM,981,RC,13133,HCPCS,Outpatient,,,503,377.25,,462.76,92,,,percent of total billed charges,92% of total billed charges,12.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,467.79,93,,,percent of total billed charges,93% of total billed charges,452.7,90,,,percent of total billed charges,90% of total billed charges,452.7,90,,,percent of total billed charges,90% of total billed charges,487.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,487.91,97,,,percent of total billed charges,97% of total billed charges,377.25,75,,,percent of total billed charges,75% of total billed charges,482.88,96,,,percent of total billed charges,96% of total billed charges,12.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,377.25,75,,,percent of total billed charges,75% of total billed charges,377.25,75,,,percent of total billed charges,75% of total billed charges,12.15,487.91,
REPAIR COMPLEX WOUND EYELID NOSE EAR LIP 1.1-2.5CM,78000250G,CDM,981,RC,13151,HCPCS,Outpatient,,,562,421.5,,517.04,92,,,percent of total billed charges,92% of total billed charges,24.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,522.66,93,,,percent of total billed charges,93% of total billed charges,505.8,90,,,percent of total billed charges,90% of total billed charges,505.8,90,,,percent of total billed charges,90% of total billed charges,545.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,545.14,97,,,percent of total billed charges,97% of total billed charges,421.5,75,,,percent of total billed charges,75% of total billed charges,539.52,96,,,percent of total billed charges,96% of total billed charges,24.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,421.5,75,,,percent of total billed charges,75% of total billed charges,421.5,75,,,percent of total billed charges,75% of total billed charges,24.18,545.14,
REPAIR COMPLEX WOUND EYELID NOSE EAR LIP 2.6-7.5CM,78000252G,CDM,981,RC,13152,HCPCS,Outpatient,,,881,660.75,,810.52,92,,,percent of total billed charges,92% of total billed charges,29.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,819.33,93,,,percent of total billed charges,93% of total billed charges,792.9,90,,,percent of total billed charges,90% of total billed charges,792.9,90,,,percent of total billed charges,90% of total billed charges,854.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,854.57,97,,,percent of total billed charges,97% of total billed charges,660.75,75,,,percent of total billed charges,75% of total billed charges,845.76,96,,,percent of total billed charges,96% of total billed charges,29.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,660.75,75,,,percent of total billed charges,75% of total billed charges,660.75,75,,,percent of total billed charges,75% of total billed charges,29.39,854.57,
REPAIR COMPLEX WOUND EYELID NOSE EAR LIP EACH ADDL 5CM,78000254G,CDM,981,RC,13153,HCPCS,Outpatient,,,358,268.5,,329.36,92,,,percent of total billed charges,92% of total billed charges,14.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,332.94,93,,,percent of total billed charges,93% of total billed charges,322.2,90,,,percent of total billed charges,90% of total billed charges,322.2,90,,,percent of total billed charges,90% of total billed charges,347.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,347.26,97,,,percent of total billed charges,97% of total billed charges,268.5,75,,,percent of total billed charges,75% of total billed charges,343.68,96,,,percent of total billed charges,96% of total billed charges,14.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,268.5,75,,,percent of total billed charges,75% of total billed charges,268.5,75,,,percent of total billed charges,75% of total billed charges,14.7,347.26,
REMOVE SUTURE/STAPLE W/O ANESTHESIA,68500066G,CDM,981,RC,15853,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges,0.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,27.9,93,,,percent of total billed charges,93% of total billed charges,27,90,,,percent of total billed charges,90% of total billed charges,27,90,,,percent of total billed charges,90% of total billed charges,29.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,29.1,97,,,percent of total billed charges,97% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges,28.8,96,,,percent of total billed charges,96% of total billed charges,0.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,22.5,75,,,percent of total billed charges,75% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges,0.67,29.1,
INITIAL TREATMENT 1ST DEGREE BURN LOCAL,78000302G,CDM,981,RC,16000,HCPCS,Outpatient,,,182,136.5,,167.44,92,,,percent of total billed charges,92% of total billed charges,5.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,169.26,93,,,percent of total billed charges,93% of total billed charges,163.8,90,,,percent of total billed charges,90% of total billed charges,163.8,90,,,percent of total billed charges,90% of total billed charges,176.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.54,97,,,percent of total billed charges,97% of total billed charges,136.5,75,,,percent of total billed charges,75% of total billed charges,174.72,96,,,percent of total billed charges,96% of total billed charges,5.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,136.5,75,,,percent of total billed charges,75% of total billed charges,136.5,75,,,percent of total billed charges,75% of total billed charges,5.36,176.54,
DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE (LESS THAN 5%,78000304G,CDM,981,RC,16020,HCPCS,Outpatient,,,418,313.5,,384.56,92,,,percent of total billed charges,92% of total billed charges,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388.74,93,,,percent of total billed charges,93% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,405.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,405.46,97,,,percent of total billed charges,97% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,401.28,96,,,percent of total billed charges,96% of total billed charges,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,313.5,75,,,percent of total billed charges,75% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,5.19,405.46,
DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/SBSQ MEDIUM,78000306G,CDM,981,RC,16025,HCPCS,Outpatient,,,434,325.5,,399.28,92,,,percent of total billed charges,92% of total billed charges,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.62,93,,,percent of total billed charges,93% of total billed charges,390.6,90,,,percent of total billed charges,90% of total billed charges,390.6,90,,,percent of total billed charges,90% of total billed charges,420.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,420.98,97,,,percent of total billed charges,97% of total billed charges,325.5,75,,,percent of total billed charges,75% of total billed charges,416.64,96,,,percent of total billed charges,96% of total billed charges,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,325.5,75,,,percent of total billed charges,75% of total billed charges,325.5,75,,,percent of total billed charges,75% of total billed charges,11.71,420.98,
DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/SBSQ LARGE,78000308G,CDM,981,RC,16030,HCPCS,Outpatient,,,346,259.5,,318.32,92,,,percent of total billed charges,92% of total billed charges,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321.78,93,,,percent of total billed charges,93% of total billed charges,311.4,90,,,percent of total billed charges,90% of total billed charges,311.4,90,,,percent of total billed charges,90% of total billed charges,335.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,335.62,97,,,percent of total billed charges,97% of total billed charges,259.5,75,,,percent of total billed charges,75% of total billed charges,332.16,96,,,percent of total billed charges,96% of total billed charges,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,259.5,75,,,percent of total billed charges,75% of total billed charges,259.5,75,,,percent of total billed charges,75% of total billed charges,15.94,335.62,
DESTRUCTION PREMALIGNANT LESION 1ST,78000310G,CDM,981,RC,17000,HCPCS,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,3.54,97.97,
DESTRUCTION PREMALIGNANT LESION 2 TO 14,78000312G,CDM,981,RC,17003,HCPCS,Outpatient,,,7,5.25,,6.44,92,,,percent of total billed charges,92% of total billed charges,0.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6.51,93,,,percent of total billed charges,93% of total billed charges,6.3,90,,,percent of total billed charges,90% of total billed charges,6.3,90,,,percent of total billed charges,90% of total billed charges,6.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6.79,97,,,percent of total billed charges,97% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges,6.72,96,,,percent of total billed charges,96% of total billed charges,0.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5.25,75,,,percent of total billed charges,75% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges,0.07,6.79,
DESTRUCTION BENIGN LESIONS UP TO 14,78000316G,CDM,981,RC,17110,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.58,93,,,percent of total billed charges,93% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,199.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,199.82,97,,,percent of total billed charges,97% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,197.76,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.5,75,,,percent of total billed charges,75% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,4.28,199.82,
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE,78000320G,CDM,981,RC,17250,HCPCS,Outpatient,,,136,102,,125.12,92,,,percent of total billed charges,92% of total billed charges,3.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126.48,93,,,percent of total billed charges,93% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,131.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.92,97,,,percent of total billed charges,97% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,130.56,96,,,percent of total billed charges,96% of total billed charges,3.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102,75,,,percent of total billed charges,75% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,3.47,131.92,
PF BIOPSY OF BREAST PERCUTANEOUS NEEDLE CORE W/O GUIDANCE,78002852G,CDM,981,RC,19100,HCPCS,Outpatient,,,379,284.25,,348.68,92,,,percent of total billed charges,92% of total billed charges,10.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.47,93,,,percent of total billed charges,93% of total billed charges,341.1,90,,,percent of total billed charges,90% of total billed charges,341.1,90,,,percent of total billed charges,90% of total billed charges,367.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.63,97,,,percent of total billed charges,97% of total billed charges,284.25,75,,,percent of total billed charges,75% of total billed charges,363.84,96,,,percent of total billed charges,96% of total billed charges,10.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.25,75,,,percent of total billed charges,75% of total billed charges,284.25,75,,,percent of total billed charges,75% of total billed charges,10.78,367.63,
PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNC,78000325G,CDM,981,RC,19281,HCPCS,Outpatient,,,261,195.75,,240.12,92,,,percent of total billed charges,92% of total billed charges,8.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,242.73,93,,,percent of total billed charges,93% of total billed charges,234.9,90,,,percent of total billed charges,90% of total billed charges,234.9,90,,,percent of total billed charges,90% of total billed charges,253.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,253.17,97,,,percent of total billed charges,97% of total billed charges,195.75,75,,,percent of total billed charges,75% of total billed charges,250.56,96,,,percent of total billed charges,96% of total billed charges,8.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.75,75,,,percent of total billed charges,75% of total billed charges,195.75,75,,,percent of total billed charges,75% of total billed charges,8.21,253.17,
EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK,78000330G,CDM,981,RC,20102,HCPCS,Outpatient,,,1863,1397.25,,1713.96,92,,,percent of total billed charges,92% of total billed charges,35.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1732.59,93,,,percent of total billed charges,93% of total billed charges,1676.7,90,,,percent of total billed charges,90% of total billed charges,1676.7,90,,,percent of total billed charges,90% of total billed charges,1807.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,35.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1807.11,97,,,percent of total billed charges,97% of total billed charges,1397.25,75,,,percent of total billed charges,75% of total billed charges,1788.48,96,,,percent of total billed charges,96% of total billed charges,35.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1397.25,75,,,percent of total billed charges,75% of total billed charges,1397.25,75,,,percent of total billed charges,75% of total billed charges,35.19,1807.11,
EXPLORATION PENETRATING WOUND SPX EXTREMITY,78000332G,CDM,981,RC,20103,HCPCS,Outpatient,,,2991,2243.25,,2751.72,92,,,percent of total billed charges,92% of total billed charges,39.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2781.63,93,,,percent of total billed charges,93% of total billed charges,2691.9,90,,,percent of total billed charges,90% of total billed charges,2691.9,90,,,percent of total billed charges,90% of total billed charges,2901.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,39.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2901.27,97,,,percent of total billed charges,97% of total billed charges,2243.25,75,,,percent of total billed charges,75% of total billed charges,2871.36,96,,,percent of total billed charges,96% of total billed charges,39.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2243.25,75,,,percent of total billed charges,75% of total billed charges,2243.25,75,,,percent of total billed charges,75% of total billed charges,39.89,2901.27,
BIOPSY MUSCLE DEEP,78000334G,CDM,981,RC,20205,HCPCS,Outpatient,,,799,599.25,,735.08,92,,,percent of total billed charges,92% of total billed charges,23.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,743.07,93,,,percent of total billed charges,93% of total billed charges,719.1,90,,,percent of total billed charges,90% of total billed charges,719.1,90,,,percent of total billed charges,90% of total billed charges,775.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,775.03,97,,,percent of total billed charges,97% of total billed charges,599.25,75,,,percent of total billed charges,75% of total billed charges,767.04,96,,,percent of total billed charges,96% of total billed charges,23.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,599.25,75,,,percent of total billed charges,75% of total billed charges,599.25,75,,,percent of total billed charges,75% of total billed charges,23.27,775.03,
REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE,78000342G,CDM,981,RC,20520,HCPCS,Outpatient,,,1019,764.25,,937.48,92,,,percent of total billed charges,92% of total billed charges,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,947.67,93,,,percent of total billed charges,93% of total billed charges,917.1,90,,,percent of total billed charges,90% of total billed charges,917.1,90,,,percent of total billed charges,90% of total billed charges,988.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,988.43,97,,,percent of total billed charges,97% of total billed charges,764.25,75,,,percent of total billed charges,75% of total billed charges,978.24,96,,,percent of total billed charges,96% of total billed charges,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,764.25,75,,,percent of total billed charges,75% of total billed charges,764.25,75,,,percent of total billed charges,75% of total billed charges,13.01,988.43,
REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH COMPLICATED,78000344G,CDM,981,RC,20525,HCPCS,Outpatient,,,1364,1023,,1254.88,92,,,percent of total billed charges,92% of total billed charges,26.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1268.52,93,,,percent of total billed charges,93% of total billed charges,1227.6,90,,,percent of total billed charges,90% of total billed charges,1227.6,90,,,percent of total billed charges,90% of total billed charges,1323.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1323.08,97,,,percent of total billed charges,97% of total billed charges,1023,75,,,percent of total billed charges,75% of total billed charges,1309.44,96,,,percent of total billed charges,96% of total billed charges,26.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1023,75,,,percent of total billed charges,75% of total billed charges,1023,75,,,percent of total billed charges,75% of total billed charges,26.48,1323.08,
INJECTION THERAPEUTIC CARPAL TUNNEL,78000346G,CDM,981,RC,20526,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,6.57,201.76,
INJECTION SINGLE TENDON ORIGIN/INSERTION,78000350G,CDM,981,RC,20551,HCPCS,Outpatient,,,158,118.5,,145.36,92,,,percent of total billed charges,92% of total billed charges,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.94,93,,,percent of total billed charges,93% of total billed charges,142.2,90,,,percent of total billed charges,90% of total billed charges,142.2,90,,,percent of total billed charges,90% of total billed charges,153.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,153.26,97,,,percent of total billed charges,97% of total billed charges,118.5,75,,,percent of total billed charges,75% of total billed charges,151.68,96,,,percent of total billed charges,96% of total billed charges,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,118.5,75,,,percent of total billed charges,75% of total billed charges,118.5,75,,,percent of total billed charges,75% of total billed charges,3.77,153.26,
INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,78000352G,CDM,981,RC,20552,HCPCS,Outpatient,,,152,114,,139.84,92,,,percent of total billed charges,92% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.36,93,,,percent of total billed charges,93% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,147.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.44,97,,,percent of total billed charges,97% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,145.92,96,,,percent of total billed charges,96% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,114,75,,,percent of total billed charges,75% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,3.44,147.44,
INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,78000354G,CDM,981,RC,20553,HCPCS,Outpatient,,,170,127.5,,156.4,92,,,percent of total billed charges,92% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.1,93,,,percent of total billed charges,93% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,164.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.9,97,,,percent of total billed charges,97% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,163.2,96,,,percent of total billed charges,96% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.5,75,,,percent of total billed charges,75% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,3.88,164.9,
ARTHROCENTESIS ASPIR and /INJ SMALL JT/BURSA W/O US,78000356G,CDM,981,RC,20600,HCPCS,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.06,93,,,percent of total billed charges,93% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,137.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,137.74,97,,,percent of total billed charges,97% of total billed charges,106.5,75,,,percent of total billed charges,75% of total billed charges,136.32,96,,,percent of total billed charges,96% of total billed charges,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.5,75,,,percent of total billed charges,75% of total billed charges,106.5,75,,,percent of total billed charges,75% of total billed charges,3.67,137.74,
ARTHROCENTESIS ASPIR and /INJ SML JT/BURSAW/US REC RPRT,78000360G,CDM,981,RC,20604,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.33,93,,,percent of total billed charges,93% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,175.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.57,97,,,percent of total billed charges,97% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,173.76,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.75,75,,,percent of total billed charges,75% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,4.28,175.57,
ARTHROCENTESIS ASPIR and /INJ INTERM JT/BURS W/O US,78000362G,CDM,981,RC,20605,HCPCS,Outpatient,,,147,110.25,,135.24,92,,,percent of total billed charges,92% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,136.71,93,,,percent of total billed charges,93% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,142.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.59,97,,,percent of total billed charges,97% of total billed charges,110.25,75,,,percent of total billed charges,75% of total billed charges,141.12,96,,,percent of total billed charges,96% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.25,75,,,percent of total billed charges,75% of total billed charges,110.25,75,,,percent of total billed charges,75% of total billed charges,3.71,142.59,
ARTHROCENTESIS ASPIR and /INJ INTERM JT/BURS W/US,78000366G,CDM,981,RC,20606,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,5.31,201.76,
ARTHROCENTESIS ASPIR and /INJ MAJOR JT/BURSA W/O US,78000368G,CDM,981,RC,20610,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.33,93,,,percent of total billed charges,93% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,175.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.57,97,,,percent of total billed charges,97% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,173.76,96,,,percent of total billed charges,96% of total billed charges,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.75,75,,,percent of total billed charges,75% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,5.09,175.57,
ARTHROCENTESIS ASPIR and /INJ MAJOR JT/BURSA W/US,78000372G,CDM,981,RC,20611,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.48,93,,,percent of total billed charges,93% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,228.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.92,97,,,percent of total billed charges,97% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,226.56,96,,,percent of total billed charges,96% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177,75,,,percent of total billed charges,75% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,6.09,228.92,
CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION,78000390G,CDM,981,RC,21320,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,229.71,93,,,percent of total billed charges,93% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,239.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,239.59,97,,,percent of total billed charges,97% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,237.12,96,,,percent of total billed charges,96% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.25,75,,,percent of total billed charges,75% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,9.79,239.59,
CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ,78000392G,CDM,981,RC,21480,HCPCS,Outpatient,,,463,347.25,,425.96,92,,,percent of total billed charges,92% of total billed charges,4.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.59,93,,,percent of total billed charges,93% of total billed charges,416.7,90,,,percent of total billed charges,90% of total billed charges,416.7,90,,,percent of total billed charges,90% of total billed charges,449.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,449.11,97,,,percent of total billed charges,97% of total billed charges,347.25,75,,,percent of total billed charges,75% of total billed charges,444.48,96,,,percent of total billed charges,96% of total billed charges,4.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,347.25,75,,,percent of total billed charges,75% of total billed charges,347.25,75,,,percent of total billed charges,75% of total billed charges,4.33,449.11,
INCISION  and  DRAIN DEEP ABSC/HEMATOMA SOFT TISSUE NECK THO,78000394G,CDM,981,RC,21501,HCPCS,Outpatient,,,1335,1001.25,,1228.2,92,,,percent of total billed charges,92% of total billed charges,34.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1241.55,93,,,percent of total billed charges,93% of total billed charges,1201.5,90,,,percent of total billed charges,90% of total billed charges,1201.5,90,,,percent of total billed charges,90% of total billed charges,1294.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,34.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1294.95,97,,,percent of total billed charges,97% of total billed charges,1001.25,75,,,percent of total billed charges,75% of total billed charges,1281.6,96,,,percent of total billed charges,96% of total billed charges,34.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1001.25,75,,,percent of total billed charges,75% of total billed charges,1001.25,75,,,percent of total billed charges,75% of total billed charges,34.04,1294.95,
CLOSED TREATMENT STERNUM FRACTURE,78000400G,CDM,981,RC,21820,HCPCS,Outpatient,,,721,540.75,,663.32,92,,,percent of total billed charges,92% of total billed charges,13.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,670.53,93,,,percent of total billed charges,93% of total billed charges,648.9,90,,,percent of total billed charges,90% of total billed charges,648.9,90,,,percent of total billed charges,90% of total billed charges,699.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.37,97,,,percent of total billed charges,97% of total billed charges,540.75,75,,,percent of total billed charges,75% of total billed charges,692.16,96,,,percent of total billed charges,96% of total billed charges,13.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,540.75,75,,,percent of total billed charges,75% of total billed charges,540.75,75,,,percent of total billed charges,75% of total billed charges,13.17,699.37,
CLOSED TX VERT BODY FX W/O MANIP REQUIRES CASTING OR BRACING,78000406G,CDM,981,RC,22310,HCPCS,Outpatient,,,792,594,,728.64,92,,,percent of total billed charges,92% of total billed charges,31.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,736.56,93,,,percent of total billed charges,93% of total billed charges,712.8,90,,,percent of total billed charges,90% of total billed charges,712.8,90,,,percent of total billed charges,90% of total billed charges,768.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,31.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,768.24,97,,,percent of total billed charges,97% of total billed charges,594,75,,,percent of total billed charges,75% of total billed charges,760.32,96,,,percent of total billed charges,96% of total billed charges,31.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594,75,,,percent of total billed charges,75% of total billed charges,594,75,,,percent of total billed charges,75% of total billed charges,31.36,768.24,
INCISION  and  DRAIN SHOULDER DEEP ABSCESS/HEMATOMA,78000413G,CDM,981,RC,23030,HCPCS,Outpatient,,,1388,1041,,1276.96,92,,,percent of total billed charges,92% of total billed charges,27.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1290.84,93,,,percent of total billed charges,93% of total billed charges,1249.2,90,,,percent of total billed charges,90% of total billed charges,1249.2,90,,,percent of total billed charges,90% of total billed charges,1346.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1346.36,97,,,percent of total billed charges,97% of total billed charges,1041,75,,,percent of total billed charges,75% of total billed charges,1332.48,96,,,percent of total billed charges,96% of total billed charges,27.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1041,75,,,percent of total billed charges,75% of total billed charges,1041,75,,,percent of total billed charges,75% of total billed charges,27.89,1346.36,
REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS,78000424G,CDM,981,RC,23330,HCPCS,Outpatient,,,652,489,,599.84,92,,,percent of total billed charges,92% of total billed charges,16.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,606.36,93,,,percent of total billed charges,93% of total billed charges,586.8,90,,,percent of total billed charges,90% of total billed charges,586.8,90,,,percent of total billed charges,90% of total billed charges,632.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,632.44,97,,,percent of total billed charges,97% of total billed charges,489,75,,,percent of total billed charges,75% of total billed charges,625.92,96,,,percent of total billed charges,96% of total billed charges,16.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,489,75,,,percent of total billed charges,75% of total billed charges,489,75,,,percent of total billed charges,75% of total billed charges,16.46,632.44,
CLOSED TX CLAVICULAR FRACTURE W/O MANIPULATION,78000449G,CDM,981,RC,23500,HCPCS,Outpatient,,,614,460.5,,564.88,92,,,percent of total billed charges,92% of total billed charges,20.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,571.02,93,,,percent of total billed charges,93% of total billed charges,552.6,90,,,percent of total billed charges,90% of total billed charges,552.6,90,,,percent of total billed charges,90% of total billed charges,595.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,595.58,97,,,percent of total billed charges,97% of total billed charges,460.5,75,,,percent of total billed charges,75% of total billed charges,589.44,96,,,percent of total billed charges,96% of total billed charges,20.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,460.5,75,,,percent of total billed charges,75% of total billed charges,460.5,75,,,percent of total billed charges,75% of total billed charges,20.2,595.58,
CLOSED TX CLAVICULAR FRACTURE W/MANIPULATION,78000451G,CDM,981,RC,23505,HCPCS,Outpatient,,,1387,1040.25,,1276.04,92,,,percent of total billed charges,92% of total billed charges,32.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1289.91,93,,,percent of total billed charges,93% of total billed charges,1248.3,90,,,percent of total billed charges,90% of total billed charges,1248.3,90,,,percent of total billed charges,90% of total billed charges,1345.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1345.39,97,,,percent of total billed charges,97% of total billed charges,1040.25,75,,,percent of total billed charges,75% of total billed charges,1331.52,96,,,percent of total billed charges,96% of total billed charges,32.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.25,75,,,percent of total billed charges,75% of total billed charges,1040.25,75,,,percent of total billed charges,75% of total billed charges,32.89,1345.39,
CLOSED TX ACROMIOCLAVICULAR DISLOCATION W/O MANIP,78000455G,CDM,981,RC,23540,HCPCS,Outpatient,,,879,659.25,,808.68,92,,,percent of total billed charges,92% of total billed charges,21.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,817.47,93,,,percent of total billed charges,93% of total billed charges,791.1,90,,,percent of total billed charges,90% of total billed charges,791.1,90,,,percent of total billed charges,90% of total billed charges,852.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,852.63,97,,,percent of total billed charges,97% of total billed charges,659.25,75,,,percent of total billed charges,75% of total billed charges,843.84,96,,,percent of total billed charges,96% of total billed charges,21.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,659.25,75,,,percent of total billed charges,75% of total billed charges,659.25,75,,,percent of total billed charges,75% of total billed charges,21.3,852.63,
CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION,78000461G,CDM,981,RC,23570,HCPCS,Outpatient,,,900,675,,828,92,,,percent of total billed charges,92% of total billed charges,21.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,837,93,,,percent of total billed charges,93% of total billed charges,810,90,,,percent of total billed charges,90% of total billed charges,810,90,,,percent of total billed charges,90% of total billed charges,873,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,873,97,,,percent of total billed charges,97% of total billed charges,675,75,,,percent of total billed charges,75% of total billed charges,864,96,,,percent of total billed charges,96% of total billed charges,21.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,675,75,,,percent of total billed charges,75% of total billed charges,675,75,,,percent of total billed charges,75% of total billed charges,21.52,873,
CLOSED TX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION,78000466G,CDM,981,RC,23600,HCPCS,Outpatient,,,1220,915,,1122.4,92,,,percent of total billed charges,92% of total billed charges,27.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1134.6,93,,,percent of total billed charges,93% of total billed charges,1098,90,,,percent of total billed charges,90% of total billed charges,1098,90,,,percent of total billed charges,90% of total billed charges,1183.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1183.4,97,,,percent of total billed charges,97% of total billed charges,915,75,,,percent of total billed charges,75% of total billed charges,1171.2,96,,,percent of total billed charges,96% of total billed charges,27.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,915,75,,,percent of total billed charges,75% of total billed charges,915,75,,,percent of total billed charges,75% of total billed charges,27.41,1183.4,
CLOSED TX SHOULDER DISLOCATION W/MANIPULATION W/O ANES,78000477G,CDM,981,RC,23650,HCPCS,Outpatient,,,1140,855,,1048.8,92,,,percent of total billed charges,92% of total billed charges,30.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1060.2,93,,,percent of total billed charges,93% of total billed charges,1026,90,,,percent of total billed charges,90% of total billed charges,1026,90,,,percent of total billed charges,90% of total billed charges,1105.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1105.8,97,,,percent of total billed charges,97% of total billed charges,855,75,,,percent of total billed charges,75% of total billed charges,1094.4,96,,,percent of total billed charges,96% of total billed charges,30.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,855,75,,,percent of total billed charges,75% of total billed charges,855,75,,,percent of total billed charges,75% of total billed charges,30.62,1105.8,
CLOSED TX SUPRA/TRANSCONDYLAR HUMERAL FX W/MANIP,78000526G,CDM,981,RC,24535,HCPCS,Outpatient,,,2228,1671,,2049.76,92,,,percent of total billed charges,92% of total billed charges,59.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2072.04,93,,,percent of total billed charges,93% of total billed charges,2005.2,90,,,percent of total billed charges,90% of total billed charges,2005.2,90,,,percent of total billed charges,90% of total billed charges,2161.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,59.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2161.16,97,,,percent of total billed charges,97% of total billed charges,1671,75,,,percent of total billed charges,75% of total billed charges,2138.88,96,,,percent of total billed charges,96% of total billed charges,59.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1671,75,,,percent of total billed charges,75% of total billed charges,1671,75,,,percent of total billed charges,75% of total billed charges,59.96,2161.16,
CLOSED TX RADIAL HEAD SUBLXTJ CHLD NURSEMAID ELBOW W/MANIP,78000548G,CDM,981,RC,24640,HCPCS,Outpatient,,,310,232.5,,285.2,92,,,percent of total billed charges,92% of total billed charges,5.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.3,93,,,percent of total billed charges,93% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,300.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.7,97,,,percent of total billed charges,97% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,297.6,96,,,percent of total billed charges,96% of total billed charges,5.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,232.5,75,,,percent of total billed charges,75% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,5.23,300.7,
EXPLORATION W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST,78000587G,CDM,981,RC,25248,HCPCS,Outpatient,,,1956,1467,,1799.52,92,,,percent of total billed charges,92% of total billed charges,45.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1819.08,93,,,percent of total billed charges,93% of total billed charges,1760.4,90,,,percent of total billed charges,90% of total billed charges,1760.4,90,,,percent of total billed charges,90% of total billed charges,1897.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1897.32,97,,,percent of total billed charges,97% of total billed charges,1467,75,,,percent of total billed charges,75% of total billed charges,1877.76,96,,,percent of total billed charges,96% of total billed charges,45.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1467,75,,,percent of total billed charges,75% of total billed charges,1467,75,,,percent of total billed charges,75% of total billed charges,45.91,1897.32,
REPAIR TENDON/MUSCLE EXTENSOR FOREARM WRIST PRIMARY EACH,78000590G,CDM,981,RC,25270,HCPCS,Outpatient,,,2836,2127,,2609.12,92,,,percent of total billed charges,92% of total billed charges,50,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2637.48,93,,,percent of total billed charges,93% of total billed charges,2552.4,90,,,percent of total billed charges,90% of total billed charges,2552.4,90,,,percent of total billed charges,90% of total billed charges,2750.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2750.92,97,,,percent of total billed charges,97% of total billed charges,2127,75,,,percent of total billed charges,75% of total billed charges,2722.56,96,,,percent of total billed charges,96% of total billed charges,50,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2127,75,,,percent of total billed charges,75% of total billed charges,2127,75,,,percent of total billed charges,75% of total billed charges,50,2750.92,
CLOSED TX RADIAL  and  ULNAR SHAFT FRACTURES W/MANIPULATION,78000618G,CDM,981,RC,25565,HCPCS,Outpatient,,,2112,1584,,1943.04,92,,,percent of total billed charges,92% of total billed charges,49.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1964.16,93,,,percent of total billed charges,93% of total billed charges,1900.8,90,,,percent of total billed charges,90% of total billed charges,1900.8,90,,,percent of total billed charges,90% of total billed charges,2048.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,49.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2048.64,97,,,percent of total billed charges,97% of total billed charges,1584,75,,,percent of total billed charges,75% of total billed charges,2027.52,96,,,percent of total billed charges,96% of total billed charges,49.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1584,75,,,percent of total billed charges,75% of total billed charges,1584,75,,,percent of total billed charges,75% of total billed charges,49.41,2048.64,
CL TX DISTAL RADIAL FRACTURE W/MANIPULATION,78000626G,CDM,981,RC,25605,HCPCS,Outpatient,,,2248,1686,,2068.16,92,,,percent of total billed charges,92% of total billed charges,52.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2090.64,93,,,percent of total billed charges,93% of total billed charges,2023.2,90,,,percent of total billed charges,90% of total billed charges,2023.2,90,,,percent of total billed charges,90% of total billed charges,2180.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,52.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2180.56,97,,,percent of total billed charges,97% of total billed charges,1686,75,,,percent of total billed charges,75% of total billed charges,2158.08,96,,,percent of total billed charges,96% of total billed charges,52.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1686,75,,,percent of total billed charges,75% of total billed charges,1686,75,,,percent of total billed charges,75% of total billed charges,52.93,2180.56,
DRAINAGE FINGER ABSCESS COMPLICATED,78000651G,CDM,981,RC,26011,HCPCS,Outpatient,,,1274,955.5,,1172.08,92,,,percent of total billed charges,92% of total billed charges,17.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1184.82,93,,,percent of total billed charges,93% of total billed charges,1146.6,90,,,percent of total billed charges,90% of total billed charges,1146.6,90,,,percent of total billed charges,90% of total billed charges,1235.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1235.78,97,,,percent of total billed charges,97% of total billed charges,955.5,75,,,percent of total billed charges,75% of total billed charges,1223.04,96,,,percent of total billed charges,96% of total billed charges,17.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,955.5,75,,,percent of total billed charges,75% of total billed charges,955.5,75,,,percent of total billed charges,75% of total billed charges,17.6,1235.78,
CLOSED TX METACARPAL FX W/MANIPULATION EACH BONE,78000704G,CDM,981,RC,26605,HCPCS,Outpatient,,,1177,882.75,,1082.84,92,,,percent of total billed charges,92% of total billed charges,26.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1094.61,93,,,percent of total billed charges,93% of total billed charges,1059.3,90,,,percent of total billed charges,90% of total billed charges,1059.3,90,,,percent of total billed charges,90% of total billed charges,1141.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1141.69,97,,,percent of total billed charges,97% of total billed charges,882.75,75,,,percent of total billed charges,75% of total billed charges,1129.92,96,,,percent of total billed charges,96% of total billed charges,26.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,882.75,75,,,percent of total billed charges,75% of total billed charges,882.75,75,,,percent of total billed charges,75% of total billed charges,26.72,1141.69,
CLOSED TX METACARPOPHALANGEAL DISLOCATION W/MANIP W/ANES,78000723G,CDM,981,RC,26705,HCPCS,Outpatient,,,1505,1128.75,,1384.6,92,,,percent of total billed charges,92% of total billed charges,38.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1399.65,93,,,percent of total billed charges,93% of total billed charges,1354.5,90,,,percent of total billed charges,90% of total billed charges,1354.5,90,,,percent of total billed charges,90% of total billed charges,1459.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,38.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1459.85,97,,,percent of total billed charges,97% of total billed charges,1128.75,75,,,percent of total billed charges,75% of total billed charges,1444.8,96,,,percent of total billed charges,96% of total billed charges,38.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1128.75,75,,,percent of total billed charges,75% of total billed charges,1128.75,75,,,percent of total billed charges,75% of total billed charges,38.9,1459.85,
CLOSED TX PHALANGEAL SHAFT FX PROX/MIDDLE W/MANIP,78000728G,CDM,981,RC,26725,HCPCS,Outpatient,,,1192,894,,1096.64,92,,,percent of total billed charges,92% of total billed charges,29.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1108.56,93,,,percent of total billed charges,93% of total billed charges,1072.8,90,,,percent of total billed charges,90% of total billed charges,1072.8,90,,,percent of total billed charges,90% of total billed charges,1156.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1156.24,97,,,percent of total billed charges,97% of total billed charges,894,75,,,percent of total billed charges,75% of total billed charges,1144.32,96,,,percent of total billed charges,96% of total billed charges,29.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,894,75,,,percent of total billed charges,75% of total billed charges,894,75,,,percent of total billed charges,75% of total billed charges,29.69,1156.24,
CLOSED TX FINGER DISLOCATION W/MANIP W/O ANESTH,78002888G,CDM,981,RC,26770,HCPCS,Outpatient,,,592.4,444.3,,545.01,92,,,percent of total billed charges,92% of total billed charges,26.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,550.93,93,,,percent of total billed charges,93% of total billed charges,533.16,90,,,percent of total billed charges,90% of total billed charges,533.16,90,,,percent of total billed charges,90% of total billed charges,574.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,574.63,97,,,percent of total billed charges,97% of total billed charges,444.3,75,,,percent of total billed charges,75% of total billed charges,568.7,96,,,percent of total billed charges,96% of total billed charges,26.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,444.3,75,,,percent of total billed charges,75% of total billed charges,444.3,75,,,percent of total billed charges,75% of total billed charges,26.31,574.63,
CLOSED TX INTERPHALANGEAL JOINT DISLOC W/MANIP W/ANESTH,78000742G,CDM,981,RC,26775,HCPCS,Outpatient,,,1289,966.75,,1185.88,92,,,percent of total billed charges,92% of total billed charges,32.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1198.77,93,,,percent of total billed charges,93% of total billed charges,1160.1,90,,,percent of total billed charges,90% of total billed charges,1160.1,90,,,percent of total billed charges,90% of total billed charges,1250.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1250.33,97,,,percent of total billed charges,97% of total billed charges,966.75,75,,,percent of total billed charges,75% of total billed charges,1237.44,96,,,percent of total billed charges,96% of total billed charges,32.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,966.75,75,,,percent of total billed charges,75% of total billed charges,966.75,75,,,percent of total billed charges,75% of total billed charges,32.84,1250.33,
INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA,78002199G,CDM,981,RC,27093,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.54,93,,,percent of total billed charges,93% of total billed charges,160.2,90,,,percent of total billed charges,90% of total billed charges,160.2,90,,,percent of total billed charges,90% of total billed charges,172.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.66,97,,,percent of total billed charges,97% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges,170.88,96,,,percent of total billed charges,96% of total billed charges,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,133.5,75,,,percent of total billed charges,75% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges,6.38,172.66,
ED CLOSED TX POST HIP ARTHROPLASTY DISLC W/O ANES,78000803G,CDM,981,RC,27265,HCPCS,Outpatient,,,1588,1191,,1460.96,92,,,percent of total billed charges,92% of total billed charges,44.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1476.84,93,,,percent of total billed charges,93% of total billed charges,1429.2,90,,,percent of total billed charges,90% of total billed charges,1429.2,90,,,percent of total billed charges,90% of total billed charges,1540.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,44.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1540.36,97,,,percent of total billed charges,97% of total billed charges,1191,75,,,percent of total billed charges,75% of total billed charges,1524.48,96,,,percent of total billed charges,96% of total billed charges,44.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1191,75,,,percent of total billed charges,75% of total billed charges,1191,75,,,percent of total billed charges,75% of total billed charges,44.96,1540.36,
ED CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA,78000909G,CDM,981,RC,27560,HCPCS,Outpatient,,,1347,1010.25,,1239.24,92,,,percent of total billed charges,92% of total billed charges,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1252.71,93,,,percent of total billed charges,93% of total billed charges,1212.3,90,,,percent of total billed charges,90% of total billed charges,1212.3,90,,,percent of total billed charges,90% of total billed charges,1306.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1306.59,97,,,percent of total billed charges,97% of total billed charges,1010.25,75,,,percent of total billed charges,75% of total billed charges,1293.12,96,,,percent of total billed charges,96% of total billed charges,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1010.25,75,,,percent of total billed charges,75% of total billed charges,1010.25,75,,,percent of total billed charges,75% of total billed charges,34.49,1306.59,
CLOSED TX TIBIAL SHAFT FX W/MANIP W/WO SKEL TRACTION,78000965G,CDM,981,RC,27752,HCPCS,Outpatient,,,2666,1999.5,,2452.72,92,,,percent of total billed charges,92% of total billed charges,52.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2479.38,93,,,percent of total billed charges,93% of total billed charges,2399.4,90,,,percent of total billed charges,90% of total billed charges,2399.4,90,,,percent of total billed charges,90% of total billed charges,2586.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,52.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2586.02,97,,,percent of total billed charges,97% of total billed charges,1999.5,75,,,percent of total billed charges,75% of total billed charges,2559.36,96,,,percent of total billed charges,96% of total billed charges,52.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1999.5,75,,,percent of total billed charges,75% of total billed charges,1999.5,75,,,percent of total billed charges,75% of total billed charges,52.37,2586.02,
CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANIP,78000996G,CDM,981,RC,27810,HCPCS,Outpatient,,,1663,1247.25,,1529.96,92,,,percent of total billed charges,92% of total billed charges,45.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1546.59,93,,,percent of total billed charges,93% of total billed charges,1496.7,90,,,percent of total billed charges,90% of total billed charges,1496.7,90,,,percent of total billed charges,90% of total billed charges,1613.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1613.11,97,,,percent of total billed charges,97% of total billed charges,1247.25,75,,,percent of total billed charges,75% of total billed charges,1596.48,96,,,percent of total billed charges,96% of total billed charges,45.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1247.25,75,,,percent of total billed charges,75% of total billed charges,1247.25,75,,,percent of total billed charges,75% of total billed charges,45.11,1613.11,
CLOSED TX TRIMALLEOLAR ANKLE FX W/MANIPULATION,78001002G,CDM,981,RC,27818,HCPCS,Outpatient,,,1709,1281.75,,1572.28,92,,,percent of total billed charges,92% of total billed charges,47.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1589.37,93,,,percent of total billed charges,93% of total billed charges,1538.1,90,,,percent of total billed charges,90% of total billed charges,1538.1,90,,,percent of total billed charges,90% of total billed charges,1657.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,47.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1657.73,97,,,percent of total billed charges,97% of total billed charges,1281.75,75,,,percent of total billed charges,75% of total billed charges,1640.64,96,,,percent of total billed charges,96% of total billed charges,47.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1281.75,75,,,percent of total billed charges,75% of total billed charges,1281.75,75,,,percent of total billed charges,75% of total billed charges,47.43,1657.73,
STRAPPING ELBOW/WRIST,78001166G,CDM,981,RC,29260,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,1.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,1.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,1.46,255.11,
APPLICATION LONG LEG CAST THIGH-TOE,78001174G,CDM,981,RC,29345,HCPCS,Outpatient,,,261,195.75,,240.12,92,,,percent of total billed charges,92% of total billed charges,10.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,242.73,93,,,percent of total billed charges,93% of total billed charges,234.9,90,,,percent of total billed charges,90% of total billed charges,234.9,90,,,percent of total billed charges,90% of total billed charges,253.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,253.17,97,,,percent of total billed charges,97% of total billed charges,195.75,75,,,percent of total billed charges,75% of total billed charges,250.56,96,,,percent of total billed charges,96% of total billed charges,10.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.75,75,,,percent of total billed charges,75% of total billed charges,195.75,75,,,percent of total billed charges,75% of total billed charges,10.48,253.17,
APPLICATION SHORT LEG CAST BELOW KNEE-TOE,78001176G,CDM,981,RC,29405,HCPCS,Outpatient,,,230,172.5,,211.6,92,,,percent of total billed charges,92% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.9,93,,,percent of total billed charges,93% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,223.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.1,97,,,percent of total billed charges,97% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,220.8,96,,,percent of total billed charges,96% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.5,75,,,percent of total billed charges,75% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,5.56,223.1,
APPLICATION SHORT LEG CAST WALKING/AMBULATORY,78001178G,CDM,981,RC,29425,HCPCS,Outpatient,,,392,294,,360.64,92,,,percent of total billed charges,92% of total billed charges,4.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,364.56,93,,,percent of total billed charges,93% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,380.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,380.24,97,,,percent of total billed charges,97% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,376.32,96,,,percent of total billed charges,96% of total billed charges,4.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,294,75,,,percent of total billed charges,75% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,4.59,380.24,
APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES,78001186G,CDM,981,RC,29505,HCPCS,Outpatient,,,197,147.75,,181.24,92,,,percent of total billed charges,92% of total billed charges,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,183.21,93,,,percent of total billed charges,93% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,191.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.09,97,,,percent of total billed charges,97% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,189.12,96,,,percent of total billed charges,96% of total billed charges,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.75,75,,,percent of total billed charges,75% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,5.07,191.09,
APPLICATION SHORT LEG SPLINT CALF FOOT,78001188G,CDM,981,RC,29515,HCPCS,Outpatient,,,193,144.75,,177.56,92,,,percent of total billed charges,92% of total billed charges,4.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.49,93,,,percent of total billed charges,93% of total billed charges,173.7,90,,,percent of total billed charges,90% of total billed charges,173.7,90,,,percent of total billed charges,90% of total billed charges,187.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,187.21,97,,,percent of total billed charges,97% of total billed charges,144.75,75,,,percent of total billed charges,75% of total billed charges,185.28,96,,,percent of total billed charges,96% of total billed charges,4.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.75,75,,,percent of total billed charges,75% of total billed charges,144.75,75,,,percent of total billed charges,75% of total billed charges,4.71,187.21,
STRAPPING KNEE,78001190G,CDM,981,RC,29530,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,93,,,percent of total billed charges,93% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,72.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72.75,97,,,percent of total billed charges,97% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,72,96,,,percent of total billed charges,96% of total billed charges,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.25,75,,,percent of total billed charges,75% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,1.15,72.75,
STRAPPING ANKLE  and /FOOT,78001192G,CDM,981,RC,29540,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges,1.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.1,93,,,percent of total billed charges,93% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,67.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,67.9,97,,,percent of total billed charges,97% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,67.2,96,,,percent of total billed charges,96% of total billed charges,1.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,52.5,75,,,percent of total billed charges,75% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,1.4,67.9,
STRAPPING TOES,78001194G,CDM,981,RC,29550,HCPCS,Outpatient,,,45,33.75,,41.4,92,,,percent of total billed charges,92% of total billed charges,0.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,41.85,93,,,percent of total billed charges,93% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,43.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.65,97,,,percent of total billed charges,97% of total billed charges,33.75,75,,,percent of total billed charges,75% of total billed charges,43.2,96,,,percent of total billed charges,96% of total billed charges,0.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,33.75,75,,,percent of total billed charges,75% of total billed charges,33.75,75,,,percent of total billed charges,75% of total billed charges,0.92,43.65,
STRAPPING UNNA BOOT,78001196G,CDM,981,RC,29580,HCPCS,Outpatient,,,107,80.25,,98.44,92,,,percent of total billed charges,92% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,99.51,93,,,percent of total billed charges,93% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,103.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.79,97,,,percent of total billed charges,97% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges,102.72,96,,,percent of total billed charges,96% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.25,75,,,percent of total billed charges,75% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges,2.8,103.79,
REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST,78001200G,CDM,981,RC,29700,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,3.85,255.11,
WINDOWING CAST,78001202G,CDM,981,RC,29730,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,5.07,255.11,
REMOVAL FOREIGN BODY INTRANASAL,78001249G,CDM,981,RC,30300,HCPCS,Outpatient,,,443,332.25,,407.56,92,,,percent of total billed charges,92% of total billed charges,8.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.99,93,,,percent of total billed charges,93% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,429.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,429.71,97,,,percent of total billed charges,97% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,425.28,96,,,percent of total billed charges,96% of total billed charges,8.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,332.25,75,,,percent of total billed charges,75% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,8.62,429.71,
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE UNI,78001251G,CDM,981,RC,30901,HCPCS,Outpatient,,,241,180.75,,221.72,92,,,percent of total billed charges,92% of total billed charges,7.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,224.13,93,,,percent of total billed charges,93% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,233.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.77,97,,,percent of total billed charges,97% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,231.36,96,,,percent of total billed charges,96% of total billed charges,7.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.75,75,,,percent of total billed charges,75% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,7.1,233.77,
CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX UNI,78001255G,CDM,981,RC,30903,HCPCS,Outpatient,,,309,231.75,,284.28,92,,,percent of total billed charges,92% of total billed charges,9.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,287.37,93,,,percent of total billed charges,93% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,299.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,299.73,97,,,percent of total billed charges,97% of total billed charges,231.75,75,,,percent of total billed charges,75% of total billed charges,296.64,96,,,percent of total billed charges,96% of total billed charges,9.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.75,75,,,percent of total billed charges,75% of total billed charges,231.75,75,,,percent of total billed charges,75% of total billed charges,9.7,299.73,
CTRL NSL HEMRRG PST NASAL PACKS and /CAUTERY 1ST,78001259G,CDM,981,RC,30905,HCPCS,Outpatient,,,417,312.75,,383.64,92,,,percent of total billed charges,92% of total billed charges,13.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,387.81,93,,,percent of total billed charges,93% of total billed charges,375.3,90,,,percent of total billed charges,90% of total billed charges,375.3,90,,,percent of total billed charges,90% of total billed charges,404.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,404.49,97,,,percent of total billed charges,97% of total billed charges,312.75,75,,,percent of total billed charges,75% of total billed charges,400.32,96,,,percent of total billed charges,96% of total billed charges,13.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312.75,75,,,percent of total billed charges,75% of total billed charges,312.75,75,,,percent of total billed charges,75% of total billed charges,13.13,404.49,
CTRL NSL HEMRRG PST NASAL PACKS and /CAUTERY SUBSQ,78001261G,CDM,981,RC,30906,HCPCS,Outpatient,,,443,332.25,,407.56,92,,,percent of total billed charges,92% of total billed charges,15.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.99,93,,,percent of total billed charges,93% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,429.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,429.71,97,,,percent of total billed charges,97% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,425.28,96,,,percent of total billed charges,96% of total billed charges,15.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,332.25,75,,,percent of total billed charges,75% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,15.41,429.71,
INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,78001263G,CDM,981,RC,31500,HCPCS,Outpatient,,,563,422.25,,517.96,92,,,percent of total billed charges,92% of total billed charges,16.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,523.59,93,,,percent of total billed charges,93% of total billed charges,506.7,90,,,percent of total billed charges,90% of total billed charges,506.7,90,,,percent of total billed charges,90% of total billed charges,546.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546.11,97,,,percent of total billed charges,97% of total billed charges,422.25,75,,,percent of total billed charges,75% of total billed charges,540.48,96,,,percent of total billed charges,96% of total billed charges,16.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,422.25,75,,,percent of total billed charges,75% of total billed charges,422.25,75,,,percent of total billed charges,75% of total billed charges,16.47,546.11,
TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL,78001266G,CDM,981,RC,31603,HCPCS,Outpatient,,,1744,1308,,1604.48,92,,,percent of total billed charges,92% of total billed charges,41.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1621.92,93,,,percent of total billed charges,93% of total billed charges,1569.6,90,,,percent of total billed charges,90% of total billed charges,1569.6,90,,,percent of total billed charges,90% of total billed charges,1691.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1691.68,97,,,percent of total billed charges,97% of total billed charges,1308,75,,,percent of total billed charges,75% of total billed charges,1674.24,96,,,percent of total billed charges,96% of total billed charges,41.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1308,75,,,percent of total billed charges,75% of total billed charges,1308,75,,,percent of total billed charges,75% of total billed charges,41.33,1691.68,
TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE,78001268G,CDM,981,RC,31605,HCPCS,Outpatient,,,1314,985.5,,1208.88,92,,,percent of total billed charges,92% of total billed charges,45.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1222.02,93,,,percent of total billed charges,93% of total billed charges,1182.6,90,,,percent of total billed charges,90% of total billed charges,1182.6,90,,,percent of total billed charges,90% of total billed charges,1274.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1274.58,97,,,percent of total billed charges,97% of total billed charges,985.5,75,,,percent of total billed charges,75% of total billed charges,1261.44,96,,,percent of total billed charges,96% of total billed charges,45.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,985.5,75,,,percent of total billed charges,75% of total billed charges,985.5,75,,,percent of total billed charges,75% of total billed charges,45.45,1274.58,
TUBE THORACOSTOMY INCLUDES WATER SEAL,78001276G,CDM,981,RC,32551,HCPCS,Outpatient,,,1218,913.5,,1120.56,92,,,percent of total billed charges,92% of total billed charges,19.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1132.74,93,,,percent of total billed charges,93% of total billed charges,1096.2,90,,,percent of total billed charges,90% of total billed charges,1096.2,90,,,percent of total billed charges,90% of total billed charges,1181.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1181.46,97,,,percent of total billed charges,97% of total billed charges,913.5,75,,,percent of total billed charges,75% of total billed charges,1169.28,96,,,percent of total billed charges,96% of total billed charges,19.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,913.5,75,,,percent of total billed charges,75% of total billed charges,913.5,75,,,percent of total billed charges,75% of total billed charges,19.66,1181.46,
THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING,78001278G,CDM,981,RC,32554,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,8.7,343.38,
THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING,78001280G,CDM,981,RC,32555,HCPCS,Outpatient,,,440,330,,404.8,92,,,percent of total billed charges,92% of total billed charges,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,409.2,93,,,percent of total billed charges,93% of total billed charges,396,90,,,percent of total billed charges,90% of total billed charges,396,90,,,percent of total billed charges,90% of total billed charges,426.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,426.8,97,,,percent of total billed charges,97% of total billed charges,330,75,,,percent of total billed charges,75% of total billed charges,422.4,96,,,percent of total billed charges,96% of total billed charges,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,330,75,,,percent of total billed charges,75% of total billed charges,330,75,,,percent of total billed charges,75% of total billed charges,9.65,426.8,
PERCUTANEOUS DRAINAGE PLEURA INSERT CATH W/O IMAGING,78001282G,CDM,981,RC,32556,HCPCS,Outpatient,,,1286,964.5,,1183.12,92,,,percent of total billed charges,92% of total billed charges,14.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1195.98,93,,,percent of total billed charges,93% of total billed charges,1157.4,90,,,percent of total billed charges,90% of total billed charges,1157.4,90,,,percent of total billed charges,90% of total billed charges,1247.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1247.42,97,,,percent of total billed charges,97% of total billed charges,964.5,75,,,percent of total billed charges,75% of total billed charges,1234.56,96,,,percent of total billed charges,96% of total billed charges,14.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,964.5,75,,,percent of total billed charges,75% of total billed charges,964.5,75,,,percent of total billed charges,75% of total billed charges,14.25,1247.42,
REPAIR LIP FULL THICKNESS VERMILLION ONLY,78002854G,CDM,981,RC,40650,HCPCS,Outpatient,,,630,472.5,,579.6,92,,,percent of total billed charges,92% of total billed charges,31.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,585.9,93,,,percent of total billed charges,93% of total billed charges,567,90,,,percent of total billed charges,90% of total billed charges,567,90,,,percent of total billed charges,90% of total billed charges,611.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,31.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,611.1,97,,,percent of total billed charges,97% of total billed charges,472.5,75,,,percent of total billed charges,75% of total billed charges,604.8,96,,,percent of total billed charges,96% of total billed charges,31.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,472.5,75,,,percent of total billed charges,75% of total billed charges,472.5,75,,,percent of total billed charges,75% of total billed charges,31.15,611.1,
DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL,78001364G,CDM,981,RC,40800,HCPCS,Outpatient,,,332,249,,305.44,92,,,percent of total billed charges,92% of total billed charges,7.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,308.76,93,,,percent of total billed charges,93% of total billed charges,298.8,90,,,percent of total billed charges,90% of total billed charges,298.8,90,,,percent of total billed charges,90% of total billed charges,322.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,322.04,97,,,percent of total billed charges,97% of total billed charges,249,75,,,percent of total billed charges,75% of total billed charges,318.72,96,,,percent of total billed charges,96% of total billed charges,7.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249,75,,,percent of total billed charges,75% of total billed charges,249,75,,,percent of total billed charges,75% of total billed charges,7.65,322.04,
RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG,78001374G,CDM,981,RC,41250,HCPCS,Outpatient,,,604,453,,555.68,92,,,percent of total billed charges,92% of total billed charges,15.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,561.72,93,,,percent of total billed charges,93% of total billed charges,543.6,90,,,percent of total billed charges,90% of total billed charges,543.6,90,,,percent of total billed charges,90% of total billed charges,585.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,585.88,97,,,percent of total billed charges,97% of total billed charges,453,75,,,percent of total billed charges,75% of total billed charges,579.84,96,,,percent of total billed charges,96% of total billed charges,15.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,453,75,,,percent of total billed charges,75% of total billed charges,453,75,,,percent of total billed charges,75% of total billed charges,15.65,585.88,
DRAINAGE OF GUM LESION,78001380G,CDM,981,RC,41800,HCPCS,Outpatient,,,332,249,,305.44,92,,,percent of total billed charges,92% of total billed charges,11.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,308.76,93,,,percent of total billed charges,93% of total billed charges,298.8,90,,,percent of total billed charges,90% of total billed charges,298.8,90,,,percent of total billed charges,90% of total billed charges,322.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,322.04,97,,,percent of total billed charges,97% of total billed charges,249,75,,,percent of total billed charges,75% of total billed charges,318.72,96,,,percent of total billed charges,96% of total billed charges,11.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249,75,,,percent of total billed charges,75% of total billed charges,249,75,,,percent of total billed charges,75% of total billed charges,11.33,322.04,
INCISION  and  DRAINAGE ISCHIORECTAL AND OR PERIRECTAL ABSCE,78001457G,CDM,981,RC,46040,HCPCS,Outpatient,,,1656,1242,,1523.52,92,,,percent of total billed charges,92% of total billed charges,46.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1540.08,93,,,percent of total billed charges,93% of total billed charges,1490.4,90,,,percent of total billed charges,90% of total billed charges,1490.4,90,,,percent of total billed charges,90% of total billed charges,1606.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1606.32,97,,,percent of total billed charges,97% of total billed charges,1242,75,,,percent of total billed charges,75% of total billed charges,1589.76,96,,,percent of total billed charges,96% of total billed charges,46.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1242,75,,,percent of total billed charges,75% of total billed charges,1242,75,,,percent of total billed charges,75% of total billed charges,46.59,1606.32,
ABDOMINAL PARACENTESIS DX/THER W/IMAGING GUIDANCE,78001497G,CDM,981,RC,49083,HCPCS,Outpatient,,,447,335.25,,411.24,92,,,percent of total billed charges,92% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,415.71,93,,,percent of total billed charges,93% of total billed charges,402.3,90,,,percent of total billed charges,90% of total billed charges,402.3,90,,,percent of total billed charges,90% of total billed charges,433.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,433.59,97,,,percent of total billed charges,97% of total billed charges,335.25,75,,,percent of total billed charges,75% of total billed charges,429.12,96,,,percent of total billed charges,96% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,335.25,75,,,percent of total billed charges,75% of total billed charges,335.25,75,,,percent of total billed charges,75% of total billed charges,9.02,433.59,
SPINAL PUNCTURE LUMBAR DIAGNOSTIC,78001703G,CDM,981,RC,62270,HCPCS,Outpatient,,,931,698.25,,856.52,92,,,percent of total billed charges,92% of total billed charges,9.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,865.83,93,,,percent of total billed charges,93% of total billed charges,837.9,90,,,percent of total billed charges,90% of total billed charges,837.9,90,,,percent of total billed charges,90% of total billed charges,903.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,903.07,97,,,percent of total billed charges,97% of total billed charges,698.25,75,,,percent of total billed charges,75% of total billed charges,893.76,96,,,percent of total billed charges,96% of total billed charges,9.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,698.25,75,,,percent of total billed charges,75% of total billed charges,698.25,75,,,percent of total billed charges,75% of total billed charges,9.51,903.07,
INJECTION ANES TRIGEMINAL NRV ANY DIV/BRANCH,78001720G,CDM,981,RC,64400,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges,7.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.35,93,,,percent of total billed charges,93% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,189.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.15,97,,,percent of total billed charges,97% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,187.2,96,,,percent of total billed charges,96% of total billed charges,7.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.25,75,,,percent of total billed charges,75% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,7.48,189.15,
INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE,78001722G,CDM,981,RC,64405,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.3,93,,,percent of total billed charges,93% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,203.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.7,97,,,percent of total billed charges,97% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,201.6,96,,,percent of total billed charges,96% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,157.5,75,,,percent of total billed charges,75% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,7.79,203.7,
INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE BILAT,78002806G,CDM,981,RC,64405,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,7.79,305.55,
ED INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,78001738G,CDM,981,RC,64450,HCPCS,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156.24,93,,,percent of total billed charges,93% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,162.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.96,97,,,percent of total billed charges,97% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,161.28,96,,,percent of total billed charges,96% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126,75,,,percent of total billed charges,75% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,3.88,162.96,
ED INJECTION ANES and /STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL,78001748G,CDM,981,RC,64483,HCPCS,Outpatient,,,293,219.75,,269.56,92,,,percent of total billed charges,92% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,272.49,93,,,percent of total billed charges,93% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,284.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.21,97,,,percent of total billed charges,97% of total billed charges,219.75,75,,,percent of total billed charges,75% of total billed charges,281.28,96,,,percent of total billed charges,96% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.75,75,,,percent of total billed charges,75% of total billed charges,219.75,75,,,percent of total billed charges,75% of total billed charges,8.7,284.21,
ED INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL,78001756G,CDM,981,RC,64490,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,386.88,93,,,percent of total billed charges,93% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,403.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.52,97,,,percent of total billed charges,97% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,399.36,96,,,percent of total billed charges,96% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312,75,,,percent of total billed charges,75% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,8.5,403.52,
INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 2ND LVL,78001758G,CDM,981,RC,64491,HCPCS,Outpatient,,,191,143.25,,175.72,92,,,percent of total billed charges,92% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.63,93,,,percent of total billed charges,93% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,185.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.27,97,,,percent of total billed charges,97% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,183.36,96,,,percent of total billed charges,96% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.25,75,,,percent of total billed charges,75% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,5.28,185.27,
REMOVAL FB EXTERNAL EYE CORNEAL W/SLIT LAMP,78001803G,CDM,981,RC,65222,HCPCS,Outpatient,,,201,150.75,,184.92,92,,,percent of total billed charges,92% of total billed charges,3.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.93,93,,,percent of total billed charges,93% of total billed charges,180.9,90,,,percent of total billed charges,90% of total billed charges,180.9,90,,,percent of total billed charges,90% of total billed charges,194.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194.97,97,,,percent of total billed charges,97% of total billed charges,150.75,75,,,percent of total billed charges,75% of total billed charges,192.96,96,,,percent of total billed charges,96% of total billed charges,3.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.75,75,,,percent of total billed charges,75% of total billed charges,150.75,75,,,percent of total billed charges,75% of total billed charges,3.07,194.97,
ED CANTHOTOMY INCISION OF EYELID FOLD,78002868G,CDM,981,RC,67715,HCPCS,Outpatient,,,215,161.25,,197.8,92,,,percent of total billed charges,92% of total billed charges,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,199.95,93,,,percent of total billed charges,93% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,208.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,208.55,97,,,percent of total billed charges,97% of total billed charges,161.25,75,,,percent of total billed charges,75% of total billed charges,206.4,96,,,percent of total billed charges,96% of total billed charges,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.25,75,,,percent of total billed charges,75% of total billed charges,161.25,75,,,percent of total billed charges,75% of total billed charges,8.03,208.55,
RMVL FB XTRNL AUDITORY CANAL W/O ANES,78001817G,CDM,981,RC,69200,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges,4.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.05,93,,,percent of total billed charges,93% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,179.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.45,97,,,percent of total billed charges,97% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,177.6,96,,,percent of total billed charges,96% of total billed charges,4.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,4.62,179.45,
REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,78001820G,CDM,981,RC,69210,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,3.29,84.39,
CARDIOPULMONARY RESUSCITATION,68500001G,CDM,981,RC,92950,HCPCS,Outpatient,,,732,549,,673.44,92,,,percent of total billed charges,92% of total billed charges,17.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,680.76,93,,,percent of total billed charges,93% of total billed charges,658.8,90,,,percent of total billed charges,90% of total billed charges,658.8,90,,,percent of total billed charges,90% of total billed charges,710.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,710.04,97,,,percent of total billed charges,97% of total billed charges,549,75,,,percent of total billed charges,75% of total billed charges,702.72,96,,,percent of total billed charges,96% of total billed charges,17.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,549,75,,,percent of total billed charges,75% of total billed charges,549,75,,,percent of total billed charges,75% of total billed charges,17.08,710.04,
TEMPORARY TRANSCUTANEOUS PACING,68500003G,CDM,981,RC,92953,HCPCS,Outpatient,,,4,3,,3.68,92,,,percent of total billed charges,92% of total billed charges,0.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3.72,93,,,percent of total billed charges,93% of total billed charges,3.6,90,,,percent of total billed charges,90% of total billed charges,3.6,90,,,percent of total billed charges,90% of total billed charges,3.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3.88,97,,,percent of total billed charges,97% of total billed charges,3,75,,,percent of total billed charges,75% of total billed charges,3.84,96,,,percent of total billed charges,96% of total billed charges,0.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3,75,,,percent of total billed charges,75% of total billed charges,3,75,,,percent of total billed charges,75% of total billed charges,0.31,3.88,
CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL,68500005G,CDM,981,RC,92960,HCPCS,Outpatient,,,428,321,,393.76,92,,,percent of total billed charges,92% of total billed charges,7.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,398.04,93,,,percent of total billed charges,93% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,415.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,415.16,97,,,percent of total billed charges,97% of total billed charges,321,75,,,percent of total billed charges,75% of total billed charges,410.88,96,,,percent of total billed charges,96% of total billed charges,7.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321,75,,,percent of total billed charges,75% of total billed charges,321,75,,,percent of total billed charges,75% of total billed charges,7.73,415.16,
CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX,68500007G,CDM,981,RC,92961,HCPCS,Outpatient,,,971,728.25,,893.32,92,,,percent of total billed charges,92% of total billed charges,34.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,903.03,93,,,percent of total billed charges,93% of total billed charges,873.9,90,,,percent of total billed charges,90% of total billed charges,873.9,90,,,percent of total billed charges,90% of total billed charges,941.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,34.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,941.87,97,,,percent of total billed charges,97% of total billed charges,728.25,75,,,percent of total billed charges,75% of total billed charges,932.16,96,,,percent of total billed charges,96% of total billed charges,34.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,728.25,75,,,percent of total billed charges,75% of total billed charges,728.25,75,,,percent of total billed charges,75% of total billed charges,34.29,941.87,
THROMBOLYSIS CORONARY INTRAVENOUS INFUSION,68500009G,CDM,981,RC,92977,HCPCS,Outpatient,,,207,155.25,,190.44,92,,,percent of total billed charges,92% of total billed charges,5.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,192.51,93,,,percent of total billed charges,93% of total billed charges,186.3,90,,,percent of total billed charges,90% of total billed charges,186.3,90,,,percent of total billed charges,90% of total billed charges,200.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,200.79,97,,,percent of total billed charges,97% of total billed charges,155.25,75,,,percent of total billed charges,75% of total billed charges,198.72,96,,,percent of total billed charges,96% of total billed charges,5.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,155.25,75,,,percent of total billed charges,75% of total billed charges,155.25,75,,,percent of total billed charges,75% of total billed charges,5.71,200.79,
ANOGENITAL CHILD/SUSPECT TRAUMA W IMAGING,68500023G,CDM,981,RC,99170,HCPCS,Outpatient,,,558,418.5,,513.36,92,,,percent of total billed charges,92% of total billed charges,6.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,518.94,93,,,percent of total billed charges,93% of total billed charges,502.2,90,,,percent of total billed charges,90% of total billed charges,502.2,90,,,percent of total billed charges,90% of total billed charges,541.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,541.26,97,,,percent of total billed charges,97% of total billed charges,418.5,75,,,percent of total billed charges,75% of total billed charges,535.68,96,,,percent of total billed charges,96% of total billed charges,6.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,418.5,75,,,percent of total billed charges,75% of total billed charges,418.5,75,,,percent of total billed charges,75% of total billed charges,6.14,541.26,
VISUAL ACUITY SCREENING BILAT,68500025G,CDM,981,RC,99173,HCPCS,Outpatient,,,74,55.5,,68.08,92,,,percent of total billed charges,92% of total billed charges,0.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,68.82,93,,,percent of total billed charges,93% of total billed charges,66.6,90,,,percent of total billed charges,90% of total billed charges,66.6,90,,,percent of total billed charges,90% of total billed charges,71.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.78,97,,,percent of total billed charges,97% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges,71.04,96,,,percent of total billed charges,96% of total billed charges,0.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,55.5,75,,,percent of total billed charges,75% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges,0.39,71.78,
PSYCHOTHERAPY PATIENT / FAMILY 30 MINUTES,78001829G,CDM,960,RC,90832,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.02,93,,,percent of total billed charges,93% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,110.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.58,97,,,percent of total billed charges,97% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,109.44,96,,,percent of total billed charges,96% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.5,75,,,percent of total billed charges,75% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,3.71,110.58,
PSYCHOTHERAPY PATIENT / FAMILY 60 MINUTES,78001835G,CDM,960,RC,90837,HCPCS,Outpatient,,,221,165.75,,203.32,92,,,percent of total billed charges,92% of total billed charges,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,205.53,93,,,percent of total billed charges,93% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,214.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.37,97,,,percent of total billed charges,97% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,212.16,96,,,percent of total billed charges,96% of total billed charges,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.75,75,,,percent of total billed charges,75% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,7.04,214.37,
PF MEDICAL TESTIMONY,78001887P,CDM,960,RC,99075,HCPCS,Outpatient,,,700,525,,644,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,651,93,,,percent of total billed charges,93% of total billed charges,630,90,,,percent of total billed charges,90% of total billed charges,630,90,,,percent of total billed charges,90% of total billed charges,679,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,679,97,,,percent of total billed charges,97% of total billed charges,525,75,,,percent of total billed charges,75% of total billed charges,672,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,525,75,,,percent of total billed charges,75% of total billed charges,525,75,,,percent of total billed charges,75% of total billed charges,525,679,
PF SPEC RPT(S) > USUAL MED COMUNICAJ/STAND RPRTG,78001888P,CDM,960,RC,99080,HCPCS,Outpatient,,,655,491.25,,602.6,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,609.15,93,,,percent of total billed charges,93% of total billed charges,589.5,90,,,percent of total billed charges,90% of total billed charges,589.5,90,,,percent of total billed charges,90% of total billed charges,635.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,635.35,97,,,percent of total billed charges,97% of total billed charges,491.25,75,,,percent of total billed charges,75% of total billed charges,628.8,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,491.25,75,,,percent of total billed charges,75% of total billed charges,491.25,75,,,percent of total billed charges,75% of total billed charges,491.25,635.35,
SPEC NEW PATIENT VISIT LEVEL 2,78001893,CDM,960,RC,,,Outpatient,,,119,89.25,,109.48,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,110.67,93,,,percent of total billed charges,93% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,115.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,115.43,97,,,percent of total billed charges,97% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,114.24,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,89.25,75,,,percent of total billed charges,75% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,89.25,115.43,
NEW PATIENT VISIT LEVEL 2,78001891,CDM,960,RC,99202,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,3.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,3.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,3.79,104.76,
NEW PATIENT VISIT LEVEL 3,78001895,CDM,960,RC,99203,HCPCS,Outpatient,,,146,109.5,,134.32,92,,,percent of total billed charges,92% of total billed charges,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.78,93,,,percent of total billed charges,93% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,141.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.62,97,,,percent of total billed charges,97% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,140.16,96,,,percent of total billed charges,96% of total billed charges,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,109.5,75,,,percent of total billed charges,75% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,7.15,141.62,
NEW PATIENT VISIT LEVEL 4,78001899,CDM,960,RC,99204,HCPCS,Outpatient,,,218,163.5,,200.56,92,,,percent of total billed charges,92% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,202.74,93,,,percent of total billed charges,93% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,211.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,211.46,97,,,percent of total billed charges,97% of total billed charges,163.5,75,,,percent of total billed charges,75% of total billed charges,209.28,96,,,percent of total billed charges,96% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.5,75,,,percent of total billed charges,75% of total billed charges,163.5,75,,,percent of total billed charges,75% of total billed charges,11.08,211.46,
NEW PATIENT VISIT LEVEL 4,78001899,CDM,960,RC,99204,HCPCS,Outpatient,,,218,163.5,,200.56,92,,,percent of total billed charges,92% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,202.74,93,,,percent of total billed charges,93% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,211.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,211.46,97,,,percent of total billed charges,97% of total billed charges,163.5,75,,,percent of total billed charges,75% of total billed charges,209.28,96,,,percent of total billed charges,96% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.5,75,,,percent of total billed charges,75% of total billed charges,163.5,75,,,percent of total billed charges,75% of total billed charges,11.08,211.46,
NEW PATIENT VISIT LEVEL 5,78001903,CDM,960,RC,99205,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges,15.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,267.84,93,,,percent of total billed charges,93% of total billed charges,259.2,90,,,percent of total billed charges,90% of total billed charges,259.2,90,,,percent of total billed charges,90% of total billed charges,279.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,279.36,97,,,percent of total billed charges,97% of total billed charges,216,75,,,percent of total billed charges,75% of total billed charges,276.48,96,,,percent of total billed charges,96% of total billed charges,15.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,216,75,,,percent of total billed charges,75% of total billed charges,216,75,,,percent of total billed charges,75% of total billed charges,15.17,279.36,
ESTABLISHED PATIENT VISIT LEVEL 1,78001907,CDM,960,RC,99211,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,32.55,93,,,percent of total billed charges,93% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,33.95,97,,,percent of total billed charges,97% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,33.6,96,,,percent of total billed charges,96% of total billed charges,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,0.57,33.95,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,960,RC,99212,HCPCS,Outpatient,,,84,63,,77.28,92,,,percent of total billed charges,92% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.12,93,,,percent of total billed charges,93% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,81.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.48,97,,,percent of total billed charges,97% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,80.64,96,,,percent of total billed charges,96% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63,75,,,percent of total billed charges,75% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,2.84,81.48,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,960,RC,99212,HCPCS,Outpatient,,,84,63,,77.28,92,,,percent of total billed charges,92% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.12,93,,,percent of total billed charges,93% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,81.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.48,97,,,percent of total billed charges,97% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,80.64,96,,,percent of total billed charges,96% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63,75,,,percent of total billed charges,75% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,2.84,81.48,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,960,RC,99212,HCPCS,Outpatient,,,84,63,,77.28,92,,,percent of total billed charges,92% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.12,93,,,percent of total billed charges,93% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,81.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.48,97,,,percent of total billed charges,97% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,80.64,96,,,percent of total billed charges,96% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63,75,,,percent of total billed charges,75% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,2.84,81.48,
ESTABLISHED PATIENT VISIT LEVEL 3,78001915,CDM,960,RC,99213,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges,4.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.6,93,,,percent of total billed charges,93% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,116.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.4,97,,,percent of total billed charges,97% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,115.2,96,,,percent of total billed charges,96% of total billed charges,4.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90,75,,,percent of total billed charges,75% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,4.97,116.4,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,960,RC,99214,HCPCS,Outpatient,,,166,124.5,,152.72,92,,,percent of total billed charges,92% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.38,93,,,percent of total billed charges,93% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,161.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.02,97,,,percent of total billed charges,97% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,159.36,96,,,percent of total billed charges,96% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,124.5,75,,,percent of total billed charges,75% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,7.12,161.02,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,960,RC,99214,HCPCS,Outpatient,,,166,124.5,,152.72,92,,,percent of total billed charges,92% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.38,93,,,percent of total billed charges,93% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,161.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.02,97,,,percent of total billed charges,97% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,159.36,96,,,percent of total billed charges,96% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,124.5,75,,,percent of total billed charges,75% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,7.12,161.02,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,960,RC,99214,HCPCS,Outpatient,,,166,124.5,,152.72,92,,,percent of total billed charges,92% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.38,93,,,percent of total billed charges,93% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,161.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.02,97,,,percent of total billed charges,97% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,159.36,96,,,percent of total billed charges,96% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,124.5,75,,,percent of total billed charges,75% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,7.12,161.02,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,960,RC,99215,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.6,93,,,percent of total billed charges,93% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,213.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.4,97,,,percent of total billed charges,97% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,211.2,96,,,percent of total billed charges,96% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165,75,,,percent of total billed charges,75% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,10.9,213.4,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,960,RC,99215,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.6,93,,,percent of total billed charges,93% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,213.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.4,97,,,percent of total billed charges,97% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,211.2,96,,,percent of total billed charges,96% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165,75,,,percent of total billed charges,75% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,10.9,213.4,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,960,RC,99215,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.6,93,,,percent of total billed charges,93% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,213.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.4,97,,,percent of total billed charges,97% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,211.2,96,,,percent of total billed charges,96% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165,75,,,percent of total billed charges,75% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,10.9,213.4,
PF INIT INPT CONSULT NEW/EST PT 20 MIN,78001931P,CDM,987,RC,99221,HCPCS,Outpatient,,,366,274.5,,336.72,92,,,percent of total billed charges,92% of total billed charges,7.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,340.38,93,,,percent of total billed charges,93% of total billed charges,329.4,90,,,percent of total billed charges,90% of total billed charges,329.4,90,,,percent of total billed charges,90% of total billed charges,355.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,355.02,97,,,percent of total billed charges,97% of total billed charges,274.5,75,,,percent of total billed charges,75% of total billed charges,351.36,96,,,percent of total billed charges,96% of total billed charges,7.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,274.5,75,,,percent of total billed charges,75% of total billed charges,274.5,75,,,percent of total billed charges,75% of total billed charges,7.71,355.02,
PF INIT INPT CONSULT NEW/EST PT 55 MIN,78001932P,CDM,987,RC,99222,HCPCS,Outpatient,,,493,369.75,,453.56,92,,,percent of total billed charges,92% of total billed charges,10.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,458.49,93,,,percent of total billed charges,93% of total billed charges,443.7,90,,,percent of total billed charges,90% of total billed charges,443.7,90,,,percent of total billed charges,90% of total billed charges,478.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,478.21,97,,,percent of total billed charges,97% of total billed charges,369.75,75,,,percent of total billed charges,75% of total billed charges,473.28,96,,,percent of total billed charges,96% of total billed charges,10.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,369.75,75,,,percent of total billed charges,75% of total billed charges,369.75,75,,,percent of total billed charges,75% of total billed charges,10.7,478.21,
PF INIT INPT CONSULT NEW/EST PT 80 MIN,78001933P,CDM,987,RC,99223,HCPCS,Outpatient,,,723,542.25,,665.16,92,,,percent of total billed charges,92% of total billed charges,12.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,672.39,93,,,percent of total billed charges,93% of total billed charges,650.7,90,,,percent of total billed charges,90% of total billed charges,650.7,90,,,percent of total billed charges,90% of total billed charges,701.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,701.31,97,,,percent of total billed charges,97% of total billed charges,542.25,75,,,percent of total billed charges,75% of total billed charges,694.08,96,,,percent of total billed charges,96% of total billed charges,12.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,542.25,75,,,percent of total billed charges,75% of total billed charges,542.25,75,,,percent of total billed charges,75% of total billed charges,12.97,701.31,
PF SBSQ HOSP CARE/DAY 15 MIN,78001937P,CDM,987,RC,99231,HCPCS,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,4.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,4.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,4.13,97.97,
PF SBSQ HOSP CARE/DAY 25 MIN,78001938P,CDM,987,RC,99232,HCPCS,Outpatient,,,188,141,,172.96,92,,,percent of total billed charges,92% of total billed charges,5.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,174.84,93,,,percent of total billed charges,93% of total billed charges,169.2,90,,,percent of total billed charges,90% of total billed charges,169.2,90,,,percent of total billed charges,90% of total billed charges,182.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,182.36,97,,,percent of total billed charges,97% of total billed charges,141,75,,,percent of total billed charges,75% of total billed charges,180.48,96,,,percent of total billed charges,96% of total billed charges,5.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141,75,,,percent of total billed charges,75% of total billed charges,141,75,,,percent of total billed charges,75% of total billed charges,5.95,182.36,
PF SBSQ HOSP CARE/DAY 35 MIN,78001939P,CDM,987,RC,99233,HCPCS,Outpatient,,,270,202.5,,248.4,92,,,percent of total billed charges,92% of total billed charges,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,251.1,93,,,percent of total billed charges,93% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,261.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,261.9,97,,,percent of total billed charges,97% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,259.2,96,,,percent of total billed charges,96% of total billed charges,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,202.5,75,,,percent of total billed charges,75% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,8.93,261.9,
PF OBSERVATION OR IP CARE 40 MIN PER DAY,78001940P,CDM,960,RC,99234,HCPCS,Outpatient,,,475,356.25,,437,92,,,percent of total billed charges,92% of total billed charges,7.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,441.75,93,,,percent of total billed charges,93% of total billed charges,427.5,90,,,percent of total billed charges,90% of total billed charges,427.5,90,,,percent of total billed charges,90% of total billed charges,460.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,460.75,97,,,percent of total billed charges,97% of total billed charges,356.25,75,,,percent of total billed charges,75% of total billed charges,456,96,,,percent of total billed charges,96% of total billed charges,7.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,356.25,75,,,percent of total billed charges,75% of total billed charges,356.25,75,,,percent of total billed charges,75% of total billed charges,7.95,460.75,
PF OBSERVATION/ADMIT/DC COMPREHENSIVE,78001941P,CDM,987,RC,99235,HCPCS,Outpatient,,,393,294.75,,361.56,92,,,percent of total billed charges,92% of total billed charges,11.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,365.49,93,,,percent of total billed charges,93% of total billed charges,353.7,90,,,percent of total billed charges,90% of total billed charges,353.7,90,,,percent of total billed charges,90% of total billed charges,381.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,381.21,97,,,percent of total billed charges,97% of total billed charges,294.75,75,,,percent of total billed charges,75% of total billed charges,377.28,96,,,percent of total billed charges,96% of total billed charges,11.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,294.75,75,,,percent of total billed charges,75% of total billed charges,294.75,75,,,percent of total billed charges,75% of total billed charges,11.95,381.21,
PF OBSERVATION/ADMIT/DC COMPLEX,78001942P,CDM,987,RC,99236,HCPCS,Outpatient,,,772,579,,710.24,92,,,percent of total billed charges,92% of total billed charges,15.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717.96,93,,,percent of total billed charges,93% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,748.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,748.84,97,,,percent of total billed charges,97% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,741.12,96,,,percent of total billed charges,96% of total billed charges,15.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,579,75,,,percent of total billed charges,75% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,15.79,748.84,
PF HOSP DC DAY MGMT 30 MIN/<,78001943P,CDM,987,RC,99238,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,5.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,5.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,5.76,255.11,
PF HOSP DC DAY MGMT > 30 MIN,78001944P,CDM,987,RC,99239,HCPCS,Outpatient,,,384,288,,353.28,92,,,percent of total billed charges,92% of total billed charges,7.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,357.12,93,,,percent of total billed charges,93% of total billed charges,345.6,90,,,percent of total billed charges,90% of total billed charges,345.6,90,,,percent of total billed charges,90% of total billed charges,372.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,372.48,97,,,percent of total billed charges,97% of total billed charges,288,75,,,percent of total billed charges,75% of total billed charges,368.64,96,,,percent of total billed charges,96% of total billed charges,7.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288,75,,,percent of total billed charges,75% of total billed charges,288,75,,,percent of total billed charges,75% of total billed charges,7.98,372.48,
OFFICE CONSULTATION NEW/EST PAT 30 MIN,78001947,CDM,988,RC,99242,HCPCS,Outpatient,,,176,132,,161.92,92,,,percent of total billed charges,92% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.68,93,,,percent of total billed charges,93% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,170.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,170.72,97,,,percent of total billed charges,97% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,168.96,96,,,percent of total billed charges,96% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132,75,,,percent of total billed charges,75% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,3.81,170.72,
PATIENT OFFICE CONSULTATION  TYPICALLY 40 MINUTES,78001949,CDM,988,RC,99243,HCPCS,Outpatient,,,177,132.75,,162.84,92,,,percent of total billed charges,92% of total billed charges,6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.61,93,,,percent of total billed charges,93% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,171.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,171.69,97,,,percent of total billed charges,97% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,169.92,96,,,percent of total billed charges,96% of total billed charges,6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.75,75,,,percent of total billed charges,75% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,6,171.69,
OFFICE CONSULTATION NEW/EST PAT 60 MIN,78001951,CDM,988,RC,99244,HCPCS,Outpatient,,,264,198,,242.88,92,,,percent of total billed charges,92% of total billed charges,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.52,93,,,percent of total billed charges,93% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,256.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,256.08,97,,,percent of total billed charges,97% of total billed charges,198,75,,,percent of total billed charges,75% of total billed charges,253.44,96,,,percent of total billed charges,96% of total billed charges,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,198,75,,,percent of total billed charges,75% of total billed charges,198,75,,,percent of total billed charges,75% of total billed charges,8.93,256.08,
OFFICE CONSULTATION NEW/EST PAT 60 MIN,78001951G,CDM,988,RC,99244,HCPCS,Outpatient,,,264,198,,242.88,92,,,percent of total billed charges,92% of total billed charges,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.52,93,,,percent of total billed charges,93% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,256.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,256.08,97,,,percent of total billed charges,97% of total billed charges,198,75,,,percent of total billed charges,75% of total billed charges,253.44,96,,,percent of total billed charges,96% of total billed charges,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,198,75,,,percent of total billed charges,75% of total billed charges,198,75,,,percent of total billed charges,75% of total billed charges,8.93,256.08,
OFFICE CONSULTATION NEW/EST PAT 80 MIN,78001953,CDM,988,RC,99245,HCPCS,Outpatient,,,322,241.5,,296.24,92,,,percent of total billed charges,92% of total billed charges,12.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,299.46,93,,,percent of total billed charges,93% of total billed charges,289.8,90,,,percent of total billed charges,90% of total billed charges,289.8,90,,,percent of total billed charges,90% of total billed charges,312.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312.34,97,,,percent of total billed charges,97% of total billed charges,241.5,75,,,percent of total billed charges,75% of total billed charges,309.12,96,,,percent of total billed charges,96% of total billed charges,12.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,241.5,75,,,percent of total billed charges,75% of total billed charges,241.5,75,,,percent of total billed charges,75% of total billed charges,12.41,312.34,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 40 MIN,78001956P,CDM,988,RC,99252,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges,4.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.56,93,,,percent of total billed charges,93% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,186.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.24,97,,,percent of total billed charges,97% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,184.32,96,,,percent of total billed charges,96% of total billed charges,4.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144,75,,,percent of total billed charges,75% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,4.87,186.24,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 55 MIN,78001957P,CDM,988,RC,99253,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,6.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,6.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,6.66,289.06,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 80 MIN,78001958P,CDM,988,RC,99254,HCPCS,Outpatient,,,430,322.5,,395.6,92,,,percent of total billed charges,92% of total billed charges,9.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,399.9,93,,,percent of total billed charges,93% of total billed charges,387,90,,,percent of total billed charges,90% of total billed charges,387,90,,,percent of total billed charges,90% of total billed charges,417.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,417.1,97,,,percent of total billed charges,97% of total billed charges,322.5,75,,,percent of total billed charges,75% of total billed charges,412.8,96,,,percent of total billed charges,96% of total billed charges,9.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,322.5,75,,,percent of total billed charges,75% of total billed charges,322.5,75,,,percent of total billed charges,75% of total billed charges,9.07,417.1,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 110 MIN,78001959P,CDM,988,RC,99255,HCPCS,Outpatient,,,519,389.25,,477.48,92,,,percent of total billed charges,92% of total billed charges,12.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,482.67,93,,,percent of total billed charges,93% of total billed charges,467.1,90,,,percent of total billed charges,90% of total billed charges,467.1,90,,,percent of total billed charges,90% of total billed charges,503.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,503.43,97,,,percent of total billed charges,97% of total billed charges,389.25,75,,,percent of total billed charges,75% of total billed charges,498.24,96,,,percent of total billed charges,96% of total billed charges,12.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,389.25,75,,,percent of total billed charges,75% of total billed charges,389.25,75,,,percent of total billed charges,75% of total billed charges,12.6,503.43,
PF NURSING FACILITY CARE/DAY E/M STABLE 10 MIN,78001960P,CDM,987,RC,99307,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges,2.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.15,93,,,percent of total billed charges,93% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,150.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.35,97,,,percent of total billed charges,97% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,148.8,96,,,percent of total billed charges,96% of total billed charges,2.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,75,,,percent of total billed charges,75% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,2.74,150.35,
PF SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN,78001961P,CDM,987,RC,99308,HCPCS,Outpatient,,,240,180,,220.8,92,,,percent of total billed charges,92% of total billed charges,5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.2,93,,,percent of total billed charges,93% of total billed charges,216,90,,,percent of total billed charges,90% of total billed charges,216,90,,,percent of total billed charges,90% of total billed charges,232.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,232.8,97,,,percent of total billed charges,97% of total billed charges,180,75,,,percent of total billed charges,75% of total billed charges,230.4,96,,,percent of total billed charges,96% of total billed charges,5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180,75,,,percent of total billed charges,75% of total billed charges,180,75,,,percent of total billed charges,75% of total billed charges,5,232.8,
PF SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN,78001962P,CDM,987,RC,99309,HCPCS,Outpatient,,,316,237,,290.72,92,,,percent of total billed charges,92% of total billed charges,7.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,293.88,93,,,percent of total billed charges,93% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,306.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.52,97,,,percent of total billed charges,97% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,303.36,96,,,percent of total billed charges,96% of total billed charges,7.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237,75,,,percent of total billed charges,75% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,7.22,306.52,
PF HOME HEALTH VISIT EST COMPREHENSIVE 60 MIN,78001967P,CDM,960,RC,99350,HCPCS,Outpatient,,,369,276.75,,339.48,92,,,percent of total billed charges,92% of total billed charges,12.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.17,93,,,percent of total billed charges,93% of total billed charges,332.1,90,,,percent of total billed charges,90% of total billed charges,332.1,90,,,percent of total billed charges,90% of total billed charges,357.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,357.93,97,,,percent of total billed charges,97% of total billed charges,276.75,75,,,percent of total billed charges,75% of total billed charges,354.24,96,,,percent of total billed charges,96% of total billed charges,12.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,276.75,75,,,percent of total billed charges,75% of total billed charges,276.75,75,,,percent of total billed charges,75% of total billed charges,12.86,357.93,
INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS,78001976,CDM,960,RC,99383,HCPCS,Outpatient,,,176,132,,161.92,92,,,percent of total billed charges,92% of total billed charges,5.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.68,93,,,percent of total billed charges,93% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,170.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,170.72,97,,,percent of total billed charges,97% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,168.96,96,,,percent of total billed charges,96% of total billed charges,5.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132,75,,,percent of total billed charges,75% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,5.54,170.72,
PERIODIC PREVENTIVE MED EST PAT 40-64YRS,78001996,CDM,983,RC,99396,HCPCS,Outpatient,,,186,139.5,,171.12,92,,,percent of total billed charges,92% of total billed charges,6.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.98,93,,,percent of total billed charges,93% of total billed charges,167.4,90,,,percent of total billed charges,90% of total billed charges,167.4,90,,,percent of total billed charges,90% of total billed charges,180.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.42,97,,,percent of total billed charges,97% of total billed charges,139.5,75,,,percent of total billed charges,75% of total billed charges,178.56,96,,,percent of total billed charges,96% of total billed charges,6.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,139.5,75,,,percent of total billed charges,75% of total billed charges,139.5,75,,,percent of total billed charges,75% of total billed charges,6.43,180.42,
PF INIT HOSP/BIRTH CTR CARE E/M NORMAL NB,78002011P,CDM,960,RC,99460,HCPCS,Outpatient,,,332,249,,305.44,92,,,percent of total billed charges,92% of total billed charges,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,308.76,93,,,percent of total billed charges,93% of total billed charges,298.8,90,,,percent of total billed charges,90% of total billed charges,298.8,90,,,percent of total billed charges,90% of total billed charges,322.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,322.04,97,,,percent of total billed charges,97% of total billed charges,249,75,,,percent of total billed charges,75% of total billed charges,318.72,96,,,percent of total billed charges,96% of total billed charges,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249,75,,,percent of total billed charges,75% of total billed charges,249,75,,,percent of total billed charges,75% of total billed charges,6.69,322.04,
PF SUBSQ HOSP CARE PER DAY E/M NORMAL NB,78002012P,CDM,960,RC,99462,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges,3.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,140.43,93,,,percent of total billed charges,93% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,146.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.47,97,,,percent of total billed charges,97% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,144.96,96,,,percent of total billed charges,96% of total billed charges,3.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,113.25,75,,,percent of total billed charges,75% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,3.02,146.47,
PF INIT HOSP/BIRTH CTR CARE E/M NORMAL NB ADM/DC,78002013P,CDM,960,RC,99463,HCPCS,Outpatient,,,242,181.5,,222.64,92,,,percent of total billed charges,92% of total billed charges,7.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,225.06,93,,,percent of total billed charges,93% of total billed charges,217.8,90,,,percent of total billed charges,90% of total billed charges,217.8,90,,,percent of total billed charges,90% of total billed charges,234.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,234.74,97,,,percent of total billed charges,97% of total billed charges,181.5,75,,,percent of total billed charges,75% of total billed charges,232.32,96,,,percent of total billed charges,96% of total billed charges,7.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.5,75,,,percent of total billed charges,75% of total billed charges,181.5,75,,,percent of total billed charges,75% of total billed charges,7.76,234.74,
DELIVERY/BIRTHING ROOM RESUSCITATION,78002014,CDM,960,RC,99465,HCPCS,Outpatient,,,686,514.5,,631.12,92,,,percent of total billed charges,92% of total billed charges,10.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,637.98,93,,,percent of total billed charges,93% of total billed charges,617.4,90,,,percent of total billed charges,90% of total billed charges,617.4,90,,,percent of total billed charges,90% of total billed charges,665.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,665.42,97,,,percent of total billed charges,97% of total billed charges,514.5,75,,,percent of total billed charges,75% of total billed charges,658.56,96,,,percent of total billed charges,96% of total billed charges,10.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,514.5,75,,,percent of total billed charges,75% of total billed charges,514.5,75,,,percent of total billed charges,75% of total billed charges,10.27,665.42,
ALCOHOL OR SUBSTANCE MISUSE ASSESSMENT 15-30MIN,78002070,CDM,960,RC,,,Outpatient,,,53,39.75,,48.76,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,49.29,93,,,percent of total billed charges,93% of total billed charges,47.7,90,,,percent of total billed charges,90% of total billed charges,47.7,90,,,percent of total billed charges,90% of total billed charges,51.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,51.41,97,,,percent of total billed charges,97% of total billed charges,39.75,75,,,percent of total billed charges,75% of total billed charges,50.88,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,39.75,75,,,percent of total billed charges,75% of total billed charges,39.75,75,,,percent of total billed charges,75% of total billed charges,39.75,51.41,
ALCOHOL OR SUBSTANCE MISUSE ASSESSMENT 30+ MIN,78002072,CDM,960,RC,,,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,97.97,
PF CONSCIOUS SEDATION SAME MD 5+ YRS INIT 15 MIN,68500013P,CDM,964,RC,1992,HCPCS,Outpatient,,,591,443.25,,543.72,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,549.63,93,,,percent of total billed charges,93% of total billed charges,531.9,90,,,percent of total billed charges,90% of total billed charges,531.9,90,,,percent of total billed charges,90% of total billed charges,573.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,573.27,97,,,percent of total billed charges,97% of total billed charges,443.25,75,,,percent of total billed charges,75% of total billed charges,567.36,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,443.25,75,,,percent of total billed charges,75% of total billed charges,443.25,75,,,percent of total billed charges,75% of total billed charges,443.25,573.27,
PF CONSCIOUS SEDATION SAME MD EA ADDL 15 MIN,68500015P,CDM,964,RC,1992,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,39.06,93,,,percent of total billed charges,93% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,40.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.74,97,,,percent of total billed charges,97% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,40.32,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,31.5,75,,,percent of total billed charges,75% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,31.5,40.74,
PF DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMIN,78200001P,CDM,960,RC,1996,HCPCS,Outpatient,,,677,507.75,,622.84,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,629.61,93,,,percent of total billed charges,93% of total billed charges,609.3,90,,,percent of total billed charges,90% of total billed charges,609.3,90,,,percent of total billed charges,90% of total billed charges,656.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,656.69,97,,,percent of total billed charges,97% of total billed charges,507.75,75,,,percent of total billed charges,75% of total billed charges,649.92,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,507.75,75,,,percent of total billed charges,75% of total billed charges,507.75,75,,,percent of total billed charges,75% of total billed charges,507.75,656.69,
INJECTION INTRALESIONAL UP TO & INCLUD 7 LESION (TC/PC),78000156G,CDM,960,RC,11900,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.61,93,,,percent of total billed charges,93% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,74.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.69,97,,,percent of total billed charges,97% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,73.92,96,,,percent of total billed charges,96% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.75,75,,,percent of total billed charges,75% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,2.65,74.69,
INJECTION THERAPEUTIC CARPAL TUNNEL (TC/PC),78000346G,CDM,960,RC,20526,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,6.57,201.76,
INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS (TC/PC),78000348G,CDM,960,RC,20550,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,95.79,93,,,percent of total billed charges,93% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,99.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,99.91,97,,,percent of total billed charges,97% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges,98.88,96,,,percent of total billed charges,96% of total billed charges,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,77.25,75,,,percent of total billed charges,75% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges,4.05,99.91,
INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES (TC/PC),78000352G,CDM,960,RC,20552,HCPCS,Outpatient,,,152,114,,139.84,92,,,percent of total billed charges,92% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.36,93,,,percent of total billed charges,93% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,147.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.44,97,,,percent of total billed charges,97% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,145.92,96,,,percent of total billed charges,96% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,114,75,,,percent of total billed charges,75% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,3.44,147.44,
PF INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,78000352P,CDM,960,RC,20552,HCPCS,Outpatient,,,152,114,,139.84,92,,,percent of total billed charges,92% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.36,93,,,percent of total billed charges,93% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,147.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.44,97,,,percent of total billed charges,97% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,145.92,96,,,percent of total billed charges,96% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,114,75,,,percent of total billed charges,75% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,3.44,147.44,
INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES (TC/PC),78000354G,CDM,960,RC,20553,HCPCS,Outpatient,,,170,127.5,,156.4,92,,,percent of total billed charges,92% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.1,93,,,percent of total billed charges,93% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,164.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.9,97,,,percent of total billed charges,97% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,163.2,96,,,percent of total billed charges,96% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.5,75,,,percent of total billed charges,75% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,3.88,164.9,
ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US BILAT (TC/PC,78000358G,CDM,960,RC,20600,HCPCS,Outpatient,,,213,159.75,,195.96,92,,,percent of total billed charges,92% of total billed charges,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,198.09,93,,,percent of total billed charges,93% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,206.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,206.61,97,,,percent of total billed charges,97% of total billed charges,159.75,75,,,percent of total billed charges,75% of total billed charges,204.48,96,,,percent of total billed charges,96% of total billed charges,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,159.75,75,,,percent of total billed charges,75% of total billed charges,159.75,75,,,percent of total billed charges,75% of total billed charges,3.67,206.61,
ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US (TC/PC),78000356G,CDM,960,RC,20600,HCPCS,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.06,93,,,percent of total billed charges,93% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,137.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,137.74,97,,,percent of total billed charges,97% of total billed charges,106.5,75,,,percent of total billed charges,75% of total billed charges,136.32,96,,,percent of total billed charges,96% of total billed charges,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.5,75,,,percent of total billed charges,75% of total billed charges,106.5,75,,,percent of total billed charges,75% of total billed charges,3.67,137.74,
ARTHROCENTESIS ASPIR&/INJ SML JT/BURSAW/US REC RPRT (TC/PC),78000360G,CDM,960,RC,20604,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.33,93,,,percent of total billed charges,93% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,175.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.57,97,,,percent of total billed charges,97% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,173.76,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.75,75,,,percent of total billed charges,75% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,4.28,175.57,
ARTHROCENTESIS ASPIR&/INJ SML JT/BUR/US REC RPRT BIL (TC/PC),78002269G,CDM,960,RC,20604,HCPCS,Outpatient,,,271,203.25,,249.32,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,252.03,93,,,percent of total billed charges,93% of total billed charges,243.9,90,,,percent of total billed charges,90% of total billed charges,243.9,90,,,percent of total billed charges,90% of total billed charges,262.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,262.87,97,,,percent of total billed charges,97% of total billed charges,203.25,75,,,percent of total billed charges,75% of total billed charges,260.16,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.25,75,,,percent of total billed charges,75% of total billed charges,203.25,75,,,percent of total billed charges,75% of total billed charges,4.28,262.87,
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US BILAT (TC/PC,78000364G,CDM,960,RC,20605,HCPCS,Outpatient,,,221,165.75,,203.32,92,,,percent of total billed charges,92% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,205.53,93,,,percent of total billed charges,93% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,214.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.37,97,,,percent of total billed charges,97% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,212.16,96,,,percent of total billed charges,96% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.75,75,,,percent of total billed charges,75% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,3.71,214.37,
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US (TC/PC),78000362G,CDM,960,RC,20605,HCPCS,Outpatient,,,147,110.25,,135.24,92,,,percent of total billed charges,92% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,136.71,93,,,percent of total billed charges,93% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,142.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.59,97,,,percent of total billed charges,97% of total billed charges,110.25,75,,,percent of total billed charges,75% of total billed charges,141.12,96,,,percent of total billed charges,96% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.25,75,,,percent of total billed charges,75% of total billed charges,110.25,75,,,percent of total billed charges,75% of total billed charges,3.71,142.59,
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US (TC/PC),78000366G,CDM,960,RC,20606,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,5.31,201.76,
ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US BIL (TC/PC),78002271G,CDM,960,RC,20606,HCPCS,Outpatient,,,312,234,,287.04,92,,,percent of total billed charges,92% of total billed charges,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,290.16,93,,,percent of total billed charges,93% of total billed charges,280.8,90,,,percent of total billed charges,90% of total billed charges,280.8,90,,,percent of total billed charges,90% of total billed charges,302.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,302.64,97,,,percent of total billed charges,97% of total billed charges,234,75,,,percent of total billed charges,75% of total billed charges,299.52,96,,,percent of total billed charges,96% of total billed charges,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,234,75,,,percent of total billed charges,75% of total billed charges,234,75,,,percent of total billed charges,75% of total billed charges,5.31,302.64,
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US BIL (TC/PC),78000370G,CDM,960,RC,20610,HCPCS,Outpatient,,,271,203.25,,249.32,92,,,percent of total billed charges,92% of total billed charges,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,252.03,93,,,percent of total billed charges,93% of total billed charges,243.9,90,,,percent of total billed charges,90% of total billed charges,243.9,90,,,percent of total billed charges,90% of total billed charges,262.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,262.87,97,,,percent of total billed charges,97% of total billed charges,203.25,75,,,percent of total billed charges,75% of total billed charges,260.16,96,,,percent of total billed charges,96% of total billed charges,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.25,75,,,percent of total billed charges,75% of total billed charges,203.25,75,,,percent of total billed charges,75% of total billed charges,5.09,262.87,
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US (TC/PC),78000368G,CDM,960,RC,20610,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.33,93,,,percent of total billed charges,93% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,175.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.57,97,,,percent of total billed charges,97% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,173.76,96,,,percent of total billed charges,96% of total billed charges,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.75,75,,,percent of total billed charges,75% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,5.09,175.57,
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US (TC/PC),78000372G,CDM,960,RC,20611,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.48,93,,,percent of total billed charges,93% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,228.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.92,97,,,percent of total billed charges,97% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,226.56,96,,,percent of total billed charges,96% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177,75,,,percent of total billed charges,75% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,6.09,228.92,
ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US BIL (TC/PC),78002273G,CDM,960,RC,20611,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,6.09,343.38,
INJECTION SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA (TC/PC),78000764G,CDM,960,RC,27096,HCPCS,Outpatient,,,246,184.5,,226.32,92,,,percent of total billed charges,92% of total billed charges,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.78,93,,,percent of total billed charges,93% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,238.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,238.62,97,,,percent of total billed charges,97% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges,236.16,96,,,percent of total billed charges,96% of total billed charges,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.5,75,,,percent of total billed charges,75% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges,6.64,238.62,
INJECTION SI JOINT ARTHRY&/ANES/STEROID W/IMA BIL (TC/PC),78000766G,CDM,960,RC,27096,HCPCS,Outpatient,,,369,276.75,,339.48,92,,,percent of total billed charges,92% of total billed charges,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.17,93,,,percent of total billed charges,93% of total billed charges,332.1,90,,,percent of total billed charges,90% of total billed charges,332.1,90,,,percent of total billed charges,90% of total billed charges,357.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,357.93,97,,,percent of total billed charges,97% of total billed charges,276.75,75,,,percent of total billed charges,75% of total billed charges,354.24,96,,,percent of total billed charges,96% of total billed charges,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,276.75,75,,,percent of total billed charges,75% of total billed charges,276.75,75,,,percent of total billed charges,75% of total billed charges,6.64,357.93,
INJECTION DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN (TC/PC),78001709G,CDM,960,RC,62320,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,10.21,255.11,
INJECTION DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN (TC/PC),78001711G,CDM,960,RC,62321,HCPCS,Outpatient,,,424,318,,390.08,92,,,percent of total billed charges,92% of total billed charges,8.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,394.32,93,,,percent of total billed charges,93% of total billed charges,381.6,90,,,percent of total billed charges,90% of total billed charges,381.6,90,,,percent of total billed charges,90% of total billed charges,411.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.28,97,,,percent of total billed charges,97% of total billed charges,318,75,,,percent of total billed charges,75% of total billed charges,407.04,96,,,percent of total billed charges,96% of total billed charges,8.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,318,75,,,percent of total billed charges,75% of total billed charges,318,75,,,percent of total billed charges,75% of total billed charges,8.84,411.28,
62322 NJX Interlaminar Lumbar or Sacral - Profee,78001713P,CDM,960,RC,62322,HCPCS,Outpatient,,,213,159.75,,195.96,92,,,percent of total billed charges,92% of total billed charges,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,198.09,93,,,percent of total billed charges,93% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,206.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,206.61,97,,,percent of total billed charges,97% of total billed charges,159.75,75,,,percent of total billed charges,75% of total billed charges,204.48,96,,,percent of total billed charges,96% of total billed charges,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,159.75,75,,,percent of total billed charges,75% of total billed charges,159.75,75,,,percent of total billed charges,75% of total billed charges,7.33,206.61,
INJECTION DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN (TC/PC),78001715G,CDM,960,RC,62323,HCPCS,Outpatient,,,262,196.5,,241.04,92,,,percent of total billed charges,92% of total billed charges,8.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,243.66,93,,,percent of total billed charges,93% of total billed charges,235.8,90,,,percent of total billed charges,90% of total billed charges,235.8,90,,,percent of total billed charges,90% of total billed charges,254.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,254.14,97,,,percent of total billed charges,97% of total billed charges,196.5,75,,,percent of total billed charges,75% of total billed charges,251.52,96,,,percent of total billed charges,96% of total billed charges,8.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,196.5,75,,,percent of total billed charges,75% of total billed charges,196.5,75,,,percent of total billed charges,75% of total billed charges,8.29,254.14,
62324 NJX Interlaminar Cervical Thoracic - Profee,78002160P,CDM,960,RC,62324,HCPCS,Outpatient,,,277,207.75,,254.84,92,,,percent of total billed charges,92% of total billed charges,7.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,257.61,93,,,percent of total billed charges,93% of total billed charges,249.3,90,,,percent of total billed charges,90% of total billed charges,249.3,90,,,percent of total billed charges,90% of total billed charges,268.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,268.69,97,,,percent of total billed charges,97% of total billed charges,207.75,75,,,percent of total billed charges,75% of total billed charges,265.92,96,,,percent of total billed charges,96% of total billed charges,7.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,207.75,75,,,percent of total billed charges,75% of total billed charges,207.75,75,,,percent of total billed charges,75% of total billed charges,7.38,268.69,
INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE (TC/PC),78001722G,CDM,960,RC,64405,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.3,93,,,percent of total billed charges,93% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,203.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.7,97,,,percent of total billed charges,97% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,201.6,96,,,percent of total billed charges,96% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,157.5,75,,,percent of total billed charges,75% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,7.79,203.7,
INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE (TC/PC),78001726G,CDM,960,RC,64418,HCPCS,Outpatient,,,148,111,,136.16,92,,,percent of total billed charges,92% of total billed charges,5.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,137.64,93,,,percent of total billed charges,93% of total billed charges,133.2,90,,,percent of total billed charges,90% of total billed charges,133.2,90,,,percent of total billed charges,90% of total billed charges,143.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.56,97,,,percent of total billed charges,97% of total billed charges,111,75,,,percent of total billed charges,75% of total billed charges,142.08,96,,,percent of total billed charges,96% of total billed charges,5.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111,75,,,percent of total billed charges,75% of total billed charges,111,75,,,percent of total billed charges,75% of total billed charges,5.15,143.56,
INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE (TC/PC),78001728G,CDM,960,RC,64420,HCPCS,Outpatient,,,156,117,,143.52,92,,,percent of total billed charges,92% of total billed charges,4.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,145.08,93,,,percent of total billed charges,93% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,151.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,151.32,97,,,percent of total billed charges,97% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,149.76,96,,,percent of total billed charges,96% of total billed charges,4.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117,75,,,percent of total billed charges,75% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,4.7,151.32,
MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES (TC/PC),78001730G,CDM,960,RC,64421,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges,2.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.38,93,,,percent of total billed charges,93% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,64.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.02,97,,,percent of total billed charges,97% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,63.36,96,,,percent of total billed charges,96% of total billed charges,2.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.5,75,,,percent of total billed charges,75% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,2.21,64.02,
INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRV (TC/PC),78001732G,CDM,960,RC,64425,HCPCS,Outpatient,,,145,108.75,,133.4,92,,,percent of total billed charges,92% of total billed charges,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,134.85,93,,,percent of total billed charges,93% of total billed charges,130.5,90,,,percent of total billed charges,90% of total billed charges,130.5,90,,,percent of total billed charges,90% of total billed charges,140.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,140.65,97,,,percent of total billed charges,97% of total billed charges,108.75,75,,,percent of total billed charges,75% of total billed charges,139.2,96,,,percent of total billed charges,96% of total billed charges,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,108.75,75,,,percent of total billed charges,75% of total billed charges,108.75,75,,,percent of total billed charges,75% of total billed charges,4.58,140.65,
INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE (TC/PC),78001736G,CDM,960,RC,64445,HCPCS,Outpatient,,,141,105.75,,129.72,92,,,percent of total billed charges,92% of total billed charges,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.13,93,,,percent of total billed charges,93% of total billed charges,126.9,90,,,percent of total billed charges,90% of total billed charges,126.9,90,,,percent of total billed charges,90% of total billed charges,136.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,136.77,97,,,percent of total billed charges,97% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges,135.36,96,,,percent of total billed charges,96% of total billed charges,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,105.75,75,,,percent of total billed charges,75% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges,6.26,136.77,
INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH (TC/PC),78001738G,CDM,960,RC,64450,HCPCS,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156.24,93,,,percent of total billed charges,93% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,162.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.96,97,,,percent of total billed charges,97% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,161.28,96,,,percent of total billed charges,96% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126,75,,,percent of total billed charges,75% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,3.88,162.96,
PF INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE,78001722P,CDM,960,RC,64450,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.3,93,,,percent of total billed charges,93% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,203.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.7,97,,,percent of total billed charges,97% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,201.6,96,,,percent of total billed charges,96% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,157.5,75,,,percent of total billed charges,75% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,3.88,203.7,
INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG (TC/PC),78001740G,CDM,960,RC,64451,HCPCS,Outpatient,,,292,219,,268.64,92,,,percent of total billed charges,92% of total billed charges,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,271.56,93,,,percent of total billed charges,93% of total billed charges,262.8,90,,,percent of total billed charges,90% of total billed charges,262.8,90,,,percent of total billed charges,90% of total billed charges,283.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,283.24,97,,,percent of total billed charges,97% of total billed charges,219,75,,,percent of total billed charges,75% of total billed charges,280.32,96,,,percent of total billed charges,96% of total billed charges,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219,75,,,percent of total billed charges,75% of total billed charges,219,75,,,percent of total billed charges,75% of total billed charges,6.59,283.24,
INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG (TC/PC),78001742G,CDM,960,RC,64454,HCPCS,Outpatient,,,310,232.5,,285.2,92,,,percent of total billed charges,92% of total billed charges,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.3,93,,,percent of total billed charges,93% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,300.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.7,97,,,percent of total billed charges,97% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,297.6,96,,,percent of total billed charges,96% of total billed charges,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,232.5,75,,,percent of total billed charges,75% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,6.62,300.7,
PVB THORACIC SINGLE INJECTION SITE W/IMG GUIDE (TC/PC),78001744G,CDM,960,RC,64461,HCPCS,Outpatient,,,1012,759,,931.04,92,,,percent of total billed charges,92% of total billed charges,7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,941.16,93,,,percent of total billed charges,93% of total billed charges,910.8,90,,,percent of total billed charges,90% of total billed charges,910.8,90,,,percent of total billed charges,90% of total billed charges,981.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,981.64,97,,,percent of total billed charges,97% of total billed charges,759,75,,,percent of total billed charges,75% of total billed charges,971.52,96,,,percent of total billed charges,96% of total billed charges,7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,759,75,,,percent of total billed charges,75% of total billed charges,759,75,,,percent of total billed charges,75% of total billed charges,7,981.64,
PVB THORACIC SECOND & ADDL INJ SITE W/IMG GUIDANCE (TC/PC),78001746G,CDM,960,RC,64462,HCPCS,Outpatient,,,843,632.25,,775.56,92,,,percent of total billed charges,92% of total billed charges,4.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,783.99,93,,,percent of total billed charges,93% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,817.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,817.71,97,,,percent of total billed charges,97% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,809.28,96,,,percent of total billed charges,96% of total billed charges,4.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,632.25,75,,,percent of total billed charges,75% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,4.09,817.71,
INJECTION ANES/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL (TC/PC),78001748G,CDM,960,RC,64483,HCPCS,Outpatient,,,293,219.75,,269.56,92,,,percent of total billed charges,92% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,272.49,93,,,percent of total billed charges,93% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,284.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.21,97,,,percent of total billed charges,97% of total billed charges,219.75,75,,,percent of total billed charges,75% of total billed charges,281.28,96,,,percent of total billed charges,96% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.75,75,,,percent of total billed charges,75% of total billed charges,219.75,75,,,percent of total billed charges,75% of total billed charges,8.7,284.21,
INJECTION ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV (TC/PC),78001750G,CDM,960,RC,64484,HCPCS,Outpatient,,,136,102,,125.12,92,,,percent of total billed charges,92% of total billed charges,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126.48,93,,,percent of total billed charges,93% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,131.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.92,97,,,percent of total billed charges,97% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,130.56,96,,,percent of total billed charges,96% of total billed charges,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102,75,,,percent of total billed charges,75% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,4.47,131.92,
TRANSVERSUS ABDIMINIS PLANE BLOCK W/GUIDANCE (TC/PC),78001752G,CDM,960,RC,64486,HCPCS,Outpatient,,,146,109.5,,134.32,92,,,percent of total billed charges,92% of total billed charges,4.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.78,93,,,percent of total billed charges,93% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,141.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.62,97,,,percent of total billed charges,97% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,140.16,96,,,percent of total billed charges,96% of total billed charges,4.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,109.5,75,,,percent of total billed charges,75% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,4.86,141.62,
TAP BLOCK BILATERAL BY INJECTION(S) (TC/PC),78001754G,CDM,960,RC,64488,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges,5.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.33,93,,,percent of total billed charges,93% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,175.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.57,97,,,percent of total billed charges,97% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,173.76,96,,,percent of total billed charges,96% of total billed charges,5.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.75,75,,,percent of total billed charges,75% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,5.86,175.57,
INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 1 LVL  (TC/PC),78001756G,CDM,960,RC,64490,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,386.88,93,,,percent of total billed charges,93% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,403.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.52,97,,,percent of total billed charges,97% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,399.36,96,,,percent of total billed charges,96% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312,75,,,percent of total billed charges,75% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,8.5,403.52,
INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 2ND LVL (TC/PC),78001758G,CDM,960,RC,64491,HCPCS,Outpatient,,,191,143.25,,175.72,92,,,percent of total billed charges,92% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.63,93,,,percent of total billed charges,93% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,185.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.27,97,,,percent of total billed charges,97% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,183.36,96,,,percent of total billed charges,96% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.25,75,,,percent of total billed charges,75% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,5.28,185.27,
INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 1 LVL  (TC/PC),78001762G,CDM,960,RC,64493,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,7.18,343.38,
INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LVL (TC/PC),78001764G,CDM,960,RC,64494,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.55,93,,,percent of total billed charges,93% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,130.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.95,97,,,percent of total billed charges,97% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,129.6,96,,,percent of total billed charges,96% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.25,75,,,percent of total billed charges,75% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,4.45,130.95,
INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL (TC/PC,78001766G,CDM,960,RC,64495,HCPCS,Outpatient,,,137,102.75,,126.04,92,,,percent of total billed charges,92% of total billed charges,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.41,93,,,percent of total billed charges,93% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,132.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.89,97,,,percent of total billed charges,97% of total billed charges,102.75,75,,,percent of total billed charges,75% of total billed charges,131.52,96,,,percent of total billed charges,96% of total billed charges,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102.75,75,,,percent of total billed charges,75% of total billed charges,102.75,75,,,percent of total billed charges,75% of total billed charges,4.48,132.89,
INJECTION ANES AGENT SPHENOPALATINE GANGLION (TC/PC),78001768G,CDM,960,RC,64505,HCPCS,Outpatient,,,580,435,,533.6,92,,,percent of total billed charges,92% of total billed charges,13.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,539.4,93,,,percent of total billed charges,93% of total billed charges,522,90,,,percent of total billed charges,90% of total billed charges,522,90,,,percent of total billed charges,90% of total billed charges,562.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,562.6,97,,,percent of total billed charges,97% of total billed charges,435,75,,,percent of total billed charges,75% of total billed charges,556.8,96,,,percent of total billed charges,96% of total billed charges,13.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,435,75,,,percent of total billed charges,75% of total billed charges,435,75,,,percent of total billed charges,75% of total billed charges,13.69,562.6,
64510 NJX Stellate Ganglion Block - Profee,78002802P,CDM,960,RC,64510,HCPCS,Outpatient,,,379,284.25,,348.68,92,,,percent of total billed charges,92% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.47,93,,,percent of total billed charges,93% of total billed charges,341.1,90,,,percent of total billed charges,90% of total billed charges,341.1,90,,,percent of total billed charges,90% of total billed charges,367.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.63,97,,,percent of total billed charges,97% of total billed charges,284.25,75,,,percent of total billed charges,75% of total billed charges,363.84,96,,,percent of total billed charges,96% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.25,75,,,percent of total billed charges,75% of total billed charges,284.25,75,,,percent of total billed charges,75% of total billed charges,5.9,367.63,
64520 NJX Lumbar Thoracic Paravertebral Block - Profee,78001770P,CDM,960,RC,64520,HCPCS,Outpatient,,,606,454.5,,557.52,92,,,percent of total billed charges,92% of total billed charges,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,563.58,93,,,percent of total billed charges,93% of total billed charges,545.4,90,,,percent of total billed charges,90% of total billed charges,545.4,90,,,percent of total billed charges,90% of total billed charges,587.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,587.82,97,,,percent of total billed charges,97% of total billed charges,454.5,75,,,percent of total billed charges,75% of total billed charges,581.76,96,,,percent of total billed charges,96% of total billed charges,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,454.5,75,,,percent of total billed charges,75% of total billed charges,454.5,75,,,percent of total billed charges,75% of total billed charges,6.45,587.82,
DESTRUCTION NEUROLYTIC AGENT INTERCOSTAL NERVE (TC/PC),78001772G,CDM,960,RC,64620,HCPCS,Outpatient,,,468,351,,430.56,92,,,percent of total billed charges,92% of total billed charges,15.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,435.24,93,,,percent of total billed charges,93% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,453.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,453.96,97,,,percent of total billed charges,97% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,449.28,96,,,percent of total billed charges,96% of total billed charges,15.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,351,75,,,percent of total billed charges,75% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,15.35,453.96,
DESTRUCTION NEUROLYTIC AGENT GENICULAR NRVE W/IMG (TC/PC),78001774G,CDM,960,RC,64624,HCPCS,Outpatient,,,579,434.25,,532.68,92,,,percent of total billed charges,92% of total billed charges,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,538.47,93,,,percent of total billed charges,93% of total billed charges,521.1,90,,,percent of total billed charges,90% of total billed charges,521.1,90,,,percent of total billed charges,90% of total billed charges,561.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,561.63,97,,,percent of total billed charges,97% of total billed charges,434.25,75,,,percent of total billed charges,75% of total billed charges,555.84,96,,,percent of total billed charges,96% of total billed charges,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,434.25,75,,,percent of total billed charges,75% of total billed charges,434.25,75,,,percent of total billed charges,75% of total billed charges,11.26,561.63,
DESTRUCTION NEURO AGENT PARVERTEB FCT SGL CRVCL/THOR (TC/PC),78001776G,CDM,960,RC,64633,HCPCS,Outpatient,,,867,650.25,,797.64,92,,,percent of total billed charges,92% of total billed charges,15.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,806.31,93,,,percent of total billed charges,93% of total billed charges,780.3,90,,,percent of total billed charges,90% of total billed charges,780.3,90,,,percent of total billed charges,90% of total billed charges,840.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.99,97,,,percent of total billed charges,97% of total billed charges,650.25,75,,,percent of total billed charges,75% of total billed charges,832.32,96,,,percent of total billed charges,96% of total billed charges,15.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,650.25,75,,,percent of total billed charges,75% of total billed charges,650.25,75,,,percent of total billed charges,75% of total billed charges,15.29,840.99,
DESTRUCTION NEURO AGNT PARVERTEB FCT ADDL CRVCL/THOR (TC/PC),78001778G,CDM,960,RC,64634,HCPCS,Outpatient,,,613,459.75,,563.96,92,,,percent of total billed charges,92% of total billed charges,5.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,570.09,93,,,percent of total billed charges,93% of total billed charges,551.7,90,,,percent of total billed charges,90% of total billed charges,551.7,90,,,percent of total billed charges,90% of total billed charges,594.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594.61,97,,,percent of total billed charges,97% of total billed charges,459.75,75,,,percent of total billed charges,75% of total billed charges,588.48,96,,,percent of total billed charges,96% of total billed charges,5.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,459.75,75,,,percent of total billed charges,75% of total billed charges,459.75,75,,,percent of total billed charges,75% of total billed charges,5.82,594.61,
DESTRUCTION NEURO AGNT PARVERTEB FCT SNGL LMBR/SACRL (TC/PC),78001780G,CDM,960,RC,64635,HCPCS,Outpatient,,,506,379.5,,465.52,92,,,percent of total billed charges,92% of total billed charges,15.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,470.58,93,,,percent of total billed charges,93% of total billed charges,455.4,90,,,percent of total billed charges,90% of total billed charges,455.4,90,,,percent of total billed charges,90% of total billed charges,490.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,490.82,97,,,percent of total billed charges,97% of total billed charges,379.5,75,,,percent of total billed charges,75% of total billed charges,485.76,96,,,percent of total billed charges,96% of total billed charges,15.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,379.5,75,,,percent of total billed charges,75% of total billed charges,379.5,75,,,percent of total billed charges,75% of total billed charges,15.3,490.82,
DESTRUCTION NEURO AGENT PARVERTEB FCT ADDL LMBR/SCRL (TC/PC),78001784G,CDM,960,RC,64636,HCPCS,Outpatient,,,156,117,,143.52,92,,,percent of total billed charges,92% of total billed charges,4.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,145.08,93,,,percent of total billed charges,93% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,151.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,151.32,97,,,percent of total billed charges,97% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,149.76,96,,,percent of total billed charges,96% of total billed charges,4.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117,75,,,percent of total billed charges,75% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,4.99,151.32,
DESTRUCTION NEUROLYTIC AGENT OTHER PERIPHERAL NERVE (TC/PC),78001786G,CDM,960,RC,64640,HCPCS,Outpatient,,,313,234.75,,287.96,92,,,percent of total billed charges,92% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,291.09,93,,,percent of total billed charges,93% of total billed charges,281.7,90,,,percent of total billed charges,90% of total billed charges,281.7,90,,,percent of total billed charges,90% of total billed charges,303.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,303.61,97,,,percent of total billed charges,97% of total billed charges,234.75,75,,,percent of total billed charges,75% of total billed charges,300.48,96,,,percent of total billed charges,96% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,234.75,75,,,percent of total billed charges,75% of total billed charges,234.75,75,,,percent of total billed charges,75% of total billed charges,9.79,303.61,
UNLISTED PROCEDURE NERVOUS SYSTEM (TC/PC),78001795G,CDM,960,RC,64999,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,678,876.88,
PF US GUIDANCE NEEDLE PLACEMENT IMG SI,72600031P,CDM,972,RC,76942,HCPCS,Outpatient,,,642,481.5,,590.64,92,,,percent of total billed charges,92% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,597.06,93,,,percent of total billed charges,93% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,622.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,622.74,97,,,percent of total billed charges,97% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,616.32,96,,,percent of total billed charges,96% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,481.5,75,,,percent of total billed charges,75% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,1.25,622.74,
PF XR FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,71800466P,CDM,972,RC,77002,HCPCS,Outpatient,,,316,237,,290.72,92,,,percent of total billed charges,92% of total billed charges,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,293.88,93,,,percent of total billed charges,93% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,306.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.52,97,,,percent of total billed charges,97% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,303.36,96,,,percent of total billed charges,96% of total billed charges,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237,75,,,percent of total billed charges,75% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,3.36,306.52,
PF XR FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,71800468P,CDM,972,RC,77003,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.98,93,,,percent of total billed charges,93% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,277.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.42,97,,,percent of total billed charges,97% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,274.56,96,,,percent of total billed charges,96% of total billed charges,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.5,75,,,percent of total billed charges,75% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,2.93,277.42,
PF INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,78000354P,CDM,964,RC,20553,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,3.88,
I&D PERIANAL ABSCESS SUPERFICIAL,78001459G,CDM,960,RC,46050,HCPCS,Outpatient,,,389,291.75,,357.88,92,,,percent of total billed charges,92% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,361.77,93,,,percent of total billed charges,93% of total billed charges,350.1,90,,,percent of total billed charges,90% of total billed charges,350.1,90,,,percent of total billed charges,90% of total billed charges,377.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,377.33,97,,,percent of total billed charges,97% of total billed charges,291.75,75,,,percent of total billed charges,75% of total billed charges,373.44,96,,,percent of total billed charges,96% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,291.75,75,,,percent of total billed charges,75% of total billed charges,291.75,75,,,percent of total billed charges,75% of total billed charges,10.04,377.33,
PF INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,78001738P,CDM,960,RC,64405,HCPCS,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156.24,93,,,percent of total billed charges,93% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,162.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.96,97,,,percent of total billed charges,97% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,161.28,96,,,percent of total billed charges,96% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126,75,,,percent of total billed charges,75% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,7.79,162.96,
PF INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE,78001722P,CDM,960,RC,64450,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.3,93,,,percent of total billed charges,93% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,203.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.7,97,,,percent of total billed charges,97% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,201.6,96,,,percent of total billed charges,96% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,157.5,75,,,percent of total billed charges,75% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,3.88,203.7,
NEW PATIENT VISIT LEVEL 3,78001895G,CDM,960,RC,99203,HCPCS,Outpatient,,,146,109.5,,134.32,92,,,percent of total billed charges,92% of total billed charges,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.78,93,,,percent of total billed charges,93% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,141.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.62,97,,,percent of total billed charges,97% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,140.16,96,,,percent of total billed charges,96% of total billed charges,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,109.5,75,,,percent of total billed charges,75% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,7.15,141.62,
PF TELEHEALTH CONSULTATION 30 MINUTES,68500060P,CDM,988,RC,,,Outpatient,,,550,412.5,,506,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,511.5,93,,,percent of total billed charges,93% of total billed charges,495,90,,,percent of total billed charges,90% of total billed charges,495,90,,,percent of total billed charges,90% of total billed charges,533.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,533.5,97,,,percent of total billed charges,97% of total billed charges,412.5,75,,,percent of total billed charges,75% of total billed charges,528,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,412.5,75,,,percent of total billed charges,75% of total billed charges,412.5,75,,,percent of total billed charges,75% of total billed charges,412.5,533.5,
PF IP FOLLOW-UP CONSULT 15 MINUTES,78002798P,CDM,988,RC,,,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,325.5,93,,,percent of total billed charges,93% of total billed charges,315,90,,,percent of total billed charges,90% of total billed charges,315,90,,,percent of total billed charges,90% of total billed charges,339.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,339.5,97,,,percent of total billed charges,97% of total billed charges,262.5,75,,,percent of total billed charges,75% of total billed charges,336,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,262.5,75,,,percent of total billed charges,75% of total billed charges,262.5,75,,,percent of total billed charges,75% of total billed charges,262.5,339.5,
PF IP FOLLOW-UP CONSULT 25 MINUTES,78002799P,CDM,988,RC,,,Outpatient,,,550,412.5,,506,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,511.5,93,,,percent of total billed charges,93% of total billed charges,495,90,,,percent of total billed charges,90% of total billed charges,495,90,,,percent of total billed charges,90% of total billed charges,533.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,533.5,97,,,percent of total billed charges,97% of total billed charges,412.5,75,,,percent of total billed charges,75% of total billed charges,528,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,412.5,75,,,percent of total billed charges,75% of total billed charges,412.5,75,,,percent of total billed charges,75% of total billed charges,412.5,533.5,
PF PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES,78002426P,CDM,981,RC,90792,HCPCS,Outpatient,,,563,422.25,,517.96,92,,,percent of total billed charges,92% of total billed charges,10.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,523.59,93,,,percent of total billed charges,93% of total billed charges,506.7,90,,,percent of total billed charges,90% of total billed charges,506.7,90,,,percent of total billed charges,90% of total billed charges,546.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546.11,97,,,percent of total billed charges,97% of total billed charges,422.25,75,,,percent of total billed charges,75% of total billed charges,540.48,96,,,percent of total billed charges,96% of total billed charges,10.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,422.25,75,,,percent of total billed charges,75% of total billed charges,422.25,75,,,percent of total billed charges,75% of total billed charges,10.46,546.11,
PF DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMIN,78200001P,CDM,964,RC,1996,HCPCS,Outpatient,,,677,507.75,,622.84,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,629.61,93,,,percent of total billed charges,93% of total billed charges,609.3,90,,,percent of total billed charges,90% of total billed charges,609.3,90,,,percent of total billed charges,90% of total billed charges,656.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,656.69,97,,,percent of total billed charges,97% of total billed charges,507.75,75,,,percent of total billed charges,75% of total billed charges,649.92,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,507.75,75,,,percent of total billed charges,75% of total billed charges,507.75,75,,,percent of total billed charges,75% of total billed charges,507.75,656.69,
PF FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION,78000001P,CDM,975,RC,10005,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,6.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,6.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,6.83,201.76,
PF-FINE NEEDLE ASPIRATION BX W/US GDN EA ADD'L,78002853P,CDM,960,RC,10006,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.6,93,,,percent of total billed charges,93% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,116.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.4,97,,,percent of total billed charges,97% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,115.2,96,,,percent of total billed charges,96% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90,75,,,percent of total billed charges,75% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,4.42,116.4,
PF FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESN,78000003P,CDM,975,RC,10021,HCPCS,Outpatient,,,642,481.5,,590.64,92,,,percent of total billed charges,92% of total billed charges,5.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,597.06,93,,,percent of total billed charges,93% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,622.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,622.74,97,,,percent of total billed charges,97% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,616.32,96,,,percent of total billed charges,96% of total billed charges,5.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,481.5,75,,,percent of total billed charges,75% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,5.67,622.74,
PF INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE,78000005P,CDM,975,RC,10060,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,7.23,289.06,
PF INCISION  and  DRAINAGE ABSCESS COMPLICATED/MULT,78000007P,CDM,975,RC,10061,HCPCS,Outpatient,,,712,534,,655.04,92,,,percent of total billed charges,92% of total billed charges,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,662.16,93,,,percent of total billed charges,93% of total billed charges,640.8,90,,,percent of total billed charges,90% of total billed charges,640.8,90,,,percent of total billed charges,90% of total billed charges,690.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,690.64,97,,,percent of total billed charges,97% of total billed charges,534,75,,,percent of total billed charges,75% of total billed charges,683.52,96,,,percent of total billed charges,96% of total billed charges,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534,75,,,percent of total billed charges,75% of total billed charges,534,75,,,percent of total billed charges,75% of total billed charges,15.08,690.64,
PF INCISION  and  DRAINAGE PILONIDAL CYST SIMPLE,78000009P,CDM,975,RC,10080,HCPCS,Outpatient,,,403,302.25,,370.76,92,,,percent of total billed charges,92% of total billed charges,9.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,374.79,93,,,percent of total billed charges,93% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,390.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,390.91,97,,,percent of total billed charges,97% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,386.88,96,,,percent of total billed charges,96% of total billed charges,9.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,302.25,75,,,percent of total billed charges,75% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,9.08,390.91,
PF INCISION  and  DRAINAGE PILONIDAL CYST COMPLICATED,78000011P,CDM,975,RC,10081,HCPCS,Outpatient,,,453,339.75,,416.76,92,,,percent of total billed charges,92% of total billed charges,18.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,421.29,93,,,percent of total billed charges,93% of total billed charges,407.7,90,,,percent of total billed charges,90% of total billed charges,407.7,90,,,percent of total billed charges,90% of total billed charges,439.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,439.41,97,,,percent of total billed charges,97% of total billed charges,339.75,75,,,percent of total billed charges,75% of total billed charges,434.88,96,,,percent of total billed charges,96% of total billed charges,18.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,339.75,75,,,percent of total billed charges,75% of total billed charges,339.75,75,,,percent of total billed charges,75% of total billed charges,18.68,439.41,
PF INCISION  and  REMOVAL FOREIGN BODY SUBQ TISS SIMP,78000013P,CDM,975,RC,10120,HCPCS,Outpatient,,,403,302.25,,370.76,92,,,percent of total billed charges,92% of total billed charges,7.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,374.79,93,,,percent of total billed charges,93% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,390.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,390.91,97,,,percent of total billed charges,97% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,386.88,96,,,percent of total billed charges,96% of total billed charges,7.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,302.25,75,,,percent of total billed charges,75% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,7.74,390.91,
PF INCISION  and  REMOVAL FOREIGN BODY SUBQ TISS COMPL,78000015P,CDM,975,RC,10121,HCPCS,Outpatient,,,728,546,,669.76,92,,,percent of total billed charges,92% of total billed charges,17.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,677.04,93,,,percent of total billed charges,93% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,706.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,706.16,97,,,percent of total billed charges,97% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,698.88,96,,,percent of total billed charges,96% of total billed charges,17.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546,75,,,percent of total billed charges,75% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,17.2,706.16,
PF I and D HEMATOMA SEROMA/FLUID COLLECTION,78000017P,CDM,975,RC,10140,HCPCS,Outpatient,,,410,307.5,,377.2,92,,,percent of total billed charges,92% of total billed charges,9.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,381.3,93,,,percent of total billed charges,93% of total billed charges,369,90,,,percent of total billed charges,90% of total billed charges,369,90,,,percent of total billed charges,90% of total billed charges,397.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,397.7,97,,,percent of total billed charges,97% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges,393.6,96,,,percent of total billed charges,96% of total billed charges,9.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,307.5,75,,,percent of total billed charges,75% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges,9.8,397.7,
PF PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,78000019P,CDM,975,RC,10160,HCPCS,Outpatient,,,487,365.25,,448.04,92,,,percent of total billed charges,92% of total billed charges,7.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,452.91,93,,,percent of total billed charges,93% of total billed charges,438.3,90,,,percent of total billed charges,90% of total billed charges,438.3,90,,,percent of total billed charges,90% of total billed charges,472.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,472.39,97,,,percent of total billed charges,97% of total billed charges,365.25,75,,,percent of total billed charges,75% of total billed charges,467.52,96,,,percent of total billed charges,96% of total billed charges,7.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,365.25,75,,,percent of total billed charges,75% of total billed charges,365.25,75,,,percent of total billed charges,75% of total billed charges,7.69,472.39,
PF INCISION  and  DRAIN POST OP WOUND INFECTION COMPLX,78000021P,CDM,975,RC,10180,HCPCS,Outpatient,,,907,680.25,,834.44,92,,,percent of total billed charges,92% of total billed charges,20.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,843.51,93,,,percent of total billed charges,93% of total billed charges,816.3,90,,,percent of total billed charges,90% of total billed charges,816.3,90,,,percent of total billed charges,90% of total billed charges,879.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,879.79,97,,,percent of total billed charges,97% of total billed charges,680.25,75,,,percent of total billed charges,75% of total billed charges,870.72,96,,,percent of total billed charges,96% of total billed charges,20.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,680.25,75,,,percent of total billed charges,75% of total billed charges,680.25,75,,,percent of total billed charges,75% of total billed charges,20.04,879.79,
PF DEBRID SKIN SC TISS MSCL FASCIA GENIT,78000023P,CDM,975,RC,11004,HCPCS,Outpatient,,,2301,1725.75,,2116.92,92,,,percent of total billed charges,92% of total billed charges,75.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2139.93,93,,,percent of total billed charges,93% of total billed charges,2070.9,90,,,percent of total billed charges,90% of total billed charges,2070.9,90,,,percent of total billed charges,90% of total billed charges,2231.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,75.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2231.97,97,,,percent of total billed charges,97% of total billed charges,1725.75,75,,,percent of total billed charges,75% of total billed charges,2208.96,96,,,percent of total billed charges,96% of total billed charges,75.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1725.75,75,,,percent of total billed charges,75% of total billed charges,1725.75,75,,,percent of total billed charges,75% of total billed charges,75.82,2231.97,
PF DEBRIDE SKIN ABDOMINAL WALL,78000024P,CDM,975,RC,11005,HCPCS,Outpatient,,,2083,1562.25,,1916.36,92,,,percent of total billed charges,92% of total billed charges,119.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1937.19,93,,,percent of total billed charges,93% of total billed charges,1874.7,90,,,percent of total billed charges,90% of total billed charges,1874.7,90,,,percent of total billed charges,90% of total billed charges,2020.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,119.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2020.51,97,,,percent of total billed charges,97% of total billed charges,1562.25,75,,,percent of total billed charges,75% of total billed charges,1999.68,96,,,percent of total billed charges,96% of total billed charges,119.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1562.25,75,,,percent of total billed charges,75% of total billed charges,1562.25,75,,,percent of total billed charges,75% of total billed charges,119.21,2020.51,
PF DEBRID SKIN SC TISS MSCL NECROTIZING ABD WALL,78000025P,CDM,975,RC,11008,HCPCS,Outpatient,,,733,549.75,,674.36,92,,,percent of total billed charges,92% of total billed charges,42.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,681.69,93,,,percent of total billed charges,93% of total billed charges,659.7,90,,,percent of total billed charges,90% of total billed charges,659.7,90,,,percent of total billed charges,90% of total billed charges,711.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,42.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,711.01,97,,,percent of total billed charges,97% of total billed charges,549.75,75,,,percent of total billed charges,75% of total billed charges,703.68,96,,,percent of total billed charges,96% of total billed charges,42.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,549.75,75,,,percent of total billed charges,75% of total billed charges,549.75,75,,,percent of total billed charges,75% of total billed charges,42.67,711.01,
PF DEBRIDE W/FOREIGN BODY REMOVAL SKIN  SUBC TISS,78000026P,CDM,975,RC,11010,HCPCS,Outpatient,,,728,546,,669.76,92,,,percent of total billed charges,92% of total billed charges,29.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,677.04,93,,,percent of total billed charges,93% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,706.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,706.16,97,,,percent of total billed charges,97% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,698.88,96,,,percent of total billed charges,96% of total billed charges,29.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546,75,,,percent of total billed charges,75% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,29.58,706.16,
PF DEBRIDE W/FOREIGN BODY RMVL SKIN SUBQ TISS MUSC,78000028P,CDM,975,RC,11011,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,36.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,36.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,36.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,36.54,729.44,
PF DEBRIDEMENT WFB REMOVAL AT OPEN FX/DISLOCATION,78000031P,CDM,975,RC,11012,HCPCS,Outpatient,,,2546,1909.5,,2342.32,92,,,percent of total billed charges,92% of total billed charges,50.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2367.78,93,,,percent of total billed charges,93% of total billed charges,2291.4,90,,,percent of total billed charges,90% of total billed charges,2291.4,90,,,percent of total billed charges,90% of total billed charges,2469.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2469.62,97,,,percent of total billed charges,97% of total billed charges,1909.5,75,,,percent of total billed charges,75% of total billed charges,2444.16,96,,,percent of total billed charges,96% of total billed charges,50.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1909.5,75,,,percent of total billed charges,75% of total billed charges,1909.5,75,,,percent of total billed charges,75% of total billed charges,50.63,2469.62,
PF DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,78000032P,CDM,975,RC,11042,HCPCS,Outpatient,,,239,179.25,,219.88,92,,,percent of total billed charges,92% of total billed charges,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222.27,93,,,percent of total billed charges,93% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,231.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.83,97,,,percent of total billed charges,97% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,229.44,96,,,percent of total billed charges,96% of total billed charges,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.25,75,,,percent of total billed charges,75% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,5.61,231.83,
PF DEBRIDE MUSCLE AND/OR FASCIA FIRST 20 SQCM OR <,78000034P,CDM,975,RC,11043,HCPCS,Outpatient,,,608,456,,559.36,92,,,percent of total billed charges,92% of total billed charges,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,565.44,93,,,percent of total billed charges,93% of total billed charges,547.2,90,,,percent of total billed charges,90% of total billed charges,547.2,90,,,percent of total billed charges,90% of total billed charges,589.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,589.76,97,,,percent of total billed charges,97% of total billed charges,456,75,,,percent of total billed charges,75% of total billed charges,583.68,96,,,percent of total billed charges,96% of total billed charges,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,456,75,,,percent of total billed charges,75% of total billed charges,456,75,,,percent of total billed charges,75% of total billed charges,16.12,589.76,
PF DEBRIDEMENT BONE FIRST 20 SQ CM OR LESS,78000036P,CDM,975,RC,11044,HCPCS,Outpatient,,,893,669.75,,821.56,92,,,percent of total billed charges,92% of total billed charges,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,830.49,93,,,percent of total billed charges,93% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,866.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,866.21,97,,,percent of total billed charges,97% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,857.28,96,,,percent of total billed charges,96% of total billed charges,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,669.75,75,,,percent of total billed charges,75% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,25.64,866.21,
PF DEBRIDE SUBCUTANEOUS TISSUE EACH ADDL 20 SQ CM,78000039P,CDM,975,RC,11045,HCPCS,Outpatient,,,105,78.75,,96.6,92,,,percent of total billed charges,92% of total billed charges,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.65,93,,,percent of total billed charges,93% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,101.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.85,97,,,percent of total billed charges,97% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges,100.8,96,,,percent of total billed charges,96% of total billed charges,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.75,75,,,percent of total billed charges,75% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges,3.03,101.85,
PF DEBRIDE MUSCLE AND/OR FASCIA EACH ADDL 20 SQ CM,78000040P,CDM,975,RC,11046,HCPCS,Outpatient,,,219,164.25,,201.48,92,,,percent of total billed charges,92% of total billed charges,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.67,93,,,percent of total billed charges,93% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,212.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,212.43,97,,,percent of total billed charges,97% of total billed charges,164.25,75,,,percent of total billed charges,75% of total billed charges,210.24,96,,,percent of total billed charges,96% of total billed charges,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.25,75,,,percent of total billed charges,75% of total billed charges,164.25,75,,,percent of total billed charges,75% of total billed charges,7.03,212.43,
PF DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM,78000042P,CDM,975,RC,11047,HCPCS,Outpatient,,,387,290.25,,356.04,92,,,percent of total billed charges,92% of total billed charges,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,359.91,93,,,percent of total billed charges,93% of total billed charges,348.3,90,,,percent of total billed charges,90% of total billed charges,348.3,90,,,percent of total billed charges,90% of total billed charges,375.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375.39,97,,,percent of total billed charges,97% of total billed charges,290.25,75,,,percent of total billed charges,75% of total billed charges,371.52,96,,,percent of total billed charges,96% of total billed charges,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,290.25,75,,,percent of total billed charges,75% of total billed charges,290.25,75,,,percent of total billed charges,75% of total billed charges,12.81,375.39,
PF PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,78000044P,CDM,975,RC,11055,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,39.06,93,,,percent of total billed charges,93% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,40.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,40.74,97,,,percent of total billed charges,97% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,40.32,96,,,percent of total billed charges,96% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,31.5,75,,,percent of total billed charges,75% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,1.34,40.74,
PF PARING/CUTTING BENIGN HYPERKERATOTC LESIONS 2-4,78000046P,CDM,975,RC,11056,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.94,93,,,percent of total billed charges,93% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,56.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.26,97,,,percent of total billed charges,97% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,55.68,96,,,percent of total billed charges,96% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.5,75,,,percent of total billed charges,75% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,1.83,56.26,
PF PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,78000048P,CDM,975,RC,11057,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,2.33,73.72,
PF PUNCH BIOPSY SKIN SINGLE LESION,78000054P,CDM,975,RC,11104,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.56,93,,,percent of total billed charges,93% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,186.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.24,97,,,percent of total billed charges,97% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,184.32,96,,,percent of total billed charges,96% of total billed charges,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144,75,,,percent of total billed charges,75% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,4.31,186.24,
PF PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000056P,CDM,975,RC,11105,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.7,93,,,percent of total billed charges,93% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,87.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,87.3,97,,,percent of total billed charges,97% of total billed charges,67.5,75,,,percent of total billed charges,75% of total billed charges,86.4,96,,,percent of total billed charges,96% of total billed charges,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,67.5,75,,,percent of total billed charges,75% of total billed charges,67.5,75,,,percent of total billed charges,75% of total billed charges,2.5,87.3,
PF TANGENTIAL BIOPSY SKIN SINGLE LESION,78000050P,CDM,975,RC,11102,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.15,93,,,percent of total billed charges,93% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,150.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.35,97,,,percent of total billed charges,97% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,148.8,96,,,percent of total billed charges,96% of total billed charges,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,75,,,percent of total billed charges,75% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,3.19,150.35,
PF TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000052P,CDM,975,RC,11103,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.61,93,,,percent of total billed charges,93% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,74.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.69,97,,,percent of total billed charges,97% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,73.92,96,,,percent of total billed charges,96% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.75,75,,,percent of total billed charges,75% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,1.83,74.69,
PF INCISIONAL BIOPSY SKIN SINGLE LESION,78000058P,CDM,975,RC,11106,HCPCS,Outpatient,,,238,178.5,,218.96,92,,,percent of total billed charges,92% of total billed charges,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,221.34,93,,,percent of total billed charges,93% of total billed charges,214.2,90,,,percent of total billed charges,90% of total billed charges,214.2,90,,,percent of total billed charges,90% of total billed charges,230.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,230.86,97,,,percent of total billed charges,97% of total billed charges,178.5,75,,,percent of total billed charges,75% of total billed charges,228.48,96,,,percent of total billed charges,96% of total billed charges,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.5,75,,,percent of total billed charges,75% of total billed charges,178.5,75,,,percent of total billed charges,75% of total billed charges,5.46,230.86,
PF INCISIONAL BIOPSY SKIN EA SEP/ADDL LESION,78000060P,CDM,975,RC,11107,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,2.95,104.76,
PF REMOVAL OF SKIN TAGS UP TO 15 LESIONS,78000062P,CDM,975,RC,11200,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges,5.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.55,93,,,percent of total billed charges,93% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,130.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.95,97,,,percent of total billed charges,97% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,129.6,96,,,percent of total billed charges,96% of total billed charges,5.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.25,75,,,percent of total billed charges,75% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,5.1,130.95,
PF REMOVAL OF SKIN TAGS ANY AREA EACH ADD 10 LESN,78000064P,CDM,975,RC,11201,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges,1.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,39.99,93,,,percent of total billed charges,93% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,41.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,41.71,97,,,percent of total billed charges,97% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,41.28,96,,,percent of total billed charges,96% of total billed charges,1.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,32.25,75,,,percent of total billed charges,75% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,1.37,41.71,
PF SHAVING SKIN LESN 1 TRUNK/ARM/LEG DIAM 0.5CM/<,78000066P,CDM,975,RC,11300,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges,3.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.15,93,,,percent of total billed charges,93% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,150.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.35,97,,,percent of total billed charges,97% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,148.8,96,,,percent of total billed charges,96% of total billed charges,3.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,75,,,percent of total billed charges,75% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,3.06,150.35,
PF SHVG SKIN LESN 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,78000068P,CDM,975,RC,11301,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges,4.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.05,93,,,percent of total billed charges,93% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,179.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.45,97,,,percent of total billed charges,97% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,177.6,96,,,percent of total billed charges,96% of total billed charges,4.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,4.46,179.45,
PF SHAVING SKIN LESION S/N/H/F/G DIAM 0.6-1.0 CM,78000070P,CDM,975,RC,11306,HCPCS,Outpatient,,,256,192,,235.52,92,,,percent of total billed charges,92% of total billed charges,4.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,238.08,93,,,percent of total billed charges,93% of total billed charges,230.4,90,,,percent of total billed charges,90% of total billed charges,230.4,90,,,percent of total billed charges,90% of total billed charges,248.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,248.32,97,,,percent of total billed charges,97% of total billed charges,192,75,,,percent of total billed charges,75% of total billed charges,245.76,96,,,percent of total billed charges,96% of total billed charges,4.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,192,75,,,percent of total billed charges,75% of total billed charges,192,75,,,percent of total billed charges,75% of total billed charges,4.11,248.32,
PF SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<,78000072P,CDM,975,RC,11310,HCPCS,Outpatient,,,177,132.75,,162.84,92,,,percent of total billed charges,92% of total billed charges,4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.61,93,,,percent of total billed charges,93% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,171.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,171.69,97,,,percent of total billed charges,97% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,169.92,96,,,percent of total billed charges,96% of total billed charges,4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.75,75,,,percent of total billed charges,75% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,4,171.69,
PF SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,78000074P,CDM,975,RC,11311,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,5.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,5.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,5.4,201.76,
PF EXCISE BENIGN LESION MRGN XCP SK TG T/A/L 0.5 CM/<,78000076P,CDM,975,RC,11400,HCPCS,Outpatient,,,221,165.75,,203.32,92,,,percent of total billed charges,92% of total billed charges,6.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,205.53,93,,,percent of total billed charges,93% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,214.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.37,97,,,percent of total billed charges,97% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,212.16,96,,,percent of total billed charges,96% of total billed charges,6.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.75,75,,,percent of total billed charges,75% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,6.19,214.37,
PF REMOVAL OF GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE TRUNK A,78000078P,CDM,975,RC,11401,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.48,93,,,percent of total billed charges,93% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,228.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.92,97,,,percent of total billed charges,97% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,226.56,96,,,percent of total billed charges,96% of total billed charges,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177,75,,,percent of total billed charges,75% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,8.01,228.92,
PF EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 1.1-2.0 CM,78000080P,CDM,975,RC,11402,HCPCS,Outpatient,,,260,195,,239.2,92,,,percent of total billed charges,92% of total billed charges,9.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,241.8,93,,,percent of total billed charges,93% of total billed charges,234,90,,,percent of total billed charges,90% of total billed charges,234,90,,,percent of total billed charges,90% of total billed charges,252.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,252.2,97,,,percent of total billed charges,97% of total billed charges,195,75,,,percent of total billed charges,75% of total billed charges,249.6,96,,,percent of total billed charges,96% of total billed charges,9.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195,75,,,percent of total billed charges,75% of total billed charges,195,75,,,percent of total billed charges,75% of total billed charges,9.17,252.2,
PF EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 2.1-3.0 CM,78000082P,CDM,975,RC,11403,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,12.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,12.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,12.53,289.06,
PF EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 3.1-4.0 CM,78000084P,CDM,975,RC,11404,HCPCS,Outpatient,,,338,253.5,,310.96,92,,,percent of total billed charges,92% of total billed charges,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,314.34,93,,,percent of total billed charges,93% of total billed charges,304.2,90,,,percent of total billed charges,90% of total billed charges,304.2,90,,,percent of total billed charges,90% of total billed charges,327.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,327.86,97,,,percent of total billed charges,97% of total billed charges,253.5,75,,,percent of total billed charges,75% of total billed charges,324.48,96,,,percent of total billed charges,96% of total billed charges,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,253.5,75,,,percent of total billed charges,75% of total billed charges,253.5,75,,,percent of total billed charges,75% of total billed charges,15.21,327.86,
PF EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS >4.0 CM,78000086P,CDM,975,RC,11406,HCPCS,Outpatient,,,479,359.25,,440.68,92,,,percent of total billed charges,92% of total billed charges,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,445.47,93,,,percent of total billed charges,93% of total billed charges,431.1,90,,,percent of total billed charges,90% of total billed charges,431.1,90,,,percent of total billed charges,90% of total billed charges,464.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,464.63,97,,,percent of total billed charges,97% of total billed charges,359.25,75,,,percent of total billed charges,75% of total billed charges,459.84,96,,,percent of total billed charges,96% of total billed charges,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,359.25,75,,,percent of total billed charges,75% of total billed charges,359.25,75,,,percent of total billed charges,75% of total billed charges,26.53,464.63,
PF EXCISE BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,78000088P,CDM,975,RC,11420,HCPCS,Outpatient,,,193,144.75,,177.56,92,,,percent of total billed charges,92% of total billed charges,5.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.49,93,,,percent of total billed charges,93% of total billed charges,173.7,90,,,percent of total billed charges,90% of total billed charges,173.7,90,,,percent of total billed charges,90% of total billed charges,187.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,187.21,97,,,percent of total billed charges,97% of total billed charges,144.75,75,,,percent of total billed charges,75% of total billed charges,185.28,96,,,percent of total billed charges,96% of total billed charges,5.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.75,75,,,percent of total billed charges,75% of total billed charges,144.75,75,,,percent of total billed charges,75% of total billed charges,5.57,187.21,
PF EXCISE BENIGN LESN MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM,78000090P,CDM,975,RC,11421,HCPCS,Outpatient,,,241,180.75,,221.72,92,,,percent of total billed charges,92% of total billed charges,8.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,224.13,93,,,percent of total billed charges,93% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,233.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.77,97,,,percent of total billed charges,97% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,231.36,96,,,percent of total billed charges,96% of total billed charges,8.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.75,75,,,percent of total billed charges,75% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,8.4,233.77,
PF EXCISE BENIGN LESN MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM,78000092P,CDM,975,RC,11422,HCPCS,Outpatient,,,270,202.5,,248.4,92,,,percent of total billed charges,92% of total billed charges,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,251.1,93,,,percent of total billed charges,93% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,261.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,261.9,97,,,percent of total billed charges,97% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,259.2,96,,,percent of total billed charges,96% of total billed charges,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,202.5,75,,,percent of total billed charges,75% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,10.41,261.9,
PF EXCISE BENIGN LESION MGN XCP SK TG S/N/H/F/G 2.1-3.0CM,78000094P,CDM,975,RC,11423,HCPCS,Outpatient,,,308,231,,283.36,92,,,percent of total billed charges,92% of total billed charges,12.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,286.44,93,,,percent of total billed charges,93% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,298.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,298.76,97,,,percent of total billed charges,97% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,295.68,96,,,percent of total billed charges,96% of total billed charges,12.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231,75,,,percent of total billed charges,75% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,12.78,298.76,
PF EXCISE BENIGN LESION MGN XCP SK TG S/N/H/F/G 3.1-4.0CM,78000096P,CDM,975,RC,11424,HCPCS,Outpatient,,,353,264.75,,324.76,92,,,percent of total billed charges,92% of total billed charges,16.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,328.29,93,,,percent of total billed charges,93% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,342.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,342.41,97,,,percent of total billed charges,97% of total billed charges,264.75,75,,,percent of total billed charges,75% of total billed charges,338.88,96,,,percent of total billed charges,96% of total billed charges,16.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,264.75,75,,,percent of total billed charges,75% of total billed charges,264.75,75,,,percent of total billed charges,75% of total billed charges,16.32,342.41,
PF EXCISE BENIGN LESION SCALP NECK HANDS FEET GENITALS > 4.0,78000098P,CDM,975,RC,11426,HCPCS,Outpatient,,,499,374.25,,459.08,92,,,percent of total billed charges,92% of total billed charges,26.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,464.07,93,,,percent of total billed charges,93% of total billed charges,449.1,90,,,percent of total billed charges,90% of total billed charges,449.1,90,,,percent of total billed charges,90% of total billed charges,484.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,484.03,97,,,percent of total billed charges,97% of total billed charges,374.25,75,,,percent of total billed charges,75% of total billed charges,479.04,96,,,percent of total billed charges,96% of total billed charges,26.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,374.25,75,,,percent of total billed charges,75% of total billed charges,374.25,75,,,percent of total billed charges,75% of total billed charges,26.37,484.03,
PF EXCISE BENIGN LESION FACE EARS EYELIDS NOSE LIPS MOUTH 0.,78000100P,CDM,975,RC,11440,HCPCS,Outpatient,,,217,162.75,,199.64,92,,,percent of total billed charges,92% of total billed charges,6.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.81,93,,,percent of total billed charges,93% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,210.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,210.49,97,,,percent of total billed charges,97% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,208.32,96,,,percent of total billed charges,96% of total billed charges,6.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.75,75,,,percent of total billed charges,75% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,6.71,210.49,
PF EXCISE BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM,78000102P,CDM,975,RC,11441,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,10.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,10.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,10.06,255.11,
PF EXCISE BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM,78000104P,CDM,975,RC,11442,HCPCS,Outpatient,,,291,218.25,,267.72,92,,,percent of total billed charges,92% of total billed charges,11.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,270.63,93,,,percent of total billed charges,93% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,282.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,282.27,97,,,percent of total billed charges,97% of total billed charges,218.25,75,,,percent of total billed charges,75% of total billed charges,279.36,96,,,percent of total billed charges,96% of total billed charges,11.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.25,75,,,percent of total billed charges,75% of total billed charges,218.25,75,,,percent of total billed charges,75% of total billed charges,11.62,282.27,
PF EXCISE BENIGN LESION MARGIN XCP SK TG F/E/E/N/L/M > 4.0CM,78000106P,CDM,975,RC,11446,HCPCS,Outpatient,,,843,632.25,,775.56,92,,,percent of total billed charges,92% of total billed charges,29.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,783.99,93,,,percent of total billed charges,93% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,817.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,817.71,97,,,percent of total billed charges,97% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,809.28,96,,,percent of total billed charges,96% of total billed charges,29.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,632.25,75,,,percent of total billed charges,75% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,29.41,817.71,
PF EXCISION MALIGNAT LESION TRUNK ARMS LEGS 0.5 CM/<,78000108P,CDM,975,RC,11600,HCPCS,Outpatient,,,322,241.5,,296.24,92,,,percent of total billed charges,92% of total billed charges,10.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,299.46,93,,,percent of total billed charges,93% of total billed charges,289.8,90,,,percent of total billed charges,90% of total billed charges,289.8,90,,,percent of total billed charges,90% of total billed charges,312.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312.34,97,,,percent of total billed charges,97% of total billed charges,241.5,75,,,percent of total billed charges,75% of total billed charges,309.12,96,,,percent of total billed charges,96% of total billed charges,10.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,241.5,75,,,percent of total billed charges,75% of total billed charges,241.5,75,,,percent of total billed charges,75% of total billed charges,10.2,312.34,
PF EXCISION MALIGNANT LESION TRUNK ARMS LEGS 0.6-1.0CM,78000110P,CDM,975,RC,11601,HCPCS,Outpatient,,,344,258,,316.48,92,,,percent of total billed charges,92% of total billed charges,11.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,319.92,93,,,percent of total billed charges,93% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,333.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333.68,97,,,percent of total billed charges,97% of total billed charges,258,75,,,percent of total billed charges,75% of total billed charges,330.24,96,,,percent of total billed charges,96% of total billed charges,11.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,258,75,,,percent of total billed charges,75% of total billed charges,258,75,,,percent of total billed charges,75% of total billed charges,11.9,333.68,
PF EXCISION MALIGNANT LESION TRUNK ARMS LEGS 1.1-2.0CM,78000112P,CDM,975,RC,11602,HCPCS,Outpatient,,,367,275.25,,337.64,92,,,percent of total billed charges,92% of total billed charges,12.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,341.31,93,,,percent of total billed charges,93% of total billed charges,330.3,90,,,percent of total billed charges,90% of total billed charges,330.3,90,,,percent of total billed charges,90% of total billed charges,355.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,355.99,97,,,percent of total billed charges,97% of total billed charges,275.25,75,,,percent of total billed charges,75% of total billed charges,352.32,96,,,percent of total billed charges,96% of total billed charges,12.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.25,75,,,percent of total billed charges,75% of total billed charges,275.25,75,,,percent of total billed charges,75% of total billed charges,12.34,355.99,
PF EXCISION MALIGNANT LESION TRUNK ARMS LEGS 2.1-3.0CM,78000114P,CDM,975,RC,11603,HCPCS,Outpatient,,,507,380.25,,466.44,92,,,percent of total billed charges,92% of total billed charges,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,471.51,93,,,percent of total billed charges,93% of total billed charges,456.3,90,,,percent of total billed charges,90% of total billed charges,456.3,90,,,percent of total billed charges,90% of total billed charges,491.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,491.79,97,,,percent of total billed charges,97% of total billed charges,380.25,75,,,percent of total billed charges,75% of total billed charges,486.72,96,,,percent of total billed charges,96% of total billed charges,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,380.25,75,,,percent of total billed charges,75% of total billed charges,380.25,75,,,percent of total billed charges,75% of total billed charges,15.86,491.79,
PF EXCISION MALIGNANT LESION TRUNK ARMS LEGS > 4.0CM,78000116P,CDM,975,RC,11606,HCPCS,Outpatient,,,835,626.25,,768.2,92,,,percent of total billed charges,92% of total billed charges,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,776.55,93,,,percent of total billed charges,93% of total billed charges,751.5,90,,,percent of total billed charges,90% of total billed charges,751.5,90,,,percent of total billed charges,90% of total billed charges,809.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,809.95,97,,,percent of total billed charges,97% of total billed charges,626.25,75,,,percent of total billed charges,75% of total billed charges,801.6,96,,,percent of total billed charges,96% of total billed charges,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,626.25,75,,,percent of total billed charges,75% of total billed charges,626.25,75,,,percent of total billed charges,75% of total billed charges,34.49,809.95,
PF EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT 0.6-1.0CM,78000118P,CDM,975,RC,11621,HCPCS,Outpatient,,,624,468,,574.08,92,,,percent of total billed charges,92% of total billed charges,12.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,580.32,93,,,percent of total billed charges,93% of total billed charges,561.6,90,,,percent of total billed charges,90% of total billed charges,561.6,90,,,percent of total billed charges,90% of total billed charges,605.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,605.28,97,,,percent of total billed charges,97% of total billed charges,468,75,,,percent of total billed charges,75% of total billed charges,599.04,96,,,percent of total billed charges,96% of total billed charges,12.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,468,75,,,percent of total billed charges,75% of total billed charges,468,75,,,percent of total billed charges,75% of total billed charges,12.2,605.28,
PF EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT 1.1-2.0CM,78000120P,CDM,975,RC,11622,HCPCS,Outpatient,,,444,333,,408.48,92,,,percent of total billed charges,92% of total billed charges,13.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,412.92,93,,,percent of total billed charges,93% of total billed charges,399.6,90,,,percent of total billed charges,90% of total billed charges,399.6,90,,,percent of total billed charges,90% of total billed charges,430.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.68,97,,,percent of total billed charges,97% of total billed charges,333,75,,,percent of total billed charges,75% of total billed charges,426.24,96,,,percent of total billed charges,96% of total billed charges,13.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333,75,,,percent of total billed charges,75% of total billed charges,333,75,,,percent of total billed charges,75% of total billed charges,13.7,430.68,
PF EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM,78000122P,CDM,975,RC,11623,HCPCS,Outpatient,,,549,411.75,,505.08,92,,,percent of total billed charges,92% of total billed charges,18.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,510.57,93,,,percent of total billed charges,93% of total billed charges,494.1,90,,,percent of total billed charges,90% of total billed charges,494.1,90,,,percent of total billed charges,90% of total billed charges,532.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,532.53,97,,,percent of total billed charges,97% of total billed charges,411.75,75,,,percent of total billed charges,75% of total billed charges,527.04,96,,,percent of total billed charges,96% of total billed charges,18.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.75,75,,,percent of total billed charges,75% of total billed charges,411.75,75,,,percent of total billed charges,75% of total billed charges,18.04,532.53,
PF EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT >4CM,78000124P,CDM,975,RC,11626,HCPCS,Outpatient,,,769,576.75,,707.48,92,,,percent of total billed charges,92% of total billed charges,30.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.17,93,,,percent of total billed charges,93% of total billed charges,692.1,90,,,percent of total billed charges,90% of total billed charges,692.1,90,,,percent of total billed charges,90% of total billed charges,745.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,745.93,97,,,percent of total billed charges,97% of total billed charges,576.75,75,,,percent of total billed charges,75% of total billed charges,738.24,96,,,percent of total billed charges,96% of total billed charges,30.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,576.75,75,,,percent of total billed charges,75% of total billed charges,576.75,75,,,percent of total billed charges,75% of total billed charges,30.89,745.93,
PF EXCISE MALIGNANT LESION FACE EARS EYELIDS NOSE LIPS 0.5CM,78000126P,CDM,975,RC,11640,HCPCS,Outpatient,,,333,249.75,,306.36,92,,,percent of total billed charges,92% of total billed charges,10.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,309.69,93,,,percent of total billed charges,93% of total billed charges,299.7,90,,,percent of total billed charges,90% of total billed charges,299.7,90,,,percent of total billed charges,90% of total billed charges,323.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,323.01,97,,,percent of total billed charges,97% of total billed charges,249.75,75,,,percent of total billed charges,75% of total billed charges,319.68,96,,,percent of total billed charges,96% of total billed charges,10.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249.75,75,,,percent of total billed charges,75% of total billed charges,249.75,75,,,percent of total billed charges,75% of total billed charges,10.08,323.01,
PF EXCISE MALIGNANT LESN FACE EARS EYELIDS NOSE LIPS 0.6-1.0,78000128P,CDM,975,RC,11641,HCPCS,Outpatient,,,408,306,,375.36,92,,,percent of total billed charges,92% of total billed charges,12.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,379.44,93,,,percent of total billed charges,93% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,395.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,395.76,97,,,percent of total billed charges,97% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,391.68,96,,,percent of total billed charges,96% of total billed charges,12.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306,75,,,percent of total billed charges,75% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,12.69,395.76,
PF EXCISE MALIGNANT LESN FACE EARS EYELIDS NOSE LIPS 1.1-2.0,78000130P,CDM,975,RC,11642,HCPCS,Outpatient,,,478,358.5,,439.76,92,,,percent of total billed charges,92% of total billed charges,15.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,444.54,93,,,percent of total billed charges,93% of total billed charges,430.2,90,,,percent of total billed charges,90% of total billed charges,430.2,90,,,percent of total billed charges,90% of total billed charges,463.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,463.66,97,,,percent of total billed charges,97% of total billed charges,358.5,75,,,percent of total billed charges,75% of total billed charges,458.88,96,,,percent of total billed charges,96% of total billed charges,15.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,358.5,75,,,percent of total billed charges,75% of total billed charges,358.5,75,,,percent of total billed charges,75% of total billed charges,15.49,463.66,
PF EXCISE MALIGNANT LESN FACE EAR EYELID NOSE LIPS 2.1-3.0CM,78000132P,CDM,975,RC,11643,HCPCS,Outpatient,,,597,447.75,,549.24,92,,,percent of total billed charges,92% of total billed charges,20.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,555.21,93,,,percent of total billed charges,93% of total billed charges,537.3,90,,,percent of total billed charges,90% of total billed charges,537.3,90,,,percent of total billed charges,90% of total billed charges,579.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,579.09,97,,,percent of total billed charges,97% of total billed charges,447.75,75,,,percent of total billed charges,75% of total billed charges,573.12,96,,,percent of total billed charges,96% of total billed charges,20.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.75,75,,,percent of total billed charges,75% of total billed charges,447.75,75,,,percent of total billed charges,75% of total billed charges,20.29,579.09,
PF EXCISE MALIGNANT LESN FACE EAR EYELID NOSE LIPS 3.1-4.0CM,78000134P,CDM,975,RC,11644,HCPCS,Outpatient,,,742,556.5,,682.64,92,,,percent of total billed charges,92% of total billed charges,26.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,690.06,93,,,percent of total billed charges,93% of total billed charges,667.8,90,,,percent of total billed charges,90% of total billed charges,667.8,90,,,percent of total billed charges,90% of total billed charges,719.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,719.74,97,,,percent of total billed charges,97% of total billed charges,556.5,75,,,percent of total billed charges,75% of total billed charges,712.32,96,,,percent of total billed charges,96% of total billed charges,26.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.5,75,,,percent of total billed charges,75% of total billed charges,556.5,75,,,percent of total billed charges,75% of total billed charges,26.5,719.74,
PF TRIMMING NONDYSTROPHIC NAILS ANY NUMBER,78000136P,CDM,975,RC,11719,HCPCS,Outpatient,,,21,15.75,,19.32,92,,,percent of total billed charges,92% of total billed charges,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,19.53,93,,,percent of total billed charges,93% of total billed charges,18.9,90,,,percent of total billed charges,90% of total billed charges,18.9,90,,,percent of total billed charges,90% of total billed charges,20.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,20.37,97,,,percent of total billed charges,97% of total billed charges,15.75,75,,,percent of total billed charges,75% of total billed charges,20.16,96,,,percent of total billed charges,96% of total billed charges,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,15.75,75,,,percent of total billed charges,75% of total billed charges,15.75,75,,,percent of total billed charges,75% of total billed charges,0.52,20.37,
PF DEBRIDEMENT NAIL ANY METHOD 1-5,78000138P,CDM,975,RC,11720,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges,1.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.94,93,,,percent of total billed charges,93% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,56.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.26,97,,,percent of total billed charges,97% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,55.68,96,,,percent of total billed charges,96% of total billed charges,1.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.5,75,,,percent of total billed charges,75% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,1.3,56.26,
PF EVACUATION SUBUNGUAL HEMATOMA,78000140P,CDM,975,RC,11721,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges,1.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,58.59,93,,,percent of total billed charges,93% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.11,97,,,percent of total billed charges,97% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,60.48,96,,,percent of total billed charges,96% of total billed charges,1.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,47.25,75,,,percent of total billed charges,75% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,1.89,61.11,
PF AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1,78000142P,CDM,975,RC,11730,HCPCS,Outpatient,,,215,161.25,,197.8,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,199.95,93,,,percent of total billed charges,93% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,208.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,208.55,97,,,percent of total billed charges,97% of total billed charges,161.25,75,,,percent of total billed charges,75% of total billed charges,206.4,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.25,75,,,percent of total billed charges,75% of total billed charges,161.25,75,,,percent of total billed charges,75% of total billed charges,4.28,208.55,
PF AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL,78000144P,CDM,975,RC,11732,HCPCS,Outpatient,,,69,51.75,,63.48,92,,,percent of total billed charges,92% of total billed charges,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.17,93,,,percent of total billed charges,93% of total billed charges,62.1,90,,,percent of total billed charges,90% of total billed charges,62.1,90,,,percent of total billed charges,90% of total billed charges,66.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.93,97,,,percent of total billed charges,97% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges,66.24,96,,,percent of total billed charges,96% of total billed charges,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,51.75,75,,,percent of total billed charges,75% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges,1.39,66.93,
PF EVACUATION SUBUNGUAL HEMATOMA,78000146P,CDM,975,RC,11740,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,115.32,93,,,percent of total billed charges,93% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,120.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,120.28,97,,,percent of total billed charges,97% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,119.04,96,,,percent of total billed charges,96% of total billed charges,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93,75,,,percent of total billed charges,75% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,1.93,120.28,
PF EXCISION NAIL MATRIX PERMANENT REMOVAL,78000148P,CDM,975,RC,11750,HCPCS,Outpatient,,,241,180.75,,221.72,92,,,percent of total billed charges,92% of total billed charges,7.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,224.13,93,,,percent of total billed charges,93% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,233.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.77,97,,,percent of total billed charges,97% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,231.36,96,,,percent of total billed charges,96% of total billed charges,7.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.75,75,,,percent of total billed charges,75% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,7.05,233.77,
PF REPAIR OF NAIL BED,78000150P,CDM,975,RC,11760,HCPCS,Outpatient,,,294,220.5,,270.48,92,,,percent of total billed charges,92% of total billed charges,8.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,273.42,93,,,percent of total billed charges,93% of total billed charges,264.6,90,,,percent of total billed charges,90% of total billed charges,264.6,90,,,percent of total billed charges,90% of total billed charges,285.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,285.18,97,,,percent of total billed charges,97% of total billed charges,220.5,75,,,percent of total billed charges,75% of total billed charges,282.24,96,,,percent of total billed charges,96% of total billed charges,8.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,220.5,75,,,percent of total billed charges,75% of total billed charges,220.5,75,,,percent of total billed charges,75% of total billed charges,8.94,285.18,
PF WEDGE EXCISION SKIN NAIL FOLD,78000152P,CDM,975,RC,11765,HCPCS,Outpatient,,,251,188.25,,230.92,92,,,percent of total billed charges,92% of total billed charges,5.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.43,93,,,percent of total billed charges,93% of total billed charges,225.9,90,,,percent of total billed charges,90% of total billed charges,225.9,90,,,percent of total billed charges,90% of total billed charges,243.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,243.47,97,,,percent of total billed charges,97% of total billed charges,188.25,75,,,percent of total billed charges,75% of total billed charges,240.96,96,,,percent of total billed charges,96% of total billed charges,5.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,188.25,75,,,percent of total billed charges,75% of total billed charges,188.25,75,,,percent of total billed charges,75% of total billed charges,5.93,243.47,
PF EXCISION PILONIDAL CYST/SINUS SIMPLE,78002850P,CDM,975,RC,11770,HCPCS,Outpatient,,,898,673.5,,826.16,92,,,percent of total billed charges,92% of total billed charges,22.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,835.14,93,,,percent of total billed charges,93% of total billed charges,808.2,90,,,percent of total billed charges,90% of total billed charges,808.2,90,,,percent of total billed charges,90% of total billed charges,871.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,871.06,97,,,percent of total billed charges,97% of total billed charges,673.5,75,,,percent of total billed charges,75% of total billed charges,862.08,96,,,percent of total billed charges,96% of total billed charges,22.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,673.5,75,,,percent of total billed charges,75% of total billed charges,673.5,75,,,percent of total billed charges,75% of total billed charges,22.72,871.06,
PF EXCISION OF PILONIDAL CYST OR SINUS EXTENSIVE,78002851P,CDM,975,RC,11771,HCPCS,Outpatient,,,1580,1185,,1453.6,92,,,percent of total billed charges,92% of total billed charges,53.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1469.4,93,,,percent of total billed charges,93% of total billed charges,1422,90,,,percent of total billed charges,90% of total billed charges,1422,90,,,percent of total billed charges,90% of total billed charges,1532.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1532.6,97,,,percent of total billed charges,97% of total billed charges,1185,75,,,percent of total billed charges,75% of total billed charges,1516.8,96,,,percent of total billed charges,96% of total billed charges,53.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1185,75,,,percent of total billed charges,75% of total billed charges,1185,75,,,percent of total billed charges,75% of total billed charges,53.66,1532.6,
PF EXCISION PILONIDAL CYST/SINUS COMPLICATED,78000154P,CDM,975,RC,11772,HCPCS,Outpatient,,,1551,1163.25,,1426.92,92,,,percent of total billed charges,92% of total billed charges,65.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1442.43,93,,,percent of total billed charges,93% of total billed charges,1395.9,90,,,percent of total billed charges,90% of total billed charges,1395.9,90,,,percent of total billed charges,90% of total billed charges,1504.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,65.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1504.47,97,,,percent of total billed charges,97% of total billed charges,1163.25,75,,,percent of total billed charges,75% of total billed charges,1488.96,96,,,percent of total billed charges,96% of total billed charges,65.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1163.25,75,,,percent of total billed charges,75% of total billed charges,1163.25,75,,,percent of total billed charges,75% of total billed charges,65.19,1504.47,
PF INJECTION INTRALESIONAL UP TO  and  INCLUD 7 LESION,78000156P,CDM,975,RC,11900,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.61,93,,,percent of total billed charges,93% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,74.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.69,97,,,percent of total billed charges,97% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,73.92,96,,,percent of total billed charges,96% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.75,75,,,percent of total billed charges,75% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,2.65,74.69,
PF REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES,78000158P,CDM,975,RC,11976,HCPCS,Outpatient,,,245,183.75,,225.4,92,,,percent of total billed charges,92% of total billed charges,11.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,227.85,93,,,percent of total billed charges,93% of total billed charges,220.5,90,,,percent of total billed charges,90% of total billed charges,220.5,90,,,percent of total billed charges,90% of total billed charges,237.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237.65,97,,,percent of total billed charges,97% of total billed charges,183.75,75,,,percent of total billed charges,75% of total billed charges,235.2,96,,,percent of total billed charges,96% of total billed charges,11.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,183.75,75,,,percent of total billed charges,75% of total billed charges,183.75,75,,,percent of total billed charges,75% of total billed charges,11.33,237.65,
PF SUBCUTANEOUS HORMONE PELLET IMPLANTATION,78002110P,CDM,975,RC,11980,HCPCS,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges,5.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,128.34,93,,,percent of total billed charges,93% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,133.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,133.86,97,,,percent of total billed charges,97% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges,132.48,96,,,percent of total billed charges,96% of total billed charges,5.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.5,75,,,percent of total billed charges,75% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges,5.97,133.86,
PF INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,78000160P,CDM,975,RC,11981,HCPCS,Outpatient,,,167,125.25,,153.64,92,,,percent of total billed charges,92% of total billed charges,7.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,155.31,93,,,percent of total billed charges,93% of total billed charges,150.3,90,,,percent of total billed charges,90% of total billed charges,150.3,90,,,percent of total billed charges,90% of total billed charges,161.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.99,97,,,percent of total billed charges,97% of total billed charges,125.25,75,,,percent of total billed charges,75% of total billed charges,160.32,96,,,percent of total billed charges,96% of total billed charges,7.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.25,75,,,percent of total billed charges,75% of total billed charges,125.25,75,,,percent of total billed charges,75% of total billed charges,7.85,161.99,
PF REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,78000162P,CDM,975,RC,11982,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.35,93,,,percent of total billed charges,93% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,189.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.15,97,,,percent of total billed charges,97% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,187.2,96,,,percent of total billed charges,96% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.25,75,,,percent of total billed charges,75% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,9.02,189.15,
PF REMOVAL W/REINSERT NON-BIODEGRADABLE DRUG DELIVERY IMPLT,78000164P,CDM,975,RC,11983,HCPCS,Outpatient,,,272,204,,250.24,92,,,percent of total billed charges,92% of total billed charges,12.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,252.96,93,,,percent of total billed charges,93% of total billed charges,244.8,90,,,percent of total billed charges,90% of total billed charges,244.8,90,,,percent of total billed charges,90% of total billed charges,263.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,263.84,97,,,percent of total billed charges,97% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges,261.12,96,,,percent of total billed charges,96% of total billed charges,12.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204,75,,,percent of total billed charges,75% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges,12.77,263.84,
PF SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 2.5CM/<,78000166P,CDM,975,RC,12001,HCPCS,Outpatient,,,176,132,,161.92,92,,,percent of total billed charges,92% of total billed charges,5.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.68,93,,,percent of total billed charges,93% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,170.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,170.72,97,,,percent of total billed charges,97% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,168.96,96,,,percent of total billed charges,96% of total billed charges,5.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132,75,,,percent of total billed charges,75% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,5.88,170.72,
PF SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 2.6-7.5CM,78000168P,CDM,975,RC,12002,HCPCS,Outpatient,,,235,176.25,,216.2,92,,,percent of total billed charges,92% of total billed charges,7.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.55,93,,,percent of total billed charges,93% of total billed charges,211.5,90,,,percent of total billed charges,90% of total billed charges,211.5,90,,,percent of total billed charges,90% of total billed charges,227.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,227.95,97,,,percent of total billed charges,97% of total billed charges,176.25,75,,,percent of total billed charges,75% of total billed charges,225.6,96,,,percent of total billed charges,96% of total billed charges,7.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.25,75,,,percent of total billed charges,75% of total billed charges,176.25,75,,,percent of total billed charges,75% of total billed charges,7.99,227.95,
PF SIMPLE REPAIR SCLP NECK UNDERARM TRUNK ARM LEG 7.6-12.5CM,78000170P,CDM,975,RC,12004,HCPCS,Outpatient,,,292,219,,268.64,92,,,percent of total billed charges,92% of total billed charges,10.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,271.56,93,,,percent of total billed charges,93% of total billed charges,262.8,90,,,percent of total billed charges,90% of total billed charges,262.8,90,,,percent of total billed charges,90% of total billed charges,283.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,283.24,97,,,percent of total billed charges,97% of total billed charges,219,75,,,percent of total billed charges,75% of total billed charges,280.32,96,,,percent of total billed charges,96% of total billed charges,10.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219,75,,,percent of total billed charges,75% of total billed charges,219,75,,,percent of total billed charges,75% of total billed charges,10.4,283.24,
PF SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 12.6-20CM,78000172P,CDM,975,RC,12005,HCPCS,Outpatient,,,379,284.25,,348.68,92,,,percent of total billed charges,92% of total billed charges,14.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.47,93,,,percent of total billed charges,93% of total billed charges,341.1,90,,,percent of total billed charges,90% of total billed charges,341.1,90,,,percent of total billed charges,90% of total billed charges,367.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.63,97,,,percent of total billed charges,97% of total billed charges,284.25,75,,,percent of total billed charges,75% of total billed charges,363.84,96,,,percent of total billed charges,96% of total billed charges,14.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.25,75,,,percent of total billed charges,75% of total billed charges,284.25,75,,,percent of total billed charges,75% of total billed charges,14.11,367.63,
PF SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 20.1-30CM,78000174P,CDM,975,RC,12006,HCPCS,Outpatient,,,464,348,,426.88,92,,,percent of total billed charges,92% of total billed charges,16.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,431.52,93,,,percent of total billed charges,93% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,450.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,450.08,97,,,percent of total billed charges,97% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,445.44,96,,,percent of total billed charges,96% of total billed charges,16.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,348,75,,,percent of total billed charges,75% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,16.73,450.08,
PF SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG >30CM,78000176P,CDM,975,RC,12007,HCPCS,Outpatient,,,573,429.75,,527.16,92,,,percent of total billed charges,92% of total billed charges,20.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,532.89,93,,,percent of total billed charges,93% of total billed charges,515.7,90,,,percent of total billed charges,90% of total billed charges,515.7,90,,,percent of total billed charges,90% of total billed charges,555.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,555.81,97,,,percent of total billed charges,97% of total billed charges,429.75,75,,,percent of total billed charges,75% of total billed charges,550.08,96,,,percent of total billed charges,96% of total billed charges,20.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,429.75,75,,,percent of total billed charges,75% of total billed charges,429.75,75,,,percent of total billed charges,75% of total billed charges,20.69,555.81,
PF SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<,78000178P,CDM,975,RC,12011,HCPCS,Outpatient,,,221,165.75,,203.32,92,,,percent of total billed charges,92% of total billed charges,7.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,205.53,93,,,percent of total billed charges,93% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,214.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.37,97,,,percent of total billed charges,97% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,212.16,96,,,percent of total billed charges,96% of total billed charges,7.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.75,75,,,percent of total billed charges,75% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,7.61,214.37,
PF SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM,78000180P,CDM,975,RC,12013,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,216.69,93,,,percent of total billed charges,93% of total billed charges,209.7,90,,,percent of total billed charges,90% of total billed charges,209.7,90,,,percent of total billed charges,90% of total billed charges,226.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,226.01,97,,,percent of total billed charges,97% of total billed charges,174.75,75,,,percent of total billed charges,75% of total billed charges,223.68,96,,,percent of total billed charges,96% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,174.75,75,,,percent of total billed charges,75% of total billed charges,174.75,75,,,percent of total billed charges,75% of total billed charges,8.5,226.01,
PF SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 5.1-7.5,78000182P,CDM,975,RC,12014,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,11.26,289.06,
PF SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 7.6-12.,78000184P,CDM,975,RC,12015,HCPCS,Outpatient,,,376,282,,345.92,92,,,percent of total billed charges,92% of total billed charges,14.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,349.68,93,,,percent of total billed charges,93% of total billed charges,338.4,90,,,percent of total billed charges,90% of total billed charges,338.4,90,,,percent of total billed charges,90% of total billed charges,364.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,364.72,97,,,percent of total billed charges,97% of total billed charges,282,75,,,percent of total billed charges,75% of total billed charges,360.96,96,,,percent of total billed charges,96% of total billed charges,14.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,282,75,,,percent of total billed charges,75% of total billed charges,282,75,,,percent of total billed charges,75% of total billed charges,14.09,364.72,
PF SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 12.6-20,78000186P,CDM,975,RC,12016,HCPCS,Outpatient,,,510,382.5,,469.2,92,,,percent of total billed charges,92% of total billed charges,19.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,474.3,93,,,percent of total billed charges,93% of total billed charges,459,90,,,percent of total billed charges,90% of total billed charges,459,90,,,percent of total billed charges,90% of total billed charges,494.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,494.7,97,,,percent of total billed charges,97% of total billed charges,382.5,75,,,percent of total billed charges,75% of total billed charges,489.6,96,,,percent of total billed charges,96% of total billed charges,19.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,382.5,75,,,percent of total billed charges,75% of total billed charges,382.5,75,,,percent of total billed charges,75% of total billed charges,19.04,494.7,
PF SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 20.1-30,78000188P,CDM,975,RC,12017,HCPCS,Outpatient,,,400,300,,368,92,,,percent of total billed charges,92% of total billed charges,24.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,372,93,,,percent of total billed charges,93% of total billed charges,360,90,,,percent of total billed charges,90% of total billed charges,360,90,,,percent of total billed charges,90% of total billed charges,388,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388,97,,,percent of total billed charges,97% of total billed charges,300,75,,,percent of total billed charges,75% of total billed charges,384,96,,,percent of total billed charges,96% of total billed charges,24.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300,75,,,percent of total billed charges,75% of total billed charges,300,75,,,percent of total billed charges,75% of total billed charges,24.02,388,
PF SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE >30CM,78000190P,CDM,975,RC,12018,HCPCS,Outpatient,,,687,515.25,,632.04,92,,,percent of total billed charges,92% of total billed charges,26.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,638.91,93,,,percent of total billed charges,93% of total billed charges,618.3,90,,,percent of total billed charges,90% of total billed charges,618.3,90,,,percent of total billed charges,90% of total billed charges,666.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,666.39,97,,,percent of total billed charges,97% of total billed charges,515.25,75,,,percent of total billed charges,75% of total billed charges,659.52,96,,,percent of total billed charges,96% of total billed charges,26.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,515.25,75,,,percent of total billed charges,75% of total billed charges,515.25,75,,,percent of total billed charges,75% of total billed charges,26.85,666.39,
PF TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE,78000192P,CDM,975,RC,12020,HCPCS,Outpatient,,,657,492.75,,604.44,92,,,percent of total billed charges,92% of total billed charges,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,611.01,93,,,percent of total billed charges,93% of total billed charges,591.3,90,,,percent of total billed charges,90% of total billed charges,591.3,90,,,percent of total billed charges,90% of total billed charges,637.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,637.29,97,,,percent of total billed charges,97% of total billed charges,492.75,75,,,percent of total billed charges,75% of total billed charges,630.72,96,,,percent of total billed charges,96% of total billed charges,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,492.75,75,,,percent of total billed charges,75% of total billed charges,492.75,75,,,percent of total billed charges,75% of total billed charges,17.91,637.29,
PF REPAIR INTERMEDIATE SCALP UNDERARMS TRUNK ARM LEG 2.5 CM/,78000194P,CDM,975,RC,12031,HCPCS,Outpatient,,,565,423.75,,519.8,92,,,percent of total billed charges,92% of total billed charges,12.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,525.45,93,,,percent of total billed charges,93% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,548.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,548.05,97,,,percent of total billed charges,97% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,542.4,96,,,percent of total billed charges,96% of total billed charges,12.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,423.75,75,,,percent of total billed charges,75% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,12.01,548.05,
PF REPAIR INTERMEDIATE SCALP UNDERARMS TRUNK ARM LEG 2.6-7.5,78000196P,CDM,975,RC,12032,HCPCS,Outpatient,,,748,561,,688.16,92,,,percent of total billed charges,92% of total billed charges,14.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,695.64,93,,,percent of total billed charges,93% of total billed charges,673.2,90,,,percent of total billed charges,90% of total billed charges,673.2,90,,,percent of total billed charges,90% of total billed charges,725.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,725.56,97,,,percent of total billed charges,97% of total billed charges,561,75,,,percent of total billed charges,75% of total billed charges,718.08,96,,,percent of total billed charges,96% of total billed charges,14.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,561,75,,,percent of total billed charges,75% of total billed charges,561,75,,,percent of total billed charges,75% of total billed charges,14.43,725.56,
PF REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES 7.6-12.5C,78000198P,CDM,975,RC,12034,HCPCS,Outpatient,,,807,605.25,,742.44,92,,,percent of total billed charges,92% of total billed charges,17.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,750.51,93,,,percent of total billed charges,93% of total billed charges,726.3,90,,,percent of total billed charges,90% of total billed charges,726.3,90,,,percent of total billed charges,90% of total billed charges,782.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,782.79,97,,,percent of total billed charges,97% of total billed charges,605.25,75,,,percent of total billed charges,75% of total billed charges,774.72,96,,,percent of total billed charges,96% of total billed charges,17.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,605.25,75,,,percent of total billed charges,75% of total billed charges,605.25,75,,,percent of total billed charges,75% of total billed charges,17.93,782.79,
PF REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES 12.6-20CM,78000200P,CDM,975,RC,12035,HCPCS,Outpatient,,,946,709.5,,870.32,92,,,percent of total billed charges,92% of total billed charges,25.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,879.78,93,,,percent of total billed charges,93% of total billed charges,851.4,90,,,percent of total billed charges,90% of total billed charges,851.4,90,,,percent of total billed charges,90% of total billed charges,917.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,917.62,97,,,percent of total billed charges,97% of total billed charges,709.5,75,,,percent of total billed charges,75% of total billed charges,908.16,96,,,percent of total billed charges,96% of total billed charges,25.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,709.5,75,,,percent of total billed charges,75% of total billed charges,709.5,75,,,percent of total billed charges,75% of total billed charges,25.42,917.62,
PF REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES 20.1-30CM,78000202P,CDM,975,RC,12036,HCPCS,Outpatient,,,1109,831.75,,1020.28,92,,,percent of total billed charges,92% of total billed charges,33.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1031.37,93,,,percent of total billed charges,93% of total billed charges,998.1,90,,,percent of total billed charges,90% of total billed charges,998.1,90,,,percent of total billed charges,90% of total billed charges,1075.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1075.73,97,,,percent of total billed charges,97% of total billed charges,831.75,75,,,percent of total billed charges,75% of total billed charges,1064.64,96,,,percent of total billed charges,96% of total billed charges,33.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,831.75,75,,,percent of total billed charges,75% of total billed charges,831.75,75,,,percent of total billed charges,75% of total billed charges,33.62,1075.73,
PF REPAIR INTERMED SCALP AXILLAE TRUNK EXTREMETIES >30CM,78000204P,CDM,975,RC,12037,HCPCS,Outpatient,,,1295,971.25,,1191.4,92,,,percent of total billed charges,92% of total billed charges,40.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1204.35,93,,,percent of total billed charges,93% of total billed charges,1165.5,90,,,percent of total billed charges,90% of total billed charges,1165.5,90,,,percent of total billed charges,90% of total billed charges,1256.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1256.15,97,,,percent of total billed charges,97% of total billed charges,971.25,75,,,percent of total billed charges,75% of total billed charges,1243.2,96,,,percent of total billed charges,96% of total billed charges,40.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,971.25,75,,,percent of total billed charges,75% of total billed charges,971.25,75,,,percent of total billed charges,75% of total billed charges,40.08,1256.15,
PF REPAIR INTERMEDIATE NECK HAND FEET GENITALS 2.5CM/<,78000206P,CDM,975,RC,12041,HCPCS,Outpatient,,,576,432,,529.92,92,,,percent of total billed charges,92% of total billed charges,12.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,535.68,93,,,percent of total billed charges,93% of total billed charges,518.4,90,,,percent of total billed charges,90% of total billed charges,518.4,90,,,percent of total billed charges,90% of total billed charges,558.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,558.72,97,,,percent of total billed charges,97% of total billed charges,432,75,,,percent of total billed charges,75% of total billed charges,552.96,96,,,percent of total billed charges,96% of total billed charges,12.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,432,75,,,percent of total billed charges,75% of total billed charges,432,75,,,percent of total billed charges,75% of total billed charges,12.06,558.72,
PF REPAIR INTERMEDIATE NECK HAND FEET GENITALS 2.6-7.5CM,78000208P,CDM,975,RC,12042,HCPCS,Outpatient,,,772,579,,710.24,92,,,percent of total billed charges,92% of total billed charges,15.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717.96,93,,,percent of total billed charges,93% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,748.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,748.84,97,,,percent of total billed charges,97% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,741.12,96,,,percent of total billed charges,96% of total billed charges,15.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,579,75,,,percent of total billed charges,75% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,15.69,748.84,
PF REPAIR INTERMEDIATE NECK HAND FEET GENITALS 7.6-12.5CM,78000210P,CDM,975,RC,12044,HCPCS,Outpatient,,,841,630.75,,773.72,92,,,percent of total billed charges,92% of total billed charges,19.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,782.13,93,,,percent of total billed charges,93% of total billed charges,756.9,90,,,percent of total billed charges,90% of total billed charges,756.9,90,,,percent of total billed charges,90% of total billed charges,815.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,815.77,97,,,percent of total billed charges,97% of total billed charges,630.75,75,,,percent of total billed charges,75% of total billed charges,807.36,96,,,percent of total billed charges,96% of total billed charges,19.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,630.75,75,,,percent of total billed charges,75% of total billed charges,630.75,75,,,percent of total billed charges,75% of total billed charges,19.6,815.77,
PF REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM,78000212P,CDM,975,RC,12045,HCPCS,Outpatient,,,1058,793.5,,973.36,92,,,percent of total billed charges,92% of total billed charges,28.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,983.94,93,,,percent of total billed charges,93% of total billed charges,952.2,90,,,percent of total billed charges,90% of total billed charges,952.2,90,,,percent of total billed charges,90% of total billed charges,1026.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1026.26,97,,,percent of total billed charges,97% of total billed charges,793.5,75,,,percent of total billed charges,75% of total billed charges,1015.68,96,,,percent of total billed charges,96% of total billed charges,28.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,793.5,75,,,percent of total billed charges,75% of total billed charges,793.5,75,,,percent of total billed charges,75% of total billed charges,28.18,1026.26,
PF RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM,78000214P,CDM,975,RC,12046,HCPCS,Outpatient,,,1074,805.5,,988.08,92,,,percent of total billed charges,92% of total billed charges,41.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,998.82,93,,,percent of total billed charges,93% of total billed charges,966.6,90,,,percent of total billed charges,90% of total billed charges,966.6,90,,,percent of total billed charges,90% of total billed charges,1041.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1041.78,97,,,percent of total billed charges,97% of total billed charges,805.5,75,,,percent of total billed charges,75% of total billed charges,1031.04,96,,,percent of total billed charges,96% of total billed charges,41.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,805.5,75,,,percent of total billed charges,75% of total billed charges,805.5,75,,,percent of total billed charges,75% of total billed charges,41.41,1041.78,
PF REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM,78000216P,CDM,975,RC,12047,HCPCS,Outpatient,,,1373,1029.75,,1263.16,92,,,percent of total billed charges,92% of total billed charges,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1276.89,93,,,percent of total billed charges,93% of total billed charges,1235.7,90,,,percent of total billed charges,90% of total billed charges,1235.7,90,,,percent of total billed charges,90% of total billed charges,1331.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1331.81,97,,,percent of total billed charges,97% of total billed charges,1029.75,75,,,percent of total billed charges,75% of total billed charges,1318.08,96,,,percent of total billed charges,96% of total billed charges,46.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1029.75,75,,,percent of total billed charges,75% of total billed charges,1029.75,75,,,percent of total billed charges,75% of total billed charges,46.68,1331.81,
PF REPAIR INTERMEDIATE F/E/E/N/L/MUC 2.5 CM/<,78000218P,CDM,975,RC,12051,HCPCS,Outpatient,,,445,333.75,,409.4,92,,,percent of total billed charges,92% of total billed charges,14.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.85,93,,,percent of total billed charges,93% of total billed charges,400.5,90,,,percent of total billed charges,90% of total billed charges,400.5,90,,,percent of total billed charges,90% of total billed charges,431.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,431.65,97,,,percent of total billed charges,97% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges,427.2,96,,,percent of total billed charges,96% of total billed charges,14.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333.75,75,,,percent of total billed charges,75% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges,14.26,431.65,
PF REPAIR INTERMEDIATE F/E/E/N/L/MUC 2.6-5.0 CM,78000220P,CDM,975,RC,12052,HCPCS,Outpatient,,,785,588.75,,722.2,92,,,percent of total billed charges,92% of total billed charges,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,730.05,93,,,percent of total billed charges,93% of total billed charges,706.5,90,,,percent of total billed charges,90% of total billed charges,706.5,90,,,percent of total billed charges,90% of total billed charges,761.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,761.45,97,,,percent of total billed charges,97% of total billed charges,588.75,75,,,percent of total billed charges,75% of total billed charges,753.6,96,,,percent of total billed charges,96% of total billed charges,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,588.75,75,,,percent of total billed charges,75% of total billed charges,588.75,75,,,percent of total billed charges,75% of total billed charges,16.36,761.45,
PF REPAIR INTERMEDIATE F/E/E/N/L/MUC 5.1-7.5 CM,78000222P,CDM,975,RC,12053,HCPCS,Outpatient,,,847,635.25,,779.24,92,,,percent of total billed charges,92% of total billed charges,18.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,787.71,93,,,percent of total billed charges,93% of total billed charges,762.3,90,,,percent of total billed charges,90% of total billed charges,762.3,90,,,percent of total billed charges,90% of total billed charges,821.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,821.59,97,,,percent of total billed charges,97% of total billed charges,635.25,75,,,percent of total billed charges,75% of total billed charges,813.12,96,,,percent of total billed charges,96% of total billed charges,18.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,635.25,75,,,percent of total billed charges,75% of total billed charges,635.25,75,,,percent of total billed charges,75% of total billed charges,18.26,821.59,
PF REPAIR INTERMEDIATE F/E/E/N/L/MUC 7.6-12.5 CM,78000224P,CDM,975,RC,12054,HCPCS,Outpatient,,,866,649.5,,796.72,92,,,percent of total billed charges,92% of total billed charges,21.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,805.38,93,,,percent of total billed charges,93% of total billed charges,779.4,90,,,percent of total billed charges,90% of total billed charges,779.4,90,,,percent of total billed charges,90% of total billed charges,840.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.02,97,,,percent of total billed charges,97% of total billed charges,649.5,75,,,percent of total billed charges,75% of total billed charges,831.36,96,,,percent of total billed charges,96% of total billed charges,21.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,649.5,75,,,percent of total billed charges,75% of total billed charges,649.5,75,,,percent of total billed charges,75% of total billed charges,21.69,840.02,
PF REPAIR INTERM FACE EAR EYELD NOSE LIP MUCOUS MEMBR 12.6-2,78000226P,CDM,975,RC,12055,HCPCS,Outpatient,,,1179,884.25,,1084.68,92,,,percent of total billed charges,92% of total billed charges,32.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1096.47,93,,,percent of total billed charges,93% of total billed charges,1061.1,90,,,percent of total billed charges,90% of total billed charges,1061.1,90,,,percent of total billed charges,90% of total billed charges,1143.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1143.63,97,,,percent of total billed charges,97% of total billed charges,884.25,75,,,percent of total billed charges,75% of total billed charges,1131.84,96,,,percent of total billed charges,96% of total billed charges,32.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,884.25,75,,,percent of total billed charges,75% of total billed charges,884.25,75,,,percent of total billed charges,75% of total billed charges,32.39,1143.63,
PF REPAIR INTERM FACE EAR EYELID NOSE LIP MUCOUS MEMB 20.1-3,78000228P,CDM,975,RC,12056,HCPCS,Outpatient,,,1513,1134.75,,1391.96,92,,,percent of total billed charges,92% of total billed charges,39.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1407.09,93,,,percent of total billed charges,93% of total billed charges,1361.7,90,,,percent of total billed charges,90% of total billed charges,1361.7,90,,,percent of total billed charges,90% of total billed charges,1467.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,39.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1467.61,97,,,percent of total billed charges,97% of total billed charges,1134.75,75,,,percent of total billed charges,75% of total billed charges,1452.48,96,,,percent of total billed charges,96% of total billed charges,39.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1134.75,75,,,percent of total billed charges,75% of total billed charges,1134.75,75,,,percent of total billed charges,75% of total billed charges,39.84,1467.61,
PF REPAIR INTERM FACE EAR EYELID NOSE LIP MUCOUS MEMBR >30CM,78000230P,CDM,975,RC,12057,HCPCS,Outpatient,,,1674,1255.5,,1540.08,92,,,percent of total billed charges,92% of total billed charges,44.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1556.82,93,,,percent of total billed charges,93% of total billed charges,1506.6,90,,,percent of total billed charges,90% of total billed charges,1506.6,90,,,percent of total billed charges,90% of total billed charges,1623.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,44.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1623.78,97,,,percent of total billed charges,97% of total billed charges,1255.5,75,,,percent of total billed charges,75% of total billed charges,1607.04,96,,,percent of total billed charges,96% of total billed charges,44.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1255.5,75,,,percent of total billed charges,75% of total billed charges,1255.5,75,,,percent of total billed charges,75% of total billed charges,44.85,1623.78,
PF REPAIR COMPLEX WOUND TRUNK 1.1-2.5 CM,78000232P,CDM,975,RC,13100,HCPCS,Outpatient,,,795,596.25,,731.4,92,,,percent of total billed charges,92% of total billed charges,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,739.35,93,,,percent of total billed charges,93% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,771.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,771.15,97,,,percent of total billed charges,97% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,763.2,96,,,percent of total billed charges,96% of total billed charges,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,596.25,75,,,percent of total billed charges,75% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,17.19,771.15,
PF REPAIR COMPLEX WOUND TRUNK 2.6-7.5 CM,78000234P,CDM,975,RC,13101,HCPCS,Outpatient,,,978,733.5,,899.76,92,,,percent of total billed charges,92% of total billed charges,19.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,909.54,93,,,percent of total billed charges,93% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,948.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,948.66,97,,,percent of total billed charges,97% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,938.88,96,,,percent of total billed charges,96% of total billed charges,19.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,733.5,75,,,percent of total billed charges,75% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,19.86,948.66,
PF REPAIR COMPLEX WOUND TRUNK EACH ADDITIONAL 5 CM/<,78000236P,CDM,975,RC,13102,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges,7.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.98,93,,,percent of total billed charges,93% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,277.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.42,97,,,percent of total billed charges,97% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,274.56,96,,,percent of total billed charges,96% of total billed charges,7.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.5,75,,,percent of total billed charges,75% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,7.88,277.42,
PF REPAIR COMPLEX WOUND SCALP ARM LEG 1.1-2.5 CM,78000238P,CDM,975,RC,13120,HCPCS,Outpatient,,,914,685.5,,840.88,92,,,percent of total billed charges,92% of total billed charges,18.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,850.02,93,,,percent of total billed charges,93% of total billed charges,822.6,90,,,percent of total billed charges,90% of total billed charges,822.6,90,,,percent of total billed charges,90% of total billed charges,886.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,886.58,97,,,percent of total billed charges,97% of total billed charges,685.5,75,,,percent of total billed charges,75% of total billed charges,877.44,96,,,percent of total billed charges,96% of total billed charges,18.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,685.5,75,,,percent of total billed charges,75% of total billed charges,685.5,75,,,percent of total billed charges,75% of total billed charges,18.8,886.58,
PF REPAIR COMPLEX WOUND SCALP ARM LEG 2.6-7.5 CM,78000240P,CDM,975,RC,13121,HCPCS,Outpatient,,,675,506.25,,621,92,,,percent of total billed charges,92% of total billed charges,21.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,627.75,93,,,percent of total billed charges,93% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,654.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,654.75,97,,,percent of total billed charges,97% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,648,96,,,percent of total billed charges,96% of total billed charges,21.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,506.25,75,,,percent of total billed charges,75% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,21.59,654.75,
PF REPAIR COMPLEX WOUND SCALP ARM LEG EACH ADDL 5 CM/<,78000242P,CDM,975,RC,13122,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.9,93,,,percent of total billed charges,93% of total billed charges,297,90,,,percent of total billed charges,90% of total billed charges,297,90,,,percent of total billed charges,90% of total billed charges,320.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,320.1,97,,,percent of total billed charges,97% of total billed charges,247.5,75,,,percent of total billed charges,75% of total billed charges,316.8,96,,,percent of total billed charges,96% of total billed charges,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,247.5,75,,,percent of total billed charges,75% of total billed charges,247.5,75,,,percent of total billed charges,75% of total billed charges,8.79,320.1,
PF REPAIR COMP FOREHEAD CHEEK CHIN MOUTH NECK HAND 1.1-2.5CM,78000244P,CDM,975,RC,13131,HCPCS,Outpatient,,,963,722.25,,885.96,92,,,percent of total billed charges,92% of total billed charges,20.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,895.59,93,,,percent of total billed charges,93% of total billed charges,866.7,90,,,percent of total billed charges,90% of total billed charges,866.7,90,,,percent of total billed charges,90% of total billed charges,934.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,934.11,97,,,percent of total billed charges,97% of total billed charges,722.25,75,,,percent of total billed charges,75% of total billed charges,924.48,96,,,percent of total billed charges,96% of total billed charges,20.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,722.25,75,,,percent of total billed charges,75% of total billed charges,722.25,75,,,percent of total billed charges,75% of total billed charges,20.78,934.11,
PF REPAIR COMP FOREHEAD CHEEK CHIN MOUTH NECK HAND 2.6-7.5CM,78000246P,CDM,975,RC,13132,HCPCS,Outpatient,,,795,596.25,,731.4,92,,,percent of total billed charges,92% of total billed charges,25.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,739.35,93,,,percent of total billed charges,93% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,771.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,771.15,97,,,percent of total billed charges,97% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,763.2,96,,,percent of total billed charges,96% of total billed charges,25.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,596.25,75,,,percent of total billed charges,75% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,25.28,771.15,
PF REPAIR COMP FOREHEAD CHEEK CHIN MOUTH NECK HAND EA ADD 5C,78000248P,CDM,975,RC,13133,HCPCS,Outpatient,,,503,377.25,,462.76,92,,,percent of total billed charges,92% of total billed charges,12.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,467.79,93,,,percent of total billed charges,93% of total billed charges,452.7,90,,,percent of total billed charges,90% of total billed charges,452.7,90,,,percent of total billed charges,90% of total billed charges,487.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,487.91,97,,,percent of total billed charges,97% of total billed charges,377.25,75,,,percent of total billed charges,75% of total billed charges,482.88,96,,,percent of total billed charges,96% of total billed charges,12.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,377.25,75,,,percent of total billed charges,75% of total billed charges,377.25,75,,,percent of total billed charges,75% of total billed charges,12.15,487.91,
PF REPAIR COMPLEX WOUND EYELID NOSE EAR LIP 1.1-2.5CM,78000250P,CDM,975,RC,13151,HCPCS,Outpatient,,,562,421.5,,517.04,92,,,percent of total billed charges,92% of total billed charges,24.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,522.66,93,,,percent of total billed charges,93% of total billed charges,505.8,90,,,percent of total billed charges,90% of total billed charges,505.8,90,,,percent of total billed charges,90% of total billed charges,545.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,545.14,97,,,percent of total billed charges,97% of total billed charges,421.5,75,,,percent of total billed charges,75% of total billed charges,539.52,96,,,percent of total billed charges,96% of total billed charges,24.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,421.5,75,,,percent of total billed charges,75% of total billed charges,421.5,75,,,percent of total billed charges,75% of total billed charges,24.18,545.14,
PF REPAIR COMPLEX WOUND EYELID NOSE EAR LIP 2.6-7.5CM,78000252P,CDM,975,RC,13152,HCPCS,Outpatient,,,881,660.75,,810.52,92,,,percent of total billed charges,92% of total billed charges,29.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,819.33,93,,,percent of total billed charges,93% of total billed charges,792.9,90,,,percent of total billed charges,90% of total billed charges,792.9,90,,,percent of total billed charges,90% of total billed charges,854.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,854.57,97,,,percent of total billed charges,97% of total billed charges,660.75,75,,,percent of total billed charges,75% of total billed charges,845.76,96,,,percent of total billed charges,96% of total billed charges,29.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,660.75,75,,,percent of total billed charges,75% of total billed charges,660.75,75,,,percent of total billed charges,75% of total billed charges,29.39,854.57,
PF REPAIR COMPLEX WOUND EYELID NOSE EAR LIP EACH ADDL 5CM,78000254P,CDM,975,RC,13153,HCPCS,Outpatient,,,358,268.5,,329.36,92,,,percent of total billed charges,92% of total billed charges,14.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,332.94,93,,,percent of total billed charges,93% of total billed charges,322.2,90,,,percent of total billed charges,90% of total billed charges,322.2,90,,,percent of total billed charges,90% of total billed charges,347.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,347.26,97,,,percent of total billed charges,97% of total billed charges,268.5,75,,,percent of total billed charges,75% of total billed charges,343.68,96,,,percent of total billed charges,96% of total billed charges,14.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,268.5,75,,,percent of total billed charges,75% of total billed charges,268.5,75,,,percent of total billed charges,75% of total billed charges,14.7,347.26,
PF SECONDARY CLOSURE SURG WOUND/DEHISCENCE COMPLICATED,78000256P,CDM,975,RC,13160,HCPCS,Outpatient,,,2110,1582.5,,1941.2,92,,,percent of total billed charges,92% of total billed charges,83.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1962.3,93,,,percent of total billed charges,93% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,1899,90,,,percent of total billed charges,90% of total billed charges,2046.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,83.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2046.7,97,,,percent of total billed charges,97% of total billed charges,1582.5,75,,,percent of total billed charges,75% of total billed charges,2025.6,96,,,percent of total billed charges,96% of total billed charges,83.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1582.5,75,,,percent of total billed charges,75% of total billed charges,1582.5,75,,,percent of total billed charges,75% of total billed charges,83.65,2046.7,
PF ADJACENT TISSUE TRANSFER SCALP ARM LEG 10.1-30.0 SQ CM,78000258P,CDM,975,RC,14021,HCPCS,Outpatient,,,1862,1396.5,,1713.04,92,,,percent of total billed charges,92% of total billed charges,61.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1731.66,93,,,percent of total billed charges,93% of total billed charges,1675.8,90,,,percent of total billed charges,90% of total billed charges,1675.8,90,,,percent of total billed charges,90% of total billed charges,1806.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1806.14,97,,,percent of total billed charges,97% of total billed charges,1396.5,75,,,percent of total billed charges,75% of total billed charges,1787.52,96,,,percent of total billed charges,96% of total billed charges,61.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1396.5,75,,,percent of total billed charges,75% of total billed charges,1396.5,75,,,percent of total billed charges,75% of total billed charges,61.37,1806.14,
PF ADJACENT TISSUE TRNS/REARGMT F/C/C/M/N/A/G/H 10SQCM/<,78000260P,CDM,975,RC,14040,HCPCS,Outpatient,,,1637,1227.75,,1506.04,92,,,percent of total billed charges,92% of total billed charges,51.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1522.41,93,,,percent of total billed charges,93% of total billed charges,1473.3,90,,,percent of total billed charges,90% of total billed charges,1473.3,90,,,percent of total billed charges,90% of total billed charges,1587.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,51.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1587.89,97,,,percent of total billed charges,97% of total billed charges,1227.75,75,,,percent of total billed charges,75% of total billed charges,1571.52,96,,,percent of total billed charges,96% of total billed charges,51.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1227.75,75,,,percent of total billed charges,75% of total billed charges,1227.75,75,,,percent of total billed charges,75% of total billed charges,51.94,1587.89,
PF PREPARE SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT,78000262P,CDM,975,RC,15002,HCPCS,Outpatient,,,577,432.75,,530.84,92,,,percent of total billed charges,92% of total billed charges,25.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.61,93,,,percent of total billed charges,93% of total billed charges,519.3,90,,,percent of total billed charges,90% of total billed charges,519.3,90,,,percent of total billed charges,90% of total billed charges,559.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,559.69,97,,,percent of total billed charges,97% of total billed charges,432.75,75,,,percent of total billed charges,75% of total billed charges,553.92,96,,,percent of total billed charges,96% of total billed charges,25.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,432.75,75,,,percent of total billed charges,75% of total billed charges,432.75,75,,,percent of total billed charges,75% of total billed charges,25.42,559.69,
PF PINCH GRAFT TO COVER SMALL ULCER DEFECT UP TO 2CM,78000264P,CDM,975,RC,15050,HCPCS,Outpatient,,,1579,1184.25,,1452.68,92,,,percent of total billed charges,92% of total billed charges,43.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1468.47,93,,,percent of total billed charges,93% of total billed charges,1421.1,90,,,percent of total billed charges,90% of total billed charges,1421.1,90,,,percent of total billed charges,90% of total billed charges,1531.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1531.63,97,,,percent of total billed charges,97% of total billed charges,1184.25,75,,,percent of total billed charges,75% of total billed charges,1515.84,96,,,percent of total billed charges,96% of total billed charges,43.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1184.25,75,,,percent of total billed charges,75% of total billed charges,1184.25,75,,,percent of total billed charges,75% of total billed charges,43.26,1531.63,
PF SPLIT AUTOGRAFT TRUNK ARM LEG 1ST 100SQCM OR LESS,78000266P,CDM,975,RC,15100,HCPCS,Outpatient,,,1893,1419.75,,1741.56,92,,,percent of total billed charges,92% of total billed charges,77.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1760.49,93,,,percent of total billed charges,93% of total billed charges,1703.7,90,,,percent of total billed charges,90% of total billed charges,1703.7,90,,,percent of total billed charges,90% of total billed charges,1836.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,77.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1836.21,97,,,percent of total billed charges,97% of total billed charges,1419.75,75,,,percent of total billed charges,75% of total billed charges,1817.28,96,,,percent of total billed charges,96% of total billed charges,77.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1419.75,75,,,percent of total billed charges,75% of total billed charges,1419.75,75,,,percent of total billed charges,75% of total billed charges,77.12,1836.21,
PF EPIDERMAL AUTOGRAFT TRUNK ARM LEG 1ST 100CM,78000268P,CDM,975,RC,15110,HCPCS,Outpatient,,,1875,1406.25,,1725,92,,,percent of total billed charges,92% of total billed charges,81.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1743.75,93,,,percent of total billed charges,93% of total billed charges,1687.5,90,,,percent of total billed charges,90% of total billed charges,1687.5,90,,,percent of total billed charges,90% of total billed charges,1818.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,81.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1818.75,97,,,percent of total billed charges,97% of total billed charges,1406.25,75,,,percent of total billed charges,75% of total billed charges,1800,96,,,percent of total billed charges,96% of total billed charges,81.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1406.25,75,,,percent of total billed charges,75% of total billed charges,1406.25,75,,,percent of total billed charges,75% of total billed charges,81.69,1818.75,
PF EPIDRM AGRFT T/A/L EA 100CM/EA 1% BDY INFT/CHLD,78000270P,CDM,975,RC,15111,HCPCS,Outpatient,,,268,201,,246.56,92,,,percent of total billed charges,92% of total billed charges,14.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249.24,93,,,percent of total billed charges,93% of total billed charges,241.2,90,,,percent of total billed charges,90% of total billed charges,241.2,90,,,percent of total billed charges,90% of total billed charges,259.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,259.96,97,,,percent of total billed charges,97% of total billed charges,201,75,,,percent of total billed charges,75% of total billed charges,257.28,96,,,percent of total billed charges,96% of total billed charges,14.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201,75,,,percent of total billed charges,75% of total billed charges,201,75,,,percent of total billed charges,75% of total billed charges,14.87,259.96,
PF EPIDERMAL AUTOGRFT FACE SCLP NCK GENIT HAND FEET 1ST 100S,78000272P,CDM,975,RC,15115,HCPCS,Outpatient,,,1821,1365.75,,1675.32,92,,,percent of total billed charges,92% of total billed charges,71.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1693.53,93,,,percent of total billed charges,93% of total billed charges,1638.9,90,,,percent of total billed charges,90% of total billed charges,1638.9,90,,,percent of total billed charges,90% of total billed charges,1766.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,71.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1766.37,97,,,percent of total billed charges,97% of total billed charges,1365.75,75,,,percent of total billed charges,75% of total billed charges,1748.16,96,,,percent of total billed charges,96% of total billed charges,71.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1365.75,75,,,percent of total billed charges,75% of total billed charges,1365.75,75,,,percent of total billed charges,75% of total billed charges,71.26,1766.37,
PF EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM,78000274P,CDM,975,RC,15116,HCPCS,Outpatient,,,392,294,,360.64,92,,,percent of total billed charges,92% of total billed charges,19.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,364.56,93,,,percent of total billed charges,93% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,380.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,380.24,97,,,percent of total billed charges,97% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,376.32,96,,,percent of total billed charges,96% of total billed charges,19.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,294,75,,,percent of total billed charges,75% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,19.65,380.24,
PF SPLIT AUTOGRAFT FACE SCALP NECK GENIT HAND FEET 1ST 100SQ,78000276P,CDM,975,RC,15120,HCPCS,Outpatient,,,1820,1365,,1674.4,92,,,percent of total billed charges,92% of total billed charges,69.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1692.6,93,,,percent of total billed charges,93% of total billed charges,1638,90,,,percent of total billed charges,90% of total billed charges,1638,90,,,percent of total billed charges,90% of total billed charges,1765.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,69.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1765.4,97,,,percent of total billed charges,97% of total billed charges,1365,75,,,percent of total billed charges,75% of total billed charges,1747.2,96,,,percent of total billed charges,96% of total billed charges,69.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1365,75,,,percent of total billed charges,75% of total billed charges,1365,75,,,percent of total billed charges,75% of total billed charges,69.16,1765.4,
PF FULL THICKNESS GRAFT FREE SCALP ARM LEG <20SQCN,78000278P,CDM,975,RC,15220,HCPCS,Outpatient,,,1604,1203,,1475.68,92,,,percent of total billed charges,92% of total billed charges,53.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1491.72,93,,,percent of total billed charges,93% of total billed charges,1443.6,90,,,percent of total billed charges,90% of total billed charges,1443.6,90,,,percent of total billed charges,90% of total billed charges,1555.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1555.88,97,,,percent of total billed charges,97% of total billed charges,1203,75,,,percent of total billed charges,75% of total billed charges,1539.84,96,,,percent of total billed charges,96% of total billed charges,53.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1203,75,,,percent of total billed charges,75% of total billed charges,1203,75,,,percent of total billed charges,75% of total billed charges,53.39,1555.88,
PF FULL THICK GRAFT FOREHD CHK CHIN MOUTH NCK AXIL HND <20SQ,78000280P,CDM,975,RC,15240,HCPCS,Outpatient,,,2091,1568.25,,1923.72,92,,,percent of total billed charges,92% of total billed charges,66.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1944.63,93,,,percent of total billed charges,93% of total billed charges,1881.9,90,,,percent of total billed charges,90% of total billed charges,1881.9,90,,,percent of total billed charges,90% of total billed charges,2028.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,66.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2028.27,97,,,percent of total billed charges,97% of total billed charges,1568.25,75,,,percent of total billed charges,75% of total billed charges,2007.36,96,,,percent of total billed charges,96% of total billed charges,66.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1568.25,75,,,percent of total billed charges,75% of total billed charges,1568.25,75,,,percent of total billed charges,75% of total billed charges,66.59,2028.27,
PF SKIN GRAFT TRUNK ARM LEG UP TO 100SQCM 1ST 25 SQ CM,78000282P,CDM,975,RC,15271,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges,8.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.6,93,,,percent of total billed charges,93% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,213.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.4,97,,,percent of total billed charges,97% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,211.2,96,,,percent of total billed charges,96% of total billed charges,8.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165,75,,,percent of total billed charges,75% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,8.85,213.4,
PF SKIN GRAFT TRUNK ARM LEG UP TO 100SQCM EA ADDL 25 SQ CM,78000284P,CDM,975,RC,15272,HCPCS,Outpatient,,,46,34.5,,42.32,92,,,percent of total billed charges,92% of total billed charges,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,42.78,93,,,percent of total billed charges,93% of total billed charges,41.4,90,,,percent of total billed charges,90% of total billed charges,41.4,90,,,percent of total billed charges,90% of total billed charges,44.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,44.62,97,,,percent of total billed charges,97% of total billed charges,34.5,75,,,percent of total billed charges,75% of total billed charges,44.16,96,,,percent of total billed charges,96% of total billed charges,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,34.5,75,,,percent of total billed charges,75% of total billed charges,34.5,75,,,percent of total billed charges,75% of total billed charges,1.93,44.62,
PF APPLICATION SKIN SUBSTITUTE TO TRUNK ARM LEG 1ST 100 SQ C,78000286P,CDM,975,RC,15273,HCPCS,Outpatient,,,519,389.25,,477.48,92,,,percent of total billed charges,92% of total billed charges,24.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,482.67,93,,,percent of total billed charges,93% of total billed charges,467.1,90,,,percent of total billed charges,90% of total billed charges,467.1,90,,,percent of total billed charges,90% of total billed charges,503.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,503.43,97,,,percent of total billed charges,97% of total billed charges,389.25,75,,,percent of total billed charges,75% of total billed charges,498.24,96,,,percent of total billed charges,96% of total billed charges,24.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,389.25,75,,,percent of total billed charges,75% of total billed charges,389.25,75,,,percent of total billed charges,75% of total billed charges,24.04,503.43,
PF APPLY SKIN SUBSTITUTE TRNK ARM LEG >/=100SCM ADDL 100SQCM,78000288P,CDM,975,RC,15274,HCPCS,Outpatient,,,119,89.25,,109.48,92,,,percent of total billed charges,92% of total billed charges,6.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.67,93,,,percent of total billed charges,93% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,115.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,115.43,97,,,percent of total billed charges,97% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,114.24,96,,,percent of total billed charges,96% of total billed charges,6.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,89.25,75,,,percent of total billed charges,75% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,6.13,115.43,
PF APPLY SKIN GRFT FACE NCK GENIT HAND FT TO 100SQCM 1ST 25S,78000290P,CDM,975,RC,15275,HCPCS,Outpatient,,,246,184.5,,226.32,92,,,percent of total billed charges,92% of total billed charges,8.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.78,93,,,percent of total billed charges,93% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,238.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,238.62,97,,,percent of total billed charges,97% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges,236.16,96,,,percent of total billed charges,96% of total billed charges,8.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.5,75,,,percent of total billed charges,75% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges,8.34,238.62,
PF APPLY SKIN GRFT FACE NCK GENIT HND FT TO 100SQCM ADDL 25S,78000292P,CDM,975,RC,15276,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges,2.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,62.31,93,,,percent of total billed charges,93% of total billed charges,60.3,90,,,percent of total billed charges,90% of total billed charges,60.3,90,,,percent of total billed charges,90% of total billed charges,64.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.99,97,,,percent of total billed charges,97% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges,64.32,96,,,percent of total billed charges,96% of total billed charges,2.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,50.25,75,,,percent of total billed charges,75% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges,2.75,64.99,
PF APPLY SKIN GRAFT F/S/N/H/F/G/M/D >/= 100SCM 1ST 100SQCM,78000294P,CDM,975,RC,15277,HCPCS,Outpatient,,,592,444,,544.64,92,,,percent of total billed charges,92% of total billed charges,27.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,550.56,93,,,percent of total billed charges,93% of total billed charges,532.8,90,,,percent of total billed charges,90% of total billed charges,532.8,90,,,percent of total billed charges,90% of total billed charges,574.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,574.24,97,,,percent of total billed charges,97% of total billed charges,444,75,,,percent of total billed charges,75% of total billed charges,568.32,96,,,percent of total billed charges,96% of total billed charges,27.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,444,75,,,percent of total billed charges,75% of total billed charges,444,75,,,percent of total billed charges,75% of total billed charges,27.14,574.24,
PF APPLY SKIN GRFT F/S/N/H/F/G/M/D >/= 100SCM ADDL 100SQCM,78000296P,CDM,975,RC,15278,HCPCS,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.57,93,,,percent of total billed charges,93% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,144.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.53,97,,,percent of total billed charges,97% of total billed charges,111.75,75,,,percent of total billed charges,75% of total billed charges,143.04,96,,,percent of total billed charges,96% of total billed charges,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.75,75,,,percent of total billed charges,75% of total billed charges,111.75,75,,,percent of total billed charges,75% of total billed charges,7.33,144.53,
PF FORMATION PEDICLE WITH OR WITHOUT TRNSFR FH/CH/CH/M/N/AX/,78000298P,CDM,975,RC,15574,HCPCS,Outpatient,,,3142,2356.5,,2890.64,92,,,percent of total billed charges,92% of total billed charges,70.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2922.06,93,,,percent of total billed charges,93% of total billed charges,2827.8,90,,,percent of total billed charges,90% of total billed charges,2827.8,90,,,percent of total billed charges,90% of total billed charges,3047.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3047.74,97,,,percent of total billed charges,97% of total billed charges,2356.5,75,,,percent of total billed charges,75% of total billed charges,3016.32,96,,,percent of total billed charges,96% of total billed charges,70.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2356.5,75,,,percent of total billed charges,75% of total billed charges,2356.5,75,,,percent of total billed charges,75% of total billed charges,70.89,3047.74,
PF DELAY FLAP OR SECTIONING FLAP F/C/C/N/AX/G/H/F,78000300P,CDM,975,RC,15620,HCPCS,Outpatient,,,1943,1457.25,,1787.56,92,,,percent of total billed charges,92% of total billed charges,27.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1806.99,93,,,percent of total billed charges,93% of total billed charges,1748.7,90,,,percent of total billed charges,90% of total billed charges,1748.7,90,,,percent of total billed charges,90% of total billed charges,1884.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1884.71,97,,,percent of total billed charges,97% of total billed charges,1457.25,75,,,percent of total billed charges,75% of total billed charges,1865.28,96,,,percent of total billed charges,96% of total billed charges,27.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1457.25,75,,,percent of total billed charges,75% of total billed charges,1457.25,75,,,percent of total billed charges,75% of total billed charges,27.36,1884.71,
PF GRAFTING OF AUTOLOGOUS SOFT TISSUE,78002830P,CDM,975,RC,15769,HCPCS,Outpatient,,,1204,903,,1107.68,92,,,percent of total billed charges,92% of total billed charges,50.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1119.72,93,,,percent of total billed charges,93% of total billed charges,1083.6,90,,,percent of total billed charges,90% of total billed charges,1083.6,90,,,percent of total billed charges,90% of total billed charges,1167.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1167.88,97,,,percent of total billed charges,97% of total billed charges,903,75,,,percent of total billed charges,75% of total billed charges,1155.84,96,,,percent of total billed charges,96% of total billed charges,50.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,903,75,,,percent of total billed charges,75% of total billed charges,903,75,,,percent of total billed charges,75% of total billed charges,50.85,1167.88,
PF INITIAL TREATMENT 1ST DEGREE BURN LOCAL,78000302P,CDM,975,RC,16000,HCPCS,Outpatient,,,182,136.5,,167.44,92,,,percent of total billed charges,92% of total billed charges,5.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,169.26,93,,,percent of total billed charges,93% of total billed charges,163.8,90,,,percent of total billed charges,90% of total billed charges,163.8,90,,,percent of total billed charges,90% of total billed charges,176.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.54,97,,,percent of total billed charges,97% of total billed charges,136.5,75,,,percent of total billed charges,75% of total billed charges,174.72,96,,,percent of total billed charges,96% of total billed charges,5.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,136.5,75,,,percent of total billed charges,75% of total billed charges,136.5,75,,,percent of total billed charges,75% of total billed charges,5.36,176.54,
PF DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE (LESS THAN,78000304P,CDM,975,RC,16020,HCPCS,Outpatient,,,418,313.5,,384.56,92,,,percent of total billed charges,92% of total billed charges,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388.74,93,,,percent of total billed charges,93% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,405.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,405.46,97,,,percent of total billed charges,97% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,401.28,96,,,percent of total billed charges,96% of total billed charges,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,313.5,75,,,percent of total billed charges,75% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,5.19,405.46,
PF DRS/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM,78000306P,CDM,975,RC,16025,HCPCS,Outpatient,,,434,325.5,,399.28,92,,,percent of total billed charges,92% of total billed charges,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.62,93,,,percent of total billed charges,93% of total billed charges,390.6,90,,,percent of total billed charges,90% of total billed charges,390.6,90,,,percent of total billed charges,90% of total billed charges,420.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,420.98,97,,,percent of total billed charges,97% of total billed charges,325.5,75,,,percent of total billed charges,75% of total billed charges,416.64,96,,,percent of total billed charges,96% of total billed charges,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,325.5,75,,,percent of total billed charges,75% of total billed charges,325.5,75,,,percent of total billed charges,75% of total billed charges,11.71,420.98,
PF DRS/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE,78000308P,CDM,975,RC,16030,HCPCS,Outpatient,,,346,259.5,,318.32,92,,,percent of total billed charges,92% of total billed charges,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321.78,93,,,percent of total billed charges,93% of total billed charges,311.4,90,,,percent of total billed charges,90% of total billed charges,311.4,90,,,percent of total billed charges,90% of total billed charges,335.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,335.62,97,,,percent of total billed charges,97% of total billed charges,259.5,75,,,percent of total billed charges,75% of total billed charges,332.16,96,,,percent of total billed charges,96% of total billed charges,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,259.5,75,,,percent of total billed charges,75% of total billed charges,259.5,75,,,percent of total billed charges,75% of total billed charges,15.94,335.62,
PF DESTRUCTION PREMALIGNANT LESION 1ST,78000310P,CDM,975,RC,17000,HCPCS,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,3.54,97.97,
PF DESTRUCTION PREMALIGNANT LESION 2 TO 14,78000312P,CDM,975,RC,17003,HCPCS,Outpatient,,,7,5.25,,6.44,92,,,percent of total billed charges,92% of total billed charges,0.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6.51,93,,,percent of total billed charges,93% of total billed charges,6.3,90,,,percent of total billed charges,90% of total billed charges,6.3,90,,,percent of total billed charges,90% of total billed charges,6.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6.79,97,,,percent of total billed charges,97% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges,6.72,96,,,percent of total billed charges,96% of total billed charges,0.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5.25,75,,,percent of total billed charges,75% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges,0.07,6.79,
PF DESTRUCTION PREMALIGNANT LESION 15/>,78000314P,CDM,975,RC,17004,HCPCS,Outpatient,,,253,189.75,,232.76,92,,,percent of total billed charges,92% of total billed charges,7.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,235.29,93,,,percent of total billed charges,93% of total billed charges,227.7,90,,,percent of total billed charges,90% of total billed charges,227.7,90,,,percent of total billed charges,90% of total billed charges,245.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.41,97,,,percent of total billed charges,97% of total billed charges,189.75,75,,,percent of total billed charges,75% of total billed charges,242.88,96,,,percent of total billed charges,96% of total billed charges,7.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.75,75,,,percent of total billed charges,75% of total billed charges,189.75,75,,,percent of total billed charges,75% of total billed charges,7.46,245.41,
PF DESTRUCTION BENIGN LESIONS UP TO 14,78000316P,CDM,975,RC,17110,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.58,93,,,percent of total billed charges,93% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,199.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,199.82,97,,,percent of total billed charges,97% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,197.76,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.5,75,,,percent of total billed charges,75% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,4.28,199.82,
PF DESTRUCTION BENIGN LESIONS 15/>,78000318P,CDM,975,RC,17111,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges,5.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186,93,,,percent of total billed charges,93% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,194,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194,97,,,percent of total billed charges,97% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,192,96,,,percent of total billed charges,96% of total billed charges,5.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150,75,,,percent of total billed charges,75% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,5.6,194,
PF CHEMICAL CAUTERIZATION OF GRANULATION TISSUE,78000320P,CDM,975,RC,17250,HCPCS,Outpatient,,,136,102,,125.12,92,,,percent of total billed charges,92% of total billed charges,3.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126.48,93,,,percent of total billed charges,93% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,131.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.92,97,,,percent of total billed charges,97% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,130.56,96,,,percent of total billed charges,96% of total billed charges,3.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102,75,,,percent of total billed charges,75% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,3.47,131.92,
PF PUNCTURE ASPIRATION OF CYST OF BREAST,78002193P,CDM,975,RC,19000,HCPCS,Outpatient,,,112,84,,103.04,92,,,percent of total billed charges,92% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.16,93,,,percent of total billed charges,93% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,108.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,108.64,97,,,percent of total billed charges,97% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,107.52,96,,,percent of total billed charges,96% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84,75,,,percent of total billed charges,75% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,4.42,108.64,
PF PUNCTURE ASPIRATION OF BREAST CYST EACH ADDITIONAL,78002278P,CDM,975,RC,19001,HCPCS,Outpatient,,,56,42,,51.52,92,,,percent of total billed charges,92% of total billed charges,2.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,52.08,93,,,percent of total billed charges,93% of total billed charges,50.4,90,,,percent of total billed charges,90% of total billed charges,50.4,90,,,percent of total billed charges,90% of total billed charges,54.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54.32,97,,,percent of total billed charges,97% of total billed charges,42,75,,,percent of total billed charges,75% of total billed charges,53.76,96,,,percent of total billed charges,96% of total billed charges,2.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,42,75,,,percent of total billed charges,75% of total billed charges,42,75,,,percent of total billed charges,75% of total billed charges,2.07,54.32,
PF BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUIDE,78002195P,CDM,975,RC,19083,HCPCS,Outpatient,,,408,306,,375.36,92,,,percent of total billed charges,92% of total billed charges,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,379.44,93,,,percent of total billed charges,93% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,395.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,395.76,97,,,percent of total billed charges,97% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,391.68,96,,,percent of total billed charges,96% of total billed charges,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306,75,,,percent of total billed charges,75% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,14.17,395.76,
PF BX BREAST EACH ADDITIONAL LESION,78002276P,CDM,975,RC,19084,HCPCS,Outpatient,,,201,150.75,,184.92,92,,,percent of total billed charges,92% of total billed charges,6.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.93,93,,,percent of total billed charges,93% of total billed charges,180.9,90,,,percent of total billed charges,90% of total billed charges,180.9,90,,,percent of total billed charges,90% of total billed charges,194.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194.97,97,,,percent of total billed charges,97% of total billed charges,150.75,75,,,percent of total billed charges,75% of total billed charges,192.96,96,,,percent of total billed charges,96% of total billed charges,6.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.75,75,,,percent of total billed charges,75% of total billed charges,150.75,75,,,percent of total billed charges,75% of total billed charges,6.94,194.97,
PF BIOPSY BREAST OPEN INCISIONAL,78000322P,CDM,975,RC,19101,HCPCS,Outpatient,,,1288,966,,1184.96,92,,,percent of total billed charges,92% of total billed charges,29.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1197.84,93,,,percent of total billed charges,93% of total billed charges,1159.2,90,,,percent of total billed charges,90% of total billed charges,1159.2,90,,,percent of total billed charges,90% of total billed charges,1249.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1249.36,97,,,percent of total billed charges,97% of total billed charges,966,75,,,percent of total billed charges,75% of total billed charges,1236.48,96,,,percent of total billed charges,96% of total billed charges,29.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,966,75,,,percent of total billed charges,75% of total billed charges,966,75,,,percent of total billed charges,75% of total billed charges,29.19,1249.36,
PF EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION,78000323P,CDM,975,RC,19120,HCPCS,Outpatient,,,1838,1378.5,,1690.96,92,,,percent of total billed charges,92% of total billed charges,54.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1709.34,93,,,percent of total billed charges,93% of total billed charges,1654.2,90,,,percent of total billed charges,90% of total billed charges,1654.2,90,,,percent of total billed charges,90% of total billed charges,1782.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,54.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1782.86,97,,,percent of total billed charges,97% of total billed charges,1378.5,75,,,percent of total billed charges,75% of total billed charges,1764.48,96,,,percent of total billed charges,96% of total billed charges,54.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1378.5,75,,,percent of total billed charges,75% of total billed charges,1378.5,75,,,percent of total billed charges,75% of total billed charges,54.45,1782.86,
PF EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES,78000324P,CDM,975,RC,19125,HCPCS,Outpatient,,,2040,1530,,1876.8,92,,,percent of total billed charges,92% of total billed charges,61.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1897.2,93,,,percent of total billed charges,93% of total billed charges,1836,90,,,percent of total billed charges,90% of total billed charges,1836,90,,,percent of total billed charges,90% of total billed charges,1978.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1978.8,97,,,percent of total billed charges,97% of total billed charges,1530,75,,,percent of total billed charges,75% of total billed charges,1958.4,96,,,percent of total billed charges,96% of total billed charges,61.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1530,75,,,percent of total billed charges,75% of total billed charges,1530,75,,,percent of total billed charges,75% of total billed charges,61.97,1978.8,
PF PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GUID,78000325P,CDM,975,RC,19281,HCPCS,Outpatient,,,261,195.75,,240.12,92,,,percent of total billed charges,92% of total billed charges,8.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,242.73,93,,,percent of total billed charges,93% of total billed charges,234.9,90,,,percent of total billed charges,90% of total billed charges,234.9,90,,,percent of total billed charges,90% of total billed charges,253.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,253.17,97,,,percent of total billed charges,97% of total billed charges,195.75,75,,,percent of total billed charges,75% of total billed charges,250.56,96,,,percent of total billed charges,96% of total billed charges,8.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.75,75,,,percent of total billed charges,75% of total billed charges,195.75,75,,,percent of total billed charges,75% of total billed charges,8.21,253.17,
PF PERQ BREAST LOC DEVICE PLACMT 1ST STRTCTC GDNCE,78000327P,CDM,975,RC,19283,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,9.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,9.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,9.06,289.06,
PF MASTECTOMY SIMPLE COMPLETE,78000329P,CDM,975,RC,19303,HCPCS,Outpatient,,,3577,2682.75,,3290.84,92,,,percent of total billed charges,92% of total billed charges,135.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3326.61,93,,,percent of total billed charges,93% of total billed charges,3219.3,90,,,percent of total billed charges,90% of total billed charges,3219.3,90,,,percent of total billed charges,90% of total billed charges,3469.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,135.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3469.69,97,,,percent of total billed charges,97% of total billed charges,2682.75,75,,,percent of total billed charges,75% of total billed charges,3433.92,96,,,percent of total billed charges,96% of total billed charges,135.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2682.75,75,,,percent of total billed charges,75% of total billed charges,2682.75,75,,,percent of total billed charges,75% of total billed charges,135.53,3469.69,
PF EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK,78000330P,CDM,975,RC,20102,HCPCS,Outpatient,,,1863,1397.25,,1713.96,92,,,percent of total billed charges,92% of total billed charges,35.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1732.59,93,,,percent of total billed charges,93% of total billed charges,1676.7,90,,,percent of total billed charges,90% of total billed charges,1676.7,90,,,percent of total billed charges,90% of total billed charges,1807.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,35.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1807.11,97,,,percent of total billed charges,97% of total billed charges,1397.25,75,,,percent of total billed charges,75% of total billed charges,1788.48,96,,,percent of total billed charges,96% of total billed charges,35.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1397.25,75,,,percent of total billed charges,75% of total billed charges,1397.25,75,,,percent of total billed charges,75% of total billed charges,35.19,1807.11,
PF EXPLORATION PENETRATING WOUND EXTREMITY,78000332P,CDM,975,RC,20103,HCPCS,Outpatient,,,2991,2243.25,,2751.72,92,,,percent of total billed charges,92% of total billed charges,39.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2781.63,93,,,percent of total billed charges,93% of total billed charges,2691.9,90,,,percent of total billed charges,90% of total billed charges,2691.9,90,,,percent of total billed charges,90% of total billed charges,2901.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,39.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2901.27,97,,,percent of total billed charges,97% of total billed charges,2243.25,75,,,percent of total billed charges,75% of total billed charges,2871.36,96,,,percent of total billed charges,96% of total billed charges,39.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2243.25,75,,,percent of total billed charges,75% of total billed charges,2243.25,75,,,percent of total billed charges,75% of total billed charges,39.89,2901.27,
PF BIOPSY MUSCLE DEEP,78000334P,CDM,975,RC,20205,HCPCS,Outpatient,,,799,599.25,,735.08,92,,,percent of total billed charges,92% of total billed charges,23.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,743.07,93,,,percent of total billed charges,93% of total billed charges,719.1,90,,,percent of total billed charges,90% of total billed charges,719.1,90,,,percent of total billed charges,90% of total billed charges,775.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,775.03,97,,,percent of total billed charges,97% of total billed charges,599.25,75,,,percent of total billed charges,75% of total billed charges,767.04,96,,,percent of total billed charges,96% of total billed charges,23.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,599.25,75,,,percent of total billed charges,75% of total billed charges,599.25,75,,,percent of total billed charges,75% of total billed charges,23.27,775.03,
PF BIOPSY MUSCLE PERCUTANEOUS NEEDLE,78000336P,CDM,975,RC,20206,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges,4.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,325.5,93,,,percent of total billed charges,93% of total billed charges,315,90,,,percent of total billed charges,90% of total billed charges,315,90,,,percent of total billed charges,90% of total billed charges,339.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,339.5,97,,,percent of total billed charges,97% of total billed charges,262.5,75,,,percent of total billed charges,75% of total billed charges,336,96,,,percent of total billed charges,96% of total billed charges,4.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,262.5,75,,,percent of total billed charges,75% of total billed charges,262.5,75,,,percent of total billed charges,75% of total billed charges,4.66,339.5,
PF BIOPSY BONE TROCAR/NEEDLE DEEP,78000338P,CDM,975,RC,20225,HCPCS,Outpatient,,,2015,1511.25,,1853.8,92,,,percent of total billed charges,92% of total billed charges,11.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1873.95,93,,,percent of total billed charges,93% of total billed charges,1813.5,90,,,percent of total billed charges,90% of total billed charges,1813.5,90,,,percent of total billed charges,90% of total billed charges,1954.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1954.55,97,,,percent of total billed charges,97% of total billed charges,1511.25,75,,,percent of total billed charges,75% of total billed charges,1934.4,96,,,percent of total billed charges,96% of total billed charges,11.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1511.25,75,,,percent of total billed charges,75% of total billed charges,1511.25,75,,,percent of total billed charges,75% of total billed charges,11.17,1954.55,
PF BIOPSY BONE OPEN SUPERFICIAL,78002872P,CDM,975,RC,20240,HCPCS,Outpatient,,,276,207,,253.92,92,,,percent of total billed charges,92% of total billed charges,12.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,256.68,93,,,percent of total billed charges,93% of total billed charges,248.4,90,,,percent of total billed charges,90% of total billed charges,248.4,90,,,percent of total billed charges,90% of total billed charges,267.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,267.72,97,,,percent of total billed charges,97% of total billed charges,207,75,,,percent of total billed charges,75% of total billed charges,264.96,96,,,percent of total billed charges,96% of total billed charges,12.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,207,75,,,percent of total billed charges,75% of total billed charges,207,75,,,percent of total billed charges,75% of total billed charges,12.95,267.72,
PF BIOPSY BONE OPEN DEEP,78000339P,CDM,975,RC,20245,HCPCS,Outpatient,,,2375,1781.25,,2185,92,,,percent of total billed charges,92% of total billed charges,40.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2208.75,93,,,percent of total billed charges,93% of total billed charges,2137.5,90,,,percent of total billed charges,90% of total billed charges,2137.5,90,,,percent of total billed charges,90% of total billed charges,2303.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2303.75,97,,,percent of total billed charges,97% of total billed charges,1781.25,75,,,percent of total billed charges,75% of total billed charges,2280,96,,,percent of total billed charges,96% of total billed charges,40.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1781.25,75,,,percent of total billed charges,75% of total billed charges,1781.25,75,,,percent of total billed charges,75% of total billed charges,40.28,2303.75,
PF INJECTION SINUS TRACT DIAGNOSTIC,78000340P,CDM,975,RC,20501,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges,3.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186,93,,,percent of total billed charges,93% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,194,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194,97,,,percent of total billed charges,97% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,192,96,,,percent of total billed charges,96% of total billed charges,3.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150,75,,,percent of total billed charges,75% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,3.13,194,
PF REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE,78000342P,CDM,975,RC,20520,HCPCS,Outpatient,,,1019,764.25,,937.48,92,,,percent of total billed charges,92% of total billed charges,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,947.67,93,,,percent of total billed charges,93% of total billed charges,917.1,90,,,percent of total billed charges,90% of total billed charges,917.1,90,,,percent of total billed charges,90% of total billed charges,988.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,988.43,97,,,percent of total billed charges,97% of total billed charges,764.25,75,,,percent of total billed charges,75% of total billed charges,978.24,96,,,percent of total billed charges,96% of total billed charges,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,764.25,75,,,percent of total billed charges,75% of total billed charges,764.25,75,,,percent of total billed charges,75% of total billed charges,13.01,988.43,
PF REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH COMPLICATED,78000344P,CDM,975,RC,20525,HCPCS,Outpatient,,,1364,1023,,1254.88,92,,,percent of total billed charges,92% of total billed charges,26.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1268.52,93,,,percent of total billed charges,93% of total billed charges,1227.6,90,,,percent of total billed charges,90% of total billed charges,1227.6,90,,,percent of total billed charges,90% of total billed charges,1323.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1323.08,97,,,percent of total billed charges,97% of total billed charges,1023,75,,,percent of total billed charges,75% of total billed charges,1309.44,96,,,percent of total billed charges,96% of total billed charges,26.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1023,75,,,percent of total billed charges,75% of total billed charges,1023,75,,,percent of total billed charges,75% of total billed charges,26.48,1323.08,
PF INJECTION THERAPEUTIC CARPAL TUNNEL,78000346P,CDM,975,RC,20526,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,6.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,6.57,201.76,
PF INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,78000348P,CDM,975,RC,20550,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,95.79,93,,,percent of total billed charges,93% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,99.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,99.91,97,,,percent of total billed charges,97% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges,98.88,96,,,percent of total billed charges,96% of total billed charges,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,77.25,75,,,percent of total billed charges,75% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges,4.05,99.91,
PF INJECTION SINGLE TENDON ORIGIN/INSERTION,78000350P,CDM,975,RC,20551,HCPCS,Outpatient,,,158,118.5,,145.36,92,,,percent of total billed charges,92% of total billed charges,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.94,93,,,percent of total billed charges,93% of total billed charges,142.2,90,,,percent of total billed charges,90% of total billed charges,142.2,90,,,percent of total billed charges,90% of total billed charges,153.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,153.26,97,,,percent of total billed charges,97% of total billed charges,118.5,75,,,percent of total billed charges,75% of total billed charges,151.68,96,,,percent of total billed charges,96% of total billed charges,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,118.5,75,,,percent of total billed charges,75% of total billed charges,118.5,75,,,percent of total billed charges,75% of total billed charges,3.77,153.26,
PF INJECTIONS OF TRIGGER POINTS IN 1 OR 2 MUSCLES,78000352P,CDM,975,RC,20552,HCPCS,Outpatient,,,152,114,,139.84,92,,,percent of total billed charges,92% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.36,93,,,percent of total billed charges,93% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,147.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.44,97,,,percent of total billed charges,97% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,145.92,96,,,percent of total billed charges,96% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,114,75,,,percent of total billed charges,75% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,3.44,147.44,
PF INJECTIONS OF TRIGGER POINTS IN 3 OR MORE MUSCLES,78000354P,CDM,975,RC,20553,HCPCS,Outpatient,,,170,127.5,,156.4,92,,,percent of total billed charges,92% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.1,93,,,percent of total billed charges,93% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,164.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.9,97,,,percent of total billed charges,97% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,163.2,96,,,percent of total billed charges,96% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.5,75,,,percent of total billed charges,75% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,3.88,164.9,
PF ASPIRATION INJECTION OF SMALL JOINT OR JOINT CAPSULE W/O,78000356P,CDM,975,RC,20600,HCPCS,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.06,93,,,percent of total billed charges,93% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,137.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,137.74,97,,,percent of total billed charges,97% of total billed charges,106.5,75,,,percent of total billed charges,75% of total billed charges,136.32,96,,,percent of total billed charges,96% of total billed charges,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.5,75,,,percent of total billed charges,75% of total billed charges,106.5,75,,,percent of total billed charges,75% of total billed charges,3.67,137.74,
PF ARTHROCNT ASPIR/INJ SML JT/BURSAW/US REC RPRT,78000360P,CDM,975,RC,20604,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.33,93,,,percent of total billed charges,93% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,175.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.57,97,,,percent of total billed charges,97% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,173.76,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.75,75,,,percent of total billed charges,75% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,4.28,175.57,
PF ASPIRATION INJECTION OF MEDIUM JOINT OR JOINT CAPSULE W/O,78000362P,CDM,975,RC,20605,HCPCS,Outpatient,,,147,110.25,,135.24,92,,,percent of total billed charges,92% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,136.71,93,,,percent of total billed charges,93% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,142.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.59,97,,,percent of total billed charges,97% of total billed charges,110.25,75,,,percent of total billed charges,75% of total billed charges,141.12,96,,,percent of total billed charges,96% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.25,75,,,percent of total billed charges,75% of total billed charges,110.25,75,,,percent of total billed charges,75% of total billed charges,3.71,142.59,
PF ARTHROCENTESIS ASPIR/INJ INTERM JT/BURS W/US,78000366P,CDM,975,RC,20606,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,5.31,201.76,
PF ARTHROCENTESIS ASPIRATION INJECTION MAJOR JT/BURSA W/O US,78000368P,CDM,975,RC,20610,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.33,93,,,percent of total billed charges,93% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,175.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.57,97,,,percent of total billed charges,97% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,173.76,96,,,percent of total billed charges,96% of total billed charges,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.75,75,,,percent of total billed charges,75% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,5.09,175.57,
PF ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA W/US,78000372P,CDM,975,RC,20611,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.48,93,,,percent of total billed charges,93% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,228.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.92,97,,,percent of total billed charges,97% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,226.56,96,,,percent of total billed charges,96% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177,75,,,percent of total billed charges,75% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,6.09,228.92,
PF ASPIRATION INJECTION GANGLION CYST ANY LOCATION,78000374P,CDM,975,RC,20612,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,4.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,4.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,4.13,104.76,
PF INSERTION WIRE/PIN W/APPL SKELETAL TRACTION,78000376P,CDM,975,RC,20650,HCPCS,Outpatient,,,621,465.75,,571.32,92,,,percent of total billed charges,92% of total billed charges,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,577.53,93,,,percent of total billed charges,93% of total billed charges,558.9,90,,,percent of total billed charges,90% of total billed charges,558.9,90,,,percent of total billed charges,90% of total billed charges,602.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,602.37,97,,,percent of total billed charges,97% of total billed charges,465.75,75,,,percent of total billed charges,75% of total billed charges,596.16,96,,,percent of total billed charges,96% of total billed charges,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465.75,75,,,percent of total billed charges,75% of total billed charges,465.75,75,,,percent of total billed charges,75% of total billed charges,15.86,602.37,
PF REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE,78000377P,CDM,975,RC,20670,HCPCS,Outpatient,,,1171,878.25,,1077.32,92,,,percent of total billed charges,92% of total billed charges,12.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1089.03,93,,,percent of total billed charges,93% of total billed charges,1053.9,90,,,percent of total billed charges,90% of total billed charges,1053.9,90,,,percent of total billed charges,90% of total billed charges,1135.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1135.87,97,,,percent of total billed charges,97% of total billed charges,878.25,75,,,percent of total billed charges,75% of total billed charges,1124.16,96,,,percent of total billed charges,96% of total billed charges,12.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,878.25,75,,,percent of total billed charges,75% of total billed charges,878.25,75,,,percent of total billed charges,75% of total billed charges,12.36,1135.87,
PF REMOVAL IMPLANT DEEP,78000378P,CDM,975,RC,20680,HCPCS,Outpatient,,,1874,1405.5,,1724.08,92,,,percent of total billed charges,92% of total billed charges,43.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1742.82,93,,,percent of total billed charges,93% of total billed charges,1686.6,90,,,percent of total billed charges,90% of total billed charges,1686.6,90,,,percent of total billed charges,90% of total billed charges,1817.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1817.78,97,,,percent of total billed charges,97% of total billed charges,1405.5,75,,,percent of total billed charges,75% of total billed charges,1799.04,96,,,percent of total billed charges,96% of total billed charges,43.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1405.5,75,,,percent of total billed charges,75% of total billed charges,1405.5,75,,,percent of total billed charges,75% of total billed charges,43.38,1817.78,
PF APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM,78000379P,CDM,975,RC,20690,HCPCS,Outpatient,,,2079,1559.25,,1912.68,92,,,percent of total billed charges,92% of total billed charges,67.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1933.47,93,,,percent of total billed charges,93% of total billed charges,1871.1,90,,,percent of total billed charges,90% of total billed charges,1871.1,90,,,percent of total billed charges,90% of total billed charges,2016.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,67.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2016.63,97,,,percent of total billed charges,97% of total billed charges,1559.25,75,,,percent of total billed charges,75% of total billed charges,1995.84,96,,,percent of total billed charges,96% of total billed charges,67.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1559.25,75,,,percent of total billed charges,75% of total billed charges,1559.25,75,,,percent of total billed charges,75% of total billed charges,67.43,2016.63,
PF REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES,78000380P,CDM,975,RC,20694,HCPCS,Outpatient,,,1715,1286.25,,1577.8,92,,,percent of total billed charges,92% of total billed charges,33.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1594.95,93,,,percent of total billed charges,93% of total billed charges,1543.5,90,,,percent of total billed charges,90% of total billed charges,1543.5,90,,,percent of total billed charges,90% of total billed charges,1663.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1663.55,97,,,percent of total billed charges,97% of total billed charges,1286.25,75,,,percent of total billed charges,75% of total billed charges,1646.4,96,,,percent of total billed charges,96% of total billed charges,33.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1286.25,75,,,percent of total billed charges,75% of total billed charges,1286.25,75,,,percent of total billed charges,75% of total billed charges,33.15,1663.55,
PF MANUAL PREP & INSERT DRUG DELIVERY DEVICE DEEP,49102231P,CDM,975,RC,20700,HCPCS,Outpatient,,,119,89.25,,109.48,92,,,percent of total billed charges,92% of total billed charges,10.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.67,93,,,percent of total billed charges,93% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,115.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,115.43,97,,,percent of total billed charges,97% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,114.24,96,,,percent of total billed charges,96% of total billed charges,10.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,89.25,75,,,percent of total billed charges,75% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,10.77,115.43,
PF MANUAL PREP & INSERT DRUG DELIVERY DEVICE INTRAMEDULLARY,78002869P,CDM,975,RC,20702,HCPCS,Outpatient,,,280,210,,257.6,92,,,percent of total billed charges,92% of total billed charges,18.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,260.4,93,,,percent of total billed charges,93% of total billed charges,252,90,,,percent of total billed charges,90% of total billed charges,252,90,,,percent of total billed charges,90% of total billed charges,271.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,271.6,97,,,percent of total billed charges,97% of total billed charges,210,75,,,percent of total billed charges,75% of total billed charges,268.8,96,,,percent of total billed charges,96% of total billed charges,18.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,210,75,,,percent of total billed charges,75% of total billed charges,210,75,,,percent of total billed charges,75% of total billed charges,18.17,271.6,
PF MANUAL PREP & INSERT DRUG DELIVERY DEVICE INTRA-ARTICULAR,78002870P,CDM,975,RC,20704,HCPCS,Outpatient,,,289,216.75,,265.88,92,,,percent of total billed charges,92% of total billed charges,19.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,268.77,93,,,percent of total billed charges,93% of total billed charges,260.1,90,,,percent of total billed charges,90% of total billed charges,260.1,90,,,percent of total billed charges,90% of total billed charges,280.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,280.33,97,,,percent of total billed charges,97% of total billed charges,216.75,75,,,percent of total billed charges,75% of total billed charges,277.44,96,,,percent of total billed charges,96% of total billed charges,19.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,216.75,75,,,percent of total billed charges,75% of total billed charges,216.75,75,,,percent of total billed charges,75% of total billed charges,19.24,280.33,
PF BONE GRAFT ANY DONOR AREA MINOR/SMALL,78000381P,CDM,975,RC,20900,HCPCS,Outpatient,,,1768,1326,,1626.56,92,,,percent of total billed charges,92% of total billed charges,19.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1644.24,93,,,percent of total billed charges,93% of total billed charges,1591.2,90,,,percent of total billed charges,90% of total billed charges,1591.2,90,,,percent of total billed charges,90% of total billed charges,1714.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1714.96,97,,,percent of total billed charges,97% of total billed charges,1326,75,,,percent of total billed charges,75% of total billed charges,1697.28,96,,,percent of total billed charges,96% of total billed charges,19.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1326,75,,,percent of total billed charges,75% of total billed charges,1326,75,,,percent of total billed charges,75% of total billed charges,19.77,1714.96,
PF BONE GRAFT ANY DONOR AREA MAJOR/LARGE,78000383P,CDM,975,RC,20902,HCPCS,Outpatient,,,2366,1774.5,,2176.72,92,,,percent of total billed charges,92% of total billed charges,32.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2200.38,93,,,percent of total billed charges,93% of total billed charges,2129.4,90,,,percent of total billed charges,90% of total billed charges,2129.4,90,,,percent of total billed charges,90% of total billed charges,2295.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2295.02,97,,,percent of total billed charges,97% of total billed charges,1774.5,75,,,percent of total billed charges,75% of total billed charges,2271.36,96,,,percent of total billed charges,96% of total billed charges,32.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1774.5,75,,,percent of total billed charges,75% of total billed charges,1774.5,75,,,percent of total billed charges,75% of total billed charges,32.52,2295.02,
"PF TENDON GRAFT FROM A DISTANCE (EG PALMARIS, TOE EXTENSOR,",78002859P,CDM,975,RC,20924,HCPCS,Outpatient,,,1265,948.75,,1163.8,92,,,percent of total billed charges,92% of total billed charges,51.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1176.45,93,,,percent of total billed charges,93% of total billed charges,1138.5,90,,,percent of total billed charges,90% of total billed charges,1138.5,90,,,percent of total billed charges,90% of total billed charges,1227.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,51.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1227.05,97,,,percent of total billed charges,97% of total billed charges,948.75,75,,,percent of total billed charges,75% of total billed charges,1214.4,96,,,percent of total billed charges,96% of total billed charges,51.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,948.75,75,,,percent of total billed charges,75% of total billed charges,948.75,75,,,percent of total billed charges,75% of total billed charges,51.27,1227.05,
PF ELECTRICAL STIMULATION BONE HEALING NONINVASIVE,78000385P,CDM,975,RC,20974,HCPCS,Outpatient,,,1077,807.75,,990.84,92,,,percent of total billed charges,92% of total billed charges,6.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1001.61,93,,,percent of total billed charges,93% of total billed charges,969.3,90,,,percent of total billed charges,90% of total billed charges,969.3,90,,,percent of total billed charges,90% of total billed charges,1044.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1044.69,97,,,percent of total billed charges,97% of total billed charges,807.75,75,,,percent of total billed charges,75% of total billed charges,1033.92,96,,,percent of total billed charges,96% of total billed charges,6.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,807.75,75,,,percent of total billed charges,75% of total billed charges,807.75,75,,,percent of total billed charges,75% of total billed charges,6.11,1044.69,
PF CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS,78000386P,CDM,975,RC,20985,HCPCS,Outpatient,,,300,225,,276,92,,,percent of total billed charges,92% of total billed charges,18.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,279,93,,,percent of total billed charges,93% of total billed charges,270,90,,,percent of total billed charges,90% of total billed charges,270,90,,,percent of total billed charges,90% of total billed charges,291,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,291,97,,,percent of total billed charges,97% of total billed charges,225,75,,,percent of total billed charges,75% of total billed charges,288,96,,,percent of total billed charges,96% of total billed charges,18.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,225,75,,,percent of total billed charges,75% of total billed charges,225,75,,,percent of total billed charges,75% of total billed charges,18.79,291,
PF DRY NEEDLING UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENER,78000387P,CDM,975,RC,20999,HCPCS,Outpatient,,,1001,750.75,,920.92,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,930.93,93,,,percent of total billed charges,93% of total billed charges,900.9,90,,,percent of total billed charges,90% of total billed charges,900.9,90,,,percent of total billed charges,90% of total billed charges,970.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,970.97,97,,,percent of total billed charges,97% of total billed charges,750.75,75,,,percent of total billed charges,75% of total billed charges,960.96,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,750.75,75,,,percent of total billed charges,75% of total billed charges,750.75,75,,,percent of total billed charges,75% of total billed charges,750.75,970.97,
PF EXCISION TUMOR SOFT TISSUE FACE SCALP SUBQ <2CM,78000388P,CDM,975,RC,21011,HCPCS,Outpatient,,,1311,983.25,,1206.12,92,,,percent of total billed charges,92% of total billed charges,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1219.23,93,,,percent of total billed charges,93% of total billed charges,1179.9,90,,,percent of total billed charges,90% of total billed charges,1179.9,90,,,percent of total billed charges,90% of total billed charges,1271.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1271.67,97,,,percent of total billed charges,97% of total billed charges,983.25,75,,,percent of total billed charges,75% of total billed charges,1258.56,96,,,percent of total billed charges,96% of total billed charges,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,983.25,75,,,percent of total billed charges,75% of total billed charges,983.25,75,,,percent of total billed charges,75% of total billed charges,22.94,1271.67,
PF EXCISE TUMOR SOFT TISSUE FACE/SCALP SUBCUTANEOUS 2CM OR >,78002866P,CDM,960,RC,21012,HCPCS,Outpatient,,,678,508.5,,623.76,92,,,percent of total billed charges,92% of total billed charges,36.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,630.54,93,,,percent of total billed charges,93% of total billed charges,610.2,90,,,percent of total billed charges,90% of total billed charges,610.2,90,,,percent of total billed charges,90% of total billed charges,657.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,36.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,657.66,97,,,percent of total billed charges,97% of total billed charges,508.5,75,,,percent of total billed charges,75% of total billed charges,650.88,96,,,percent of total billed charges,96% of total billed charges,36.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,508.5,75,,,percent of total billed charges,75% of total billed charges,508.5,75,,,percent of total billed charges,75% of total billed charges,36.53,657.66,
PF CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION,78000390P,CDM,975,RC,21320,HCPCS,Outpatient,,,247,185.25,,227.24,92,,,percent of total billed charges,92% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,229.71,93,,,percent of total billed charges,93% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,222.3,90,,,percent of total billed charges,90% of total billed charges,239.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,239.59,97,,,percent of total billed charges,97% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,237.12,96,,,percent of total billed charges,96% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.25,75,,,percent of total billed charges,75% of total billed charges,185.25,75,,,percent of total billed charges,75% of total billed charges,9.79,239.59,
PF CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIP,78000391P,CDM,975,RC,21400,HCPCS,Outpatient,,,728,546,,669.76,92,,,percent of total billed charges,92% of total billed charges,13.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,677.04,93,,,percent of total billed charges,93% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,706.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,706.16,97,,,percent of total billed charges,97% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,698.88,96,,,percent of total billed charges,96% of total billed charges,13.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546,75,,,percent of total billed charges,75% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,13.28,706.16,
PF CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ,78000392P,CDM,975,RC,21480,HCPCS,Outpatient,,,463,347.25,,425.96,92,,,percent of total billed charges,92% of total billed charges,4.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.59,93,,,percent of total billed charges,93% of total billed charges,416.7,90,,,percent of total billed charges,90% of total billed charges,416.7,90,,,percent of total billed charges,90% of total billed charges,449.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,449.11,97,,,percent of total billed charges,97% of total billed charges,347.25,75,,,percent of total billed charges,75% of total billed charges,444.48,96,,,percent of total billed charges,96% of total billed charges,4.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,347.25,75,,,percent of total billed charges,75% of total billed charges,347.25,75,,,percent of total billed charges,75% of total billed charges,4.33,449.11,
PF INCISION  DRAIN DEEP ABSC/HEMATOMA SOFT TISS NECK THORAX,78000394P,CDM,975,RC,21501,HCPCS,Outpatient,,,1335,1001.25,,1228.2,92,,,percent of total billed charges,92% of total billed charges,34.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1241.55,93,,,percent of total billed charges,93% of total billed charges,1201.5,90,,,percent of total billed charges,90% of total billed charges,1201.5,90,,,percent of total billed charges,90% of total billed charges,1294.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,34.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1294.95,97,,,percent of total billed charges,97% of total billed charges,1001.25,75,,,percent of total billed charges,75% of total billed charges,1281.6,96,,,percent of total billed charges,96% of total billed charges,34.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1001.25,75,,,percent of total billed charges,75% of total billed charges,1001.25,75,,,percent of total billed charges,75% of total billed charges,34.04,1294.95,
PF BIOPSY SOFT TISSUE OF NECK OR THORAX,78002197P,CDM,975,RC,21550,HCPCS,Outpatient,,,414,310.5,,380.88,92,,,percent of total billed charges,92% of total billed charges,13.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,385.02,93,,,percent of total billed charges,93% of total billed charges,372.6,90,,,percent of total billed charges,90% of total billed charges,372.6,90,,,percent of total billed charges,90% of total billed charges,401.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,401.58,97,,,percent of total billed charges,97% of total billed charges,310.5,75,,,percent of total billed charges,75% of total billed charges,397.44,96,,,percent of total billed charges,96% of total billed charges,13.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,310.5,75,,,percent of total billed charges,75% of total billed charges,310.5,75,,,percent of total billed charges,75% of total billed charges,13.82,401.58,
PF EXCISION TUMOR SOFT TISSUE NECK ANTERIOR THORAX SUBQ <3CM,78000396P,CDM,975,RC,21555,HCPCS,Outpatient,,,1578,1183.5,,1451.76,92,,,percent of total billed charges,92% of total billed charges,32.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1467.54,93,,,percent of total billed charges,93% of total billed charges,1420.2,90,,,percent of total billed charges,90% of total billed charges,1420.2,90,,,percent of total billed charges,90% of total billed charges,1530.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1530.66,97,,,percent of total billed charges,97% of total billed charges,1183.5,75,,,percent of total billed charges,75% of total billed charges,1514.88,96,,,percent of total billed charges,96% of total billed charges,32.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1183.5,75,,,percent of total billed charges,75% of total billed charges,1183.5,75,,,percent of total billed charges,75% of total billed charges,32.72,1530.66,
PF EXCISION TUMOR SOFT TISSUE NECK THORAX SUBFASCIAL <5CM,78000398P,CDM,975,RC,21556,HCPCS,Outpatient,,,2077,1557.75,,1910.84,92,,,percent of total billed charges,92% of total billed charges,59.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1931.61,93,,,percent of total billed charges,93% of total billed charges,1869.3,90,,,percent of total billed charges,90% of total billed charges,1869.3,90,,,percent of total billed charges,90% of total billed charges,2014.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,59.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2014.69,97,,,percent of total billed charges,97% of total billed charges,1557.75,75,,,percent of total billed charges,75% of total billed charges,1993.92,96,,,percent of total billed charges,96% of total billed charges,59.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1557.75,75,,,percent of total billed charges,75% of total billed charges,1557.75,75,,,percent of total billed charges,75% of total billed charges,59.16,2014.69,
PF CLOSED TREATMENT STERNUM FRACTURE,78000400P,CDM,975,RC,21820,HCPCS,Outpatient,,,721,540.75,,663.32,92,,,percent of total billed charges,92% of total billed charges,13.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,670.53,93,,,percent of total billed charges,93% of total billed charges,648.9,90,,,percent of total billed charges,90% of total billed charges,648.9,90,,,percent of total billed charges,90% of total billed charges,699.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.37,97,,,percent of total billed charges,97% of total billed charges,540.75,75,,,percent of total billed charges,75% of total billed charges,692.16,96,,,percent of total billed charges,96% of total billed charges,13.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,540.75,75,,,percent of total billed charges,75% of total billed charges,540.75,75,,,percent of total billed charges,75% of total billed charges,13.17,699.37,
PF BIOPSY SOFT TISSUE BACK/FLANK DEEP,78000402P,CDM,975,RC,21925,HCPCS,Outpatient,,,1595,1196.25,,1467.4,92,,,percent of total billed charges,92% of total billed charges,41.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1483.35,93,,,percent of total billed charges,93% of total billed charges,1435.5,90,,,percent of total billed charges,90% of total billed charges,1435.5,90,,,percent of total billed charges,90% of total billed charges,1547.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1547.15,97,,,percent of total billed charges,97% of total billed charges,1196.25,75,,,percent of total billed charges,75% of total billed charges,1531.2,96,,,percent of total billed charges,96% of total billed charges,41.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1196.25,75,,,percent of total billed charges,75% of total billed charges,1196.25,75,,,percent of total billed charges,75% of total billed charges,41.76,1547.15,
PF EXCISE TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM,78002876P,CDM,975,RC,21930,HCPCS,Outpatient,,,727,545.25,,668.84,92,,,percent of total billed charges,92% of total billed charges,42.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,676.11,93,,,percent of total billed charges,93% of total billed charges,654.3,90,,,percent of total billed charges,90% of total billed charges,654.3,90,,,percent of total billed charges,90% of total billed charges,705.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,42.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,705.19,97,,,percent of total billed charges,97% of total billed charges,545.25,75,,,percent of total billed charges,75% of total billed charges,697.92,96,,,percent of total billed charges,96% of total billed charges,42.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,545.25,75,,,percent of total billed charges,75% of total billed charges,545.25,75,,,percent of total billed charges,75% of total billed charges,42.08,705.19,
PF EXCISION TUMOR SOFT TISSUE BACK FLANK SUBQ 3CM/>,78000404P,CDM,975,RC,21931,HCPCS,Outpatient,,,1035,776.25,,952.2,92,,,percent of total billed charges,92% of total billed charges,60.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,962.55,93,,,percent of total billed charges,93% of total billed charges,931.5,90,,,percent of total billed charges,90% of total billed charges,931.5,90,,,percent of total billed charges,90% of total billed charges,1003.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,60.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1003.95,97,,,percent of total billed charges,97% of total billed charges,776.25,75,,,percent of total billed charges,75% of total billed charges,993.6,96,,,percent of total billed charges,96% of total billed charges,60.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,776.25,75,,,percent of total billed charges,75% of total billed charges,776.25,75,,,percent of total billed charges,75% of total billed charges,60.88,1003.95,
PF CLOSED TX VERT BODY FX W/O MANIP REQUIRES CASTING OR BRAC,78000406P,CDM,975,RC,22310,HCPCS,Outpatient,,,792,594,,728.64,92,,,percent of total billed charges,92% of total billed charges,31.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,736.56,93,,,percent of total billed charges,93% of total billed charges,712.8,90,,,percent of total billed charges,90% of total billed charges,712.8,90,,,percent of total billed charges,90% of total billed charges,768.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,31.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,768.24,97,,,percent of total billed charges,97% of total billed charges,594,75,,,percent of total billed charges,75% of total billed charges,760.32,96,,,percent of total billed charges,96% of total billed charges,31.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594,75,,,percent of total billed charges,75% of total billed charges,594,75,,,percent of total billed charges,75% of total billed charges,31.36,768.24,
PF CL TX VERT FX/DISLC CASTING/BRACING MANJ/TRCJ,78000408P,CDM,975,RC,22315,HCPCS,Outpatient,,,3406,2554.5,,3133.52,92,,,percent of total billed charges,92% of total billed charges,93.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3167.58,93,,,percent of total billed charges,93% of total billed charges,3065.4,90,,,percent of total billed charges,90% of total billed charges,3065.4,90,,,percent of total billed charges,90% of total billed charges,3303.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,93.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3303.82,97,,,percent of total billed charges,97% of total billed charges,2554.5,75,,,percent of total billed charges,75% of total billed charges,3269.76,96,,,percent of total billed charges,96% of total billed charges,93.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2554.5,75,,,percent of total billed charges,75% of total billed charges,2554.5,75,,,percent of total billed charges,75% of total billed charges,93.75,3303.82,
PF ARTHRODESIS ANTERIOR INTERBODY CERVICAL BELOW C2,78000409P,CDM,975,RC,22554,HCPCS,Outpatient,,,8559,6419.25,,7874.28,92,,,percent of total billed charges,92% of total billed charges,203.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7959.87,93,,,percent of total billed charges,93% of total billed charges,7703.1,90,,,percent of total billed charges,90% of total billed charges,7703.1,90,,,percent of total billed charges,90% of total billed charges,8302.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,203.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,8302.23,97,,,percent of total billed charges,97% of total billed charges,6419.25,75,,,percent of total billed charges,75% of total billed charges,8216.64,96,,,percent of total billed charges,96% of total billed charges,203.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6419.25,75,,,percent of total billed charges,75% of total billed charges,6419.25,75,,,percent of total billed charges,75% of total billed charges,203.4,8302.23,
PF ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS,78000410P,CDM,975,RC,22845,HCPCS,Outpatient,,,6950,5212.5,,6394,92,,,percent of total billed charges,92% of total billed charges,130.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6463.5,93,,,percent of total billed charges,93% of total billed charges,6255,90,,,percent of total billed charges,90% of total billed charges,6255,90,,,percent of total billed charges,90% of total billed charges,6741.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,130.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6741.5,97,,,percent of total billed charges,97% of total billed charges,5212.5,75,,,percent of total billed charges,75% of total billed charges,6672,96,,,percent of total billed charges,96% of total billed charges,130.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5212.5,75,,,percent of total billed charges,75% of total billed charges,5212.5,75,,,percent of total billed charges,75% of total billed charges,130.28,6741.5,
PF EXCISION TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM,78000411P,CDM,975,RC,22902,HCPCS,Outpatient,,,1797,1347.75,,1653.24,92,,,percent of total billed charges,92% of total billed charges,40.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1671.21,93,,,percent of total billed charges,93% of total billed charges,1617.3,90,,,percent of total billed charges,90% of total billed charges,1617.3,90,,,percent of total billed charges,90% of total billed charges,1743.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1743.09,97,,,percent of total billed charges,97% of total billed charges,1347.75,75,,,percent of total billed charges,75% of total billed charges,1725.12,96,,,percent of total billed charges,96% of total billed charges,40.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1347.75,75,,,percent of total billed charges,75% of total billed charges,1347.75,75,,,percent of total billed charges,75% of total billed charges,40.45,1743.09,
PF INCISION  DRAIN SHOULDER DEEP ABSCESS/HEMATOMA,78000413P,CDM,975,RC,23030,HCPCS,Outpatient,,,1388,1041,,1276.96,92,,,percent of total billed charges,92% of total billed charges,27.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1290.84,93,,,percent of total billed charges,93% of total billed charges,1249.2,90,,,percent of total billed charges,90% of total billed charges,1249.2,90,,,percent of total billed charges,90% of total billed charges,1346.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1346.36,97,,,percent of total billed charges,97% of total billed charges,1041,75,,,percent of total billed charges,75% of total billed charges,1332.48,96,,,percent of total billed charges,96% of total billed charges,27.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1041,75,,,percent of total billed charges,75% of total billed charges,1041,75,,,percent of total billed charges,75% of total billed charges,27.89,1346.36,
PF INCISION  DRAIN SHOULDER INFECTED BURSA,78000415P,CDM,975,RC,23031,HCPCS,Outpatient,,,1061,795.75,,976.12,92,,,percent of total billed charges,92% of total billed charges,23.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,986.73,93,,,percent of total billed charges,93% of total billed charges,954.9,90,,,percent of total billed charges,90% of total billed charges,954.9,90,,,percent of total billed charges,90% of total billed charges,1029.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1029.17,97,,,percent of total billed charges,97% of total billed charges,795.75,75,,,percent of total billed charges,75% of total billed charges,1018.56,96,,,percent of total billed charges,96% of total billed charges,23.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,795.75,75,,,percent of total billed charges,75% of total billed charges,795.75,75,,,percent of total billed charges,75% of total billed charges,23.25,1029.17,
PF ARTHROTOMY ACROMI/STERNOCLAVICULAR JOINT W/REMOVAL OF FB,78000417P,CDM,975,RC,23044,HCPCS,Outpatient,,,2712,2034,,2495.04,92,,,percent of total billed charges,92% of total billed charges,63.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2522.16,93,,,percent of total billed charges,93% of total billed charges,2440.8,90,,,percent of total billed charges,90% of total billed charges,2440.8,90,,,percent of total billed charges,90% of total billed charges,2630.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,63.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2630.64,97,,,percent of total billed charges,97% of total billed charges,2034,75,,,percent of total billed charges,75% of total billed charges,2603.52,96,,,percent of total billed charges,96% of total billed charges,63.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2034,75,,,percent of total billed charges,75% of total billed charges,2034,75,,,percent of total billed charges,75% of total billed charges,63.24,2630.64,
PF EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>,78000418P,CDM,975,RC,23071,HCPCS,Outpatient,,,1571,1178.25,,1445.32,92,,,percent of total billed charges,92% of total billed charges,52.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1461.03,93,,,percent of total billed charges,93% of total billed charges,1413.9,90,,,percent of total billed charges,90% of total billed charges,1413.9,90,,,percent of total billed charges,90% of total billed charges,1523.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,52.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1523.87,97,,,percent of total billed charges,97% of total billed charges,1178.25,75,,,percent of total billed charges,75% of total billed charges,1508.16,96,,,percent of total billed charges,96% of total billed charges,52.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1178.25,75,,,percent of total billed charges,75% of total billed charges,1178.25,75,,,percent of total billed charges,75% of total billed charges,52.13,1523.87,
PF ARTHROTOMY ACROMI/STERNOCLAVICULAR JOINT W/BIOPSY CARTILG,78000420P,CDM,975,RC,23101,HCPCS,Outpatient,,,2708,2031,,2491.36,92,,,percent of total billed charges,92% of total billed charges,48.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2518.44,93,,,percent of total billed charges,93% of total billed charges,2437.2,90,,,percent of total billed charges,90% of total billed charges,2437.2,90,,,percent of total billed charges,90% of total billed charges,2626.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,48.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2626.76,97,,,percent of total billed charges,97% of total billed charges,2031,75,,,percent of total billed charges,75% of total billed charges,2599.68,96,,,percent of total billed charges,96% of total billed charges,48.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2031,75,,,percent of total billed charges,75% of total billed charges,2031,75,,,percent of total billed charges,75% of total billed charges,48.72,2626.76,
PF CLAVICULECTOMY PARTIAL,78000421P,CDM,975,RC,23120,HCPCS,Outpatient,,,2998,2248.5,,2758.16,92,,,percent of total billed charges,92% of total billed charges,61.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2788.14,93,,,percent of total billed charges,93% of total billed charges,2698.2,90,,,percent of total billed charges,90% of total billed charges,2698.2,90,,,percent of total billed charges,90% of total billed charges,2908.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2908.06,97,,,percent of total billed charges,97% of total billed charges,2248.5,75,,,percent of total billed charges,75% of total billed charges,2878.08,96,,,percent of total billed charges,96% of total billed charges,61.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2248.5,75,,,percent of total billed charges,75% of total billed charges,2248.5,75,,,percent of total billed charges,75% of total billed charges,61.68,2908.06,
PF PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE,78000423P,CDM,975,RC,23130,HCPCS,Outpatient,,,3221,2415.75,,2963.32,92,,,percent of total billed charges,92% of total billed charges,64.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2995.53,93,,,percent of total billed charges,93% of total billed charges,2898.9,90,,,percent of total billed charges,90% of total billed charges,2898.9,90,,,percent of total billed charges,90% of total billed charges,3124.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,64.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3124.37,97,,,percent of total billed charges,97% of total billed charges,2415.75,75,,,percent of total billed charges,75% of total billed charges,3092.16,96,,,percent of total billed charges,96% of total billed charges,64.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2415.75,75,,,percent of total billed charges,75% of total billed charges,2415.75,75,,,percent of total billed charges,75% of total billed charges,64.88,3124.37,
PF REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS,78000424P,CDM,975,RC,23330,HCPCS,Outpatient,,,652,489,,599.84,92,,,percent of total billed charges,92% of total billed charges,16.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,606.36,93,,,percent of total billed charges,93% of total billed charges,586.8,90,,,percent of total billed charges,90% of total billed charges,586.8,90,,,percent of total billed charges,90% of total billed charges,632.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,632.44,97,,,percent of total billed charges,97% of total billed charges,489,75,,,percent of total billed charges,75% of total billed charges,625.92,96,,,percent of total billed charges,96% of total billed charges,16.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,489,75,,,percent of total billed charges,75% of total billed charges,489,75,,,percent of total billed charges,75% of total billed charges,16.46,632.44,
PF REMOVAL SHOULDER FOREIGN BDY DEEP SUBFASCIAL OR INTRAMUSC,78000426P,CDM,975,RC,23333,HCPCS,Outpatient,,,1821,1365.75,,1675.32,92,,,percent of total billed charges,92% of total billed charges,50.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1693.53,93,,,percent of total billed charges,93% of total billed charges,1638.9,90,,,percent of total billed charges,90% of total billed charges,1638.9,90,,,percent of total billed charges,90% of total billed charges,1766.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1766.37,97,,,percent of total billed charges,97% of total billed charges,1365.75,75,,,percent of total billed charges,75% of total billed charges,1748.16,96,,,percent of total billed charges,96% of total billed charges,50.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1365.75,75,,,percent of total billed charges,75% of total billed charges,1365.75,75,,,percent of total billed charges,75% of total billed charges,50.04,1766.37,
PF OPEN REPAIR OF ROTATOR CUFF ACUTE,78000432P,CDM,975,RC,23410,HCPCS,Outpatient,,,4802,3601.5,,4417.84,92,,,percent of total billed charges,92% of total billed charges,90.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4465.86,93,,,percent of total billed charges,93% of total billed charges,4321.8,90,,,percent of total billed charges,90% of total billed charges,4321.8,90,,,percent of total billed charges,90% of total billed charges,4657.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,90.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4657.94,97,,,percent of total billed charges,97% of total billed charges,3601.5,75,,,percent of total billed charges,75% of total billed charges,4609.92,96,,,percent of total billed charges,96% of total billed charges,90.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3601.5,75,,,percent of total billed charges,75% of total billed charges,3601.5,75,,,percent of total billed charges,75% of total billed charges,90.47,4657.94,
PF OPEN REPAIR OF ROTATOR CUFF CHRONIC,78000434P,CDM,975,RC,23412,HCPCS,Outpatient,,,5032,3774,,4629.44,92,,,percent of total billed charges,92% of total billed charges,94.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4679.76,93,,,percent of total billed charges,93% of total billed charges,4528.8,90,,,percent of total billed charges,90% of total billed charges,4528.8,90,,,percent of total billed charges,90% of total billed charges,4881.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,94.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4881.04,97,,,percent of total billed charges,97% of total billed charges,3774,75,,,percent of total billed charges,75% of total billed charges,4830.72,96,,,percent of total billed charges,96% of total billed charges,94.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3774,75,,,percent of total billed charges,75% of total billed charges,3774,75,,,percent of total billed charges,75% of total billed charges,94.85,4881.04,
PF CORACOACROMIAL LIGAMENT RELEASE W/WO ACROMIOPLASTY,78000436P,CDM,975,RC,23415,HCPCS,Outpatient,,,3156,2367,,2903.52,92,,,percent of total billed charges,92% of total billed charges,75.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2935.08,93,,,percent of total billed charges,93% of total billed charges,2840.4,90,,,percent of total billed charges,90% of total billed charges,2840.4,90,,,percent of total billed charges,90% of total billed charges,3061.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,75.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3061.32,97,,,percent of total billed charges,97% of total billed charges,2367,75,,,percent of total billed charges,75% of total billed charges,3029.76,96,,,percent of total billed charges,96% of total billed charges,75.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2367,75,,,percent of total billed charges,75% of total billed charges,2367,75,,,percent of total billed charges,75% of total billed charges,75.2,3061.32,
PF RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC,78000437P,CDM,975,RC,23420,HCPCS,Outpatient,,,5649,4236.75,,5197.08,92,,,percent of total billed charges,92% of total billed charges,108.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5253.57,93,,,percent of total billed charges,93% of total billed charges,5084.1,90,,,percent of total billed charges,90% of total billed charges,5084.1,90,,,percent of total billed charges,90% of total billed charges,5479.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,108.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5479.53,97,,,percent of total billed charges,97% of total billed charges,4236.75,75,,,percent of total billed charges,75% of total billed charges,5423.04,96,,,percent of total billed charges,96% of total billed charges,108.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4236.75,75,,,percent of total billed charges,75% of total billed charges,4236.75,75,,,percent of total billed charges,75% of total billed charges,108.86,5479.53,
PF TENODESIS LONG TENDON BICEPS,78000439P,CDM,975,RC,23430,HCPCS,Outpatient,,,3822,2866.5,,3516.24,92,,,percent of total billed charges,92% of total billed charges,80.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3554.46,93,,,percent of total billed charges,93% of total billed charges,3439.8,90,,,percent of total billed charges,90% of total billed charges,3439.8,90,,,percent of total billed charges,90% of total billed charges,3707.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,80.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3707.34,97,,,percent of total billed charges,97% of total billed charges,2866.5,75,,,percent of total billed charges,75% of total billed charges,3669.12,96,,,percent of total billed charges,96% of total billed charges,80.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2866.5,75,,,percent of total billed charges,75% of total billed charges,2866.5,75,,,percent of total billed charges,75% of total billed charges,80.57,3707.34,
PF CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TRANSFER,78000441P,CDM,975,RC,23462,HCPCS,Outpatient,,,5535,4151.25,,5092.2,92,,,percent of total billed charges,92% of total billed charges,125.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5147.55,93,,,percent of total billed charges,93% of total billed charges,4981.5,90,,,percent of total billed charges,90% of total billed charges,4981.5,90,,,percent of total billed charges,90% of total billed charges,5368.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,125.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5368.95,97,,,percent of total billed charges,97% of total billed charges,4151.25,75,,,percent of total billed charges,75% of total billed charges,5313.6,96,,,percent of total billed charges,96% of total billed charges,125.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4151.25,75,,,percent of total billed charges,75% of total billed charges,4151.25,75,,,percent of total billed charges,75% of total billed charges,125.28,5368.95,
PF ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER,78000443P,CDM,975,RC,23472,HCPCS,Outpatient,,,9827,7370.25,,9040.84,92,,,percent of total billed charges,92% of total billed charges,168.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,9139.11,93,,,percent of total billed charges,93% of total billed charges,8844.3,90,,,percent of total billed charges,90% of total billed charges,8844.3,90,,,percent of total billed charges,90% of total billed charges,9532.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,168.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,9532.19,97,,,percent of total billed charges,97% of total billed charges,7370.25,75,,,percent of total billed charges,75% of total billed charges,9433.92,96,,,percent of total billed charges,96% of total billed charges,168.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7370.25,75,,,percent of total billed charges,75% of total billed charges,7370.25,75,,,percent of total billed charges,75% of total billed charges,168.81,9532.19,
PF REVISION TOTAL SHOULD ARTHROPLASTY HUMERAL OR GLENOID COM,78002857P,CDM,975,RC,23473,HCPCS,Outpatient,,,3987,2990.25,,3668.04,92,,,percent of total billed charges,92% of total billed charges,189.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3707.91,93,,,percent of total billed charges,93% of total billed charges,3588.3,90,,,percent of total billed charges,90% of total billed charges,3588.3,90,,,percent of total billed charges,90% of total billed charges,3867.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,189.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3867.39,97,,,percent of total billed charges,97% of total billed charges,2990.25,75,,,percent of total billed charges,75% of total billed charges,3827.52,96,,,percent of total billed charges,96% of total billed charges,189.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2990.25,75,,,percent of total billed charges,75% of total billed charges,2990.25,75,,,percent of total billed charges,75% of total billed charges,189.06,3867.39,
PF REVIS SHOULDER ARTHROPLASTY HUMERAL  GLENOID COMPONENT,78000445P,CDM,975,RC,23474,HCPCS,Outpatient,,,6880,5160,,6329.6,92,,,percent of total billed charges,92% of total billed charges,205.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6398.4,93,,,percent of total billed charges,93% of total billed charges,6192,90,,,percent of total billed charges,90% of total billed charges,6192,90,,,percent of total billed charges,90% of total billed charges,6673.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,205.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6673.6,97,,,percent of total billed charges,97% of total billed charges,5160,75,,,percent of total billed charges,75% of total billed charges,6604.8,96,,,percent of total billed charges,96% of total billed charges,205.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5160,75,,,percent of total billed charges,75% of total billed charges,5160,75,,,percent of total billed charges,75% of total billed charges,205.95,6673.6,
PF OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION,78000446P,CDM,975,RC,23480,HCPCS,Outpatient,,,4205,3153.75,,3868.6,92,,,percent of total billed charges,92% of total billed charges,92.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3910.65,93,,,percent of total billed charges,93% of total billed charges,3784.5,90,,,percent of total billed charges,90% of total billed charges,3784.5,90,,,percent of total billed charges,90% of total billed charges,4078.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,92.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4078.85,97,,,percent of total billed charges,97% of total billed charges,3153.75,75,,,percent of total billed charges,75% of total billed charges,4036.8,96,,,percent of total billed charges,96% of total billed charges,92.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3153.75,75,,,percent of total billed charges,75% of total billed charges,3153.75,75,,,percent of total billed charges,75% of total billed charges,92.94,4078.85,
PF OSTEOTOMY CLAVICLE W/BONE GRAFT FOR NON/MALUNION,78000447P,CDM,975,RC,23485,HCPCS,Outpatient,,,4388,3291,,4036.96,92,,,percent of total billed charges,92% of total billed charges,109.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4080.84,93,,,percent of total billed charges,93% of total billed charges,3949.2,90,,,percent of total billed charges,90% of total billed charges,3949.2,90,,,percent of total billed charges,90% of total billed charges,4256.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4256.36,97,,,percent of total billed charges,97% of total billed charges,3291,75,,,percent of total billed charges,75% of total billed charges,4212.48,96,,,percent of total billed charges,96% of total billed charges,109.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3291,75,,,percent of total billed charges,75% of total billed charges,3291,75,,,percent of total billed charges,75% of total billed charges,109.44,4256.36,
PF CLOSED TX CLAVICULAR FRACTURE W/O MANIPULATION,78000449P,CDM,975,RC,23500,HCPCS,Outpatient,,,614,460.5,,564.88,92,,,percent of total billed charges,92% of total billed charges,20.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,571.02,93,,,percent of total billed charges,93% of total billed charges,552.6,90,,,percent of total billed charges,90% of total billed charges,552.6,90,,,percent of total billed charges,90% of total billed charges,595.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,595.58,97,,,percent of total billed charges,97% of total billed charges,460.5,75,,,percent of total billed charges,75% of total billed charges,589.44,96,,,percent of total billed charges,96% of total billed charges,20.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,460.5,75,,,percent of total billed charges,75% of total billed charges,460.5,75,,,percent of total billed charges,75% of total billed charges,20.2,595.58,
PF CLOSED TX CLAVICULAR FRACTURE W/MANIPULATION,78000451P,CDM,975,RC,23505,HCPCS,Outpatient,,,1387,1040.25,,1276.04,92,,,percent of total billed charges,92% of total billed charges,32.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1289.91,93,,,percent of total billed charges,93% of total billed charges,1248.3,90,,,percent of total billed charges,90% of total billed charges,1248.3,90,,,percent of total billed charges,90% of total billed charges,1345.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1345.39,97,,,percent of total billed charges,97% of total billed charges,1040.25,75,,,percent of total billed charges,75% of total billed charges,1331.52,96,,,percent of total billed charges,96% of total billed charges,32.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.25,75,,,percent of total billed charges,75% of total billed charges,1040.25,75,,,percent of total billed charges,75% of total billed charges,32.89,1345.39,
PF OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION,78000453P,CDM,975,RC,23515,HCPCS,Outpatient,,,2855,2141.25,,2626.6,92,,,percent of total billed charges,92% of total billed charges,77.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2655.15,93,,,percent of total billed charges,93% of total billed charges,2569.5,90,,,percent of total billed charges,90% of total billed charges,2569.5,90,,,percent of total billed charges,90% of total billed charges,2769.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,77.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2769.35,97,,,percent of total billed charges,97% of total billed charges,2141.25,75,,,percent of total billed charges,75% of total billed charges,2740.8,96,,,percent of total billed charges,96% of total billed charges,77.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2141.25,75,,,percent of total billed charges,75% of total billed charges,2141.25,75,,,percent of total billed charges,75% of total billed charges,77.6,2769.35,
PF CLOSED TX ACROMIOCLAVICULAR DISLOCATION W/O MANIP,78000455P,CDM,975,RC,23540,HCPCS,Outpatient,,,879,659.25,,808.68,92,,,percent of total billed charges,92% of total billed charges,21.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,817.47,93,,,percent of total billed charges,93% of total billed charges,791.1,90,,,percent of total billed charges,90% of total billed charges,791.1,90,,,percent of total billed charges,90% of total billed charges,852.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,852.63,97,,,percent of total billed charges,97% of total billed charges,659.25,75,,,percent of total billed charges,75% of total billed charges,843.84,96,,,percent of total billed charges,96% of total billed charges,21.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,659.25,75,,,percent of total billed charges,75% of total billed charges,659.25,75,,,percent of total billed charges,75% of total billed charges,21.3,852.63,
PF OPEN TX ACROMIOCLAVICULAR DISLOCATION ACUTE/CHRONIC,78000457P,CDM,975,RC,23550,HCPCS,Outpatient,,,3110,2332.5,,2861.2,92,,,percent of total billed charges,92% of total billed charges,61.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2892.3,93,,,percent of total billed charges,93% of total billed charges,2799,90,,,percent of total billed charges,90% of total billed charges,2799,90,,,percent of total billed charges,90% of total billed charges,3016.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3016.7,97,,,percent of total billed charges,97% of total billed charges,2332.5,75,,,percent of total billed charges,75% of total billed charges,2985.6,96,,,percent of total billed charges,96% of total billed charges,61.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2332.5,75,,,percent of total billed charges,75% of total billed charges,2332.5,75,,,percent of total billed charges,75% of total billed charges,61.07,3016.7,
PF OPEN TX ACROMCLAVICLE DISLOCATION W/FASCIAL GRAFT,78000459P,CDM,975,RC,23552,HCPCS,Outpatient,,,3645,2733.75,,3353.4,92,,,percent of total billed charges,92% of total billed charges,69.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3389.85,93,,,percent of total billed charges,93% of total billed charges,3280.5,90,,,percent of total billed charges,90% of total billed charges,3280.5,90,,,percent of total billed charges,90% of total billed charges,3535.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,69.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3535.65,97,,,percent of total billed charges,97% of total billed charges,2733.75,75,,,percent of total billed charges,75% of total billed charges,3499.2,96,,,percent of total billed charges,96% of total billed charges,69.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2733.75,75,,,percent of total billed charges,75% of total billed charges,2733.75,75,,,percent of total billed charges,75% of total billed charges,69.17,3535.65,
PF CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION,78000461P,CDM,975,RC,23570,HCPCS,Outpatient,,,900,675,,828,92,,,percent of total billed charges,92% of total billed charges,21.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,837,93,,,percent of total billed charges,93% of total billed charges,810,90,,,percent of total billed charges,90% of total billed charges,810,90,,,percent of total billed charges,90% of total billed charges,873,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,873,97,,,percent of total billed charges,97% of total billed charges,675,75,,,percent of total billed charges,75% of total billed charges,864,96,,,percent of total billed charges,96% of total billed charges,21.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,675,75,,,percent of total billed charges,75% of total billed charges,675,75,,,percent of total billed charges,75% of total billed charges,21.52,873,
PF CLOSED TX SCAPULAR FX W/MANIP W/WO SKELETAL TRACTION,78000470P,CDM,975,RC,23575,HCPCS,Outpatient,,,1158,868.5,,1065.36,92,,,percent of total billed charges,92% of total billed charges,37.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1076.94,93,,,percent of total billed charges,93% of total billed charges,1042.2,90,,,percent of total billed charges,90% of total billed charges,1042.2,90,,,percent of total billed charges,90% of total billed charges,1123.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1123.26,97,,,percent of total billed charges,97% of total billed charges,868.5,75,,,percent of total billed charges,75% of total billed charges,1111.68,96,,,percent of total billed charges,96% of total billed charges,37.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,868.5,75,,,percent of total billed charges,75% of total billed charges,868.5,75,,,percent of total billed charges,75% of total billed charges,37.48,1123.26,
PF OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PERFORMED,78000464P,CDM,975,RC,23585,HCPCS,Outpatient,,,3984,2988,,3665.28,92,,,percent of total billed charges,92% of total billed charges,109.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3705.12,93,,,percent of total billed charges,93% of total billed charges,3585.6,90,,,percent of total billed charges,90% of total billed charges,3585.6,90,,,percent of total billed charges,90% of total billed charges,3864.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3864.48,97,,,percent of total billed charges,97% of total billed charges,2988,75,,,percent of total billed charges,75% of total billed charges,3824.64,96,,,percent of total billed charges,96% of total billed charges,109.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2988,75,,,percent of total billed charges,75% of total billed charges,2988,75,,,percent of total billed charges,75% of total billed charges,109.92,3864.48,
PF CLOSED TX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION,78000466P,CDM,975,RC,23600,HCPCS,Outpatient,,,1220,915,,1122.4,92,,,percent of total billed charges,92% of total billed charges,27.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1134.6,93,,,percent of total billed charges,93% of total billed charges,1098,90,,,percent of total billed charges,90% of total billed charges,1098,90,,,percent of total billed charges,90% of total billed charges,1183.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1183.4,97,,,percent of total billed charges,97% of total billed charges,915,75,,,percent of total billed charges,75% of total billed charges,1171.2,96,,,percent of total billed charges,96% of total billed charges,27.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,915,75,,,percent of total billed charges,75% of total billed charges,915,75,,,percent of total billed charges,75% of total billed charges,27.41,1183.4,
PF CLOSED TX PROXIMAL HUMRAL FX W/MANIP W/WO SKELETAL TRACTI,78000468P,CDM,975,RC,23605,HCPCS,Outpatient,,,1907,1430.25,,1754.44,92,,,percent of total billed charges,92% of total billed charges,43.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1773.51,93,,,percent of total billed charges,93% of total billed charges,1716.3,90,,,percent of total billed charges,90% of total billed charges,1716.3,90,,,percent of total billed charges,90% of total billed charges,1849.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1849.79,97,,,percent of total billed charges,97% of total billed charges,1430.25,75,,,percent of total billed charges,75% of total billed charges,1830.72,96,,,percent of total billed charges,96% of total billed charges,43.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1430.25,75,,,percent of total billed charges,75% of total billed charges,1430.25,75,,,percent of total billed charges,75% of total billed charges,43.75,1849.79,
PF OPEN TX PROXIMAL HUMERAL FRACTURE,78002265P,CDM,975,RC,23615,HCPCS,Outpatient,,,3959,2969.25,,3642.28,92,,,percent of total billed charges,92% of total billed charges,97.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3681.87,93,,,percent of total billed charges,93% of total billed charges,3563.1,90,,,percent of total billed charges,90% of total billed charges,3563.1,90,,,percent of total billed charges,90% of total billed charges,3840.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,97.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3840.23,97,,,percent of total billed charges,97% of total billed charges,2969.25,75,,,percent of total billed charges,75% of total billed charges,3800.64,96,,,percent of total billed charges,96% of total billed charges,97.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2969.25,75,,,percent of total billed charges,75% of total billed charges,2969.25,75,,,percent of total billed charges,75% of total billed charges,97.84,3840.23,
PF CLOSED TX GREATER HUMERAL TUBEROSITY FX W/O MANIP,78000472P,CDM,975,RC,23620,HCPCS,Outpatient,,,705,528.75,,648.6,92,,,percent of total billed charges,92% of total billed charges,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,655.65,93,,,percent of total billed charges,93% of total billed charges,634.5,90,,,percent of total billed charges,90% of total billed charges,634.5,90,,,percent of total billed charges,90% of total billed charges,683.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,683.85,97,,,percent of total billed charges,97% of total billed charges,528.75,75,,,percent of total billed charges,75% of total billed charges,676.8,96,,,percent of total billed charges,96% of total billed charges,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,528.75,75,,,percent of total billed charges,75% of total billed charges,528.75,75,,,percent of total billed charges,75% of total billed charges,22.94,683.85,
PF CLOSED TX GREATER HUMERAL TUBEROSITY FX W/MANIPULATION,78000474P,CDM,975,RC,23625,HCPCS,Outpatient,,,1437,1077.75,,1322.04,92,,,percent of total billed charges,92% of total billed charges,35.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1336.41,93,,,percent of total billed charges,93% of total billed charges,1293.3,90,,,percent of total billed charges,90% of total billed charges,1293.3,90,,,percent of total billed charges,90% of total billed charges,1393.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,35.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1393.89,97,,,percent of total billed charges,97% of total billed charges,1077.75,75,,,percent of total billed charges,75% of total billed charges,1379.52,96,,,percent of total billed charges,96% of total billed charges,35.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1077.75,75,,,percent of total billed charges,75% of total billed charges,1077.75,75,,,percent of total billed charges,75% of total billed charges,35.73,1393.89,
PF OPEN TREATMNT GREATER HUMERAL TUBEROSITY FRACTURE,78000475P,CDM,975,RC,23630,HCPCS,Outpatient,,,2985,2238.75,,2746.2,92,,,percent of total billed charges,92% of total billed charges,84.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2776.05,93,,,percent of total billed charges,93% of total billed charges,2686.5,90,,,percent of total billed charges,90% of total billed charges,2686.5,90,,,percent of total billed charges,90% of total billed charges,2895.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,84.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2895.45,97,,,percent of total billed charges,97% of total billed charges,2238.75,75,,,percent of total billed charges,75% of total billed charges,2865.6,96,,,percent of total billed charges,96% of total billed charges,84.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2238.75,75,,,percent of total billed charges,75% of total billed charges,2238.75,75,,,percent of total billed charges,75% of total billed charges,84.86,2895.45,
PF CLOSED TX SHOULDER DISLOCATION W/MANIPULATION W/O ANES,78000477P,CDM,975,RC,23650,HCPCS,Outpatient,,,1140,855,,1048.8,92,,,percent of total billed charges,92% of total billed charges,30.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1060.2,93,,,percent of total billed charges,93% of total billed charges,1026,90,,,percent of total billed charges,90% of total billed charges,1026,90,,,percent of total billed charges,90% of total billed charges,1105.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1105.8,97,,,percent of total billed charges,97% of total billed charges,855,75,,,percent of total billed charges,75% of total billed charges,1094.4,96,,,percent of total billed charges,96% of total billed charges,30.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,855,75,,,percent of total billed charges,75% of total billed charges,855,75,,,percent of total billed charges,75% of total billed charges,30.62,1105.8,
PF CLOSED TX SHOULDER DISLOCATION W/MANIPULATION REQ ANES,78000479P,CDM,975,RC,23655,HCPCS,Outpatient,,,1588,1191,,1460.96,92,,,percent of total billed charges,92% of total billed charges,40.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1476.84,93,,,percent of total billed charges,93% of total billed charges,1429.2,90,,,percent of total billed charges,90% of total billed charges,1429.2,90,,,percent of total billed charges,90% of total billed charges,1540.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1540.36,97,,,percent of total billed charges,97% of total billed charges,1191,75,,,percent of total billed charges,75% of total billed charges,1524.48,96,,,percent of total billed charges,96% of total billed charges,40.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1191,75,,,percent of total billed charges,75% of total billed charges,1191,75,,,percent of total billed charges,75% of total billed charges,40.82,1540.36,
PF CLOSED TX SHOULDER DISLC W/FX HUMERAL TUBEROSITY W/MANIP,78000481P,CDM,975,RC,23665,HCPCS,Outpatient,,,1674,1255.5,,1540.08,92,,,percent of total billed charges,92% of total billed charges,40.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1556.82,93,,,percent of total billed charges,93% of total billed charges,1506.6,90,,,percent of total billed charges,90% of total billed charges,1506.6,90,,,percent of total billed charges,90% of total billed charges,1623.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1623.78,97,,,percent of total billed charges,97% of total billed charges,1255.5,75,,,percent of total billed charges,75% of total billed charges,1607.04,96,,,percent of total billed charges,96% of total billed charges,40.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1255.5,75,,,percent of total billed charges,75% of total billed charges,1255.5,75,,,percent of total billed charges,75% of total billed charges,40.65,1623.78,
PF MANIPULATION W/ANES SHOULDER JOINT W/FIXATION APPARATUS,78000483P,CDM,975,RC,23700,HCPCS,Outpatient,,,1199,899.25,,1103.08,92,,,percent of total billed charges,92% of total billed charges,20.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1115.07,93,,,percent of total billed charges,93% of total billed charges,1079.1,90,,,percent of total billed charges,90% of total billed charges,1079.1,90,,,percent of total billed charges,90% of total billed charges,1163.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1163.03,97,,,percent of total billed charges,97% of total billed charges,899.25,75,,,percent of total billed charges,75% of total billed charges,1151.04,96,,,percent of total billed charges,96% of total billed charges,20.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,899.25,75,,,percent of total billed charges,75% of total billed charges,899.25,75,,,percent of total billed charges,75% of total billed charges,20.42,1163.03,
PF UNLISTED PROCEDURE SHOULDER,78000484P,CDM,975,RC,23929,HCPCS,Outpatient,,,341,255.75,,313.72,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,317.13,93,,,percent of total billed charges,93% of total billed charges,306.9,90,,,percent of total billed charges,90% of total billed charges,306.9,90,,,percent of total billed charges,90% of total billed charges,330.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,330.77,97,,,percent of total billed charges,97% of total billed charges,255.75,75,,,percent of total billed charges,75% of total billed charges,327.36,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,255.75,75,,,percent of total billed charges,75% of total billed charges,255.75,75,,,percent of total billed charges,75% of total billed charges,255.75,330.77,
PF INCISION  DRAIN UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA,78000486P,CDM,975,RC,23930,HCPCS,Outpatient,,,1262,946.5,,1161.04,92,,,percent of total billed charges,92% of total billed charges,24.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1173.66,93,,,percent of total billed charges,93% of total billed charges,1135.8,90,,,percent of total billed charges,90% of total billed charges,1135.8,90,,,percent of total billed charges,90% of total billed charges,1224.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1224.14,97,,,percent of total billed charges,97% of total billed charges,946.5,75,,,percent of total billed charges,75% of total billed charges,1211.52,96,,,percent of total billed charges,96% of total billed charges,24.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,946.5,75,,,percent of total billed charges,75% of total billed charges,946.5,75,,,percent of total billed charges,75% of total billed charges,24.61,1224.14,
PF INCISION  DRAINAGE UPPER ARM OR ELBOW BURSA,78000488P,CDM,975,RC,23931,HCPCS,Outpatient,,,978,733.5,,899.76,92,,,percent of total billed charges,92% of total billed charges,15.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,909.54,93,,,percent of total billed charges,93% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,948.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,948.66,97,,,percent of total billed charges,97% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,938.88,96,,,percent of total billed charges,96% of total billed charges,15.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,733.5,75,,,percent of total billed charges,75% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,15.16,948.66,
PF ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB,78000489P,CDM,975,RC,24000,HCPCS,Outpatient,,,2891,2168.25,,2659.72,92,,,percent of total billed charges,92% of total billed charges,49.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2688.63,93,,,percent of total billed charges,93% of total billed charges,2601.9,90,,,percent of total billed charges,90% of total billed charges,2601.9,90,,,percent of total billed charges,90% of total billed charges,2804.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,49.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2804.27,97,,,percent of total billed charges,97% of total billed charges,2168.25,75,,,percent of total billed charges,75% of total billed charges,2775.36,96,,,percent of total billed charges,96% of total billed charges,49.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2168.25,75,,,percent of total billed charges,75% of total billed charges,2168.25,75,,,percent of total billed charges,75% of total billed charges,49.98,2804.27,
PF ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS,78000490P,CDM,975,RC,24006,HCPCS,Outpatient,,,3393,2544.75,,3121.56,92,,,percent of total billed charges,92% of total billed charges,76.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3155.49,93,,,percent of total billed charges,93% of total billed charges,3053.7,90,,,percent of total billed charges,90% of total billed charges,3053.7,90,,,percent of total billed charges,90% of total billed charges,3291.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3291.21,97,,,percent of total billed charges,97% of total billed charges,2544.75,75,,,percent of total billed charges,75% of total billed charges,3257.28,96,,,percent of total billed charges,96% of total billed charges,76.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2544.75,75,,,percent of total billed charges,75% of total billed charges,2544.75,75,,,percent of total billed charges,75% of total billed charges,76.57,3291.21,
PF BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP,78000492P,CDM,975,RC,24066,HCPCS,Outpatient,,,1779,1334.25,,1636.68,92,,,percent of total billed charges,92% of total billed charges,46.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1654.47,93,,,percent of total billed charges,93% of total billed charges,1601.1,90,,,percent of total billed charges,90% of total billed charges,1601.1,90,,,percent of total billed charges,90% of total billed charges,1725.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1725.63,97,,,percent of total billed charges,97% of total billed charges,1334.25,75,,,percent of total billed charges,75% of total billed charges,1707.84,96,,,percent of total billed charges,96% of total billed charges,46.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1334.25,75,,,percent of total billed charges,75% of total billed charges,1334.25,75,,,percent of total billed charges,75% of total billed charges,46.06,1725.63,
PF EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM,78000494P,CDM,975,RC,24075,HCPCS,Outpatient,,,1643,1232.25,,1511.56,92,,,percent of total billed charges,92% of total billed charges,35.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1527.99,93,,,percent of total billed charges,93% of total billed charges,1478.7,90,,,percent of total billed charges,90% of total billed charges,1478.7,90,,,percent of total billed charges,90% of total billed charges,1593.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,35.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1593.71,97,,,percent of total billed charges,97% of total billed charges,1232.25,75,,,percent of total billed charges,75% of total billed charges,1577.28,96,,,percent of total billed charges,96% of total billed charges,35.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1232.25,75,,,percent of total billed charges,75% of total billed charges,1232.25,75,,,percent of total billed charges,75% of total billed charges,35.98,1593.71,
PF EXCISION OLECRANON BURSA,78000496P,CDM,975,RC,24105,HCPCS,Outpatient,,,1703,1277.25,,1566.76,92,,,percent of total billed charges,92% of total billed charges,33.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1583.79,93,,,percent of total billed charges,93% of total billed charges,1532.7,90,,,percent of total billed charges,90% of total billed charges,1532.7,90,,,percent of total billed charges,90% of total billed charges,1651.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1651.91,97,,,percent of total billed charges,97% of total billed charges,1277.25,75,,,percent of total billed charges,75% of total billed charges,1634.88,96,,,percent of total billed charges,96% of total billed charges,33.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1277.25,75,,,percent of total billed charges,75% of total billed charges,1277.25,75,,,percent of total billed charges,75% of total billed charges,33.14,1651.91,
PF EXCISION RADIAL HEAD,78000498P,CDM,975,RC,24130,HCPCS,Outpatient,,,2590,1942.5,,2382.8,92,,,percent of total billed charges,92% of total billed charges,51.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2408.7,93,,,percent of total billed charges,93% of total billed charges,2331,90,,,percent of total billed charges,90% of total billed charges,2331,90,,,percent of total billed charges,90% of total billed charges,2512.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,51.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2512.3,97,,,percent of total billed charges,97% of total billed charges,1942.5,75,,,percent of total billed charges,75% of total billed charges,2486.4,96,,,percent of total billed charges,96% of total billed charges,51.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1942.5,75,,,percent of total billed charges,75% of total billed charges,1942.5,75,,,percent of total billed charges,75% of total billed charges,51.38,2512.3,
PF REMOVAL OF ELBOW JOINT,78002420P,CDM,975,RC,24155,HCPCS,Outpatient,,,2590,1942.5,,2382.8,92,,,percent of total billed charges,92% of total billed charges,97.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2408.7,93,,,percent of total billed charges,93% of total billed charges,2331,90,,,percent of total billed charges,90% of total billed charges,2331,90,,,percent of total billed charges,90% of total billed charges,2512.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,97.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2512.3,97,,,percent of total billed charges,97% of total billed charges,1942.5,75,,,percent of total billed charges,75% of total billed charges,2486.4,96,,,percent of total billed charges,96% of total billed charges,97.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1942.5,75,,,percent of total billed charges,75% of total billed charges,1942.5,75,,,percent of total billed charges,75% of total billed charges,97.28,2512.3,
PF REMOVAL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS,78000499P,CDM,975,RC,24200,HCPCS,Outpatient,,,658,493.5,,605.36,92,,,percent of total billed charges,92% of total billed charges,13.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,611.94,93,,,percent of total billed charges,93% of total billed charges,592.2,90,,,percent of total billed charges,90% of total billed charges,592.2,90,,,percent of total billed charges,90% of total billed charges,638.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,638.26,97,,,percent of total billed charges,97% of total billed charges,493.5,75,,,percent of total billed charges,75% of total billed charges,631.68,96,,,percent of total billed charges,96% of total billed charges,13.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,493.5,75,,,percent of total billed charges,75% of total billed charges,493.5,75,,,percent of total billed charges,75% of total billed charges,13.9,638.26,
PF REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP,78000501P,CDM,975,RC,24201,HCPCS,Outpatient,,,1422,1066.5,,1308.24,92,,,percent of total billed charges,92% of total billed charges,40.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1322.46,93,,,percent of total billed charges,93% of total billed charges,1279.8,90,,,percent of total billed charges,90% of total billed charges,1279.8,90,,,percent of total billed charges,90% of total billed charges,1379.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1379.34,97,,,percent of total billed charges,97% of total billed charges,1066.5,75,,,percent of total billed charges,75% of total billed charges,1365.12,96,,,percent of total billed charges,96% of total billed charges,40.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1066.5,75,,,percent of total billed charges,75% of total billed charges,1066.5,75,,,percent of total billed charges,75% of total billed charges,40.44,1379.34,
PF INJECTION ELBOW ARTHROGRAPHY,78000503P,CDM,975,RC,24220,HCPCS,Outpatient,,,211,158.25,,194.12,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,196.23,93,,,percent of total billed charges,93% of total billed charges,189.9,90,,,percent of total billed charges,90% of total billed charges,189.9,90,,,percent of total billed charges,90% of total billed charges,204.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.67,97,,,percent of total billed charges,97% of total billed charges,158.25,75,,,percent of total billed charges,75% of total billed charges,202.56,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.25,75,,,percent of total billed charges,75% of total billed charges,158.25,75,,,percent of total billed charges,75% of total billed charges,5.78,204.67,
PF REPAIR TENDON/MUSCLE UPPER ARM OR ELBOW EACH,78000507P,CDM,975,RC,24341,HCPCS,Outpatient,,,3557,2667.75,,3272.44,92,,,percent of total billed charges,92% of total billed charges,76.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3308.01,93,,,percent of total billed charges,93% of total billed charges,3201.3,90,,,percent of total billed charges,90% of total billed charges,3201.3,90,,,percent of total billed charges,90% of total billed charges,3450.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3450.29,97,,,percent of total billed charges,97% of total billed charges,2667.75,75,,,percent of total billed charges,75% of total billed charges,3414.72,96,,,percent of total billed charges,96% of total billed charges,76.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2667.75,75,,,percent of total billed charges,75% of total billed charges,2667.75,75,,,percent of total billed charges,75% of total billed charges,76.52,3450.29,
PF REINSERT RUPTUREDD BICEPS OR TRICEPS TENDON DISTAL,78000508P,CDM,975,RC,24342,HCPCS,Outpatient,,,4191,3143.25,,3855.72,92,,,percent of total billed charges,92% of total billed charges,84.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3897.63,93,,,percent of total billed charges,93% of total billed charges,3771.9,90,,,percent of total billed charges,90% of total billed charges,3771.9,90,,,percent of total billed charges,90% of total billed charges,4065.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,84.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4065.27,97,,,percent of total billed charges,97% of total billed charges,3143.25,75,,,percent of total billed charges,75% of total billed charges,4023.36,96,,,percent of total billed charges,96% of total billed charges,84.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3143.25,75,,,percent of total billed charges,75% of total billed charges,3143.25,75,,,percent of total billed charges,75% of total billed charges,84.57,4065.27,
PF REPAIR LATERAL COLLATERAL LIGAMENT ELBOW,78000510P,CDM,975,RC,24343,HCPCS,Outpatient,,,3608,2706,,3319.36,92,,,percent of total billed charges,92% of total billed charges,73.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3355.44,93,,,percent of total billed charges,93% of total billed charges,3247.2,90,,,percent of total billed charges,90% of total billed charges,3247.2,90,,,percent of total billed charges,90% of total billed charges,3499.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,73.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3499.76,97,,,percent of total billed charges,97% of total billed charges,2706,75,,,percent of total billed charges,75% of total billed charges,3463.68,96,,,percent of total billed charges,96% of total billed charges,73.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2706,75,,,percent of total billed charges,75% of total billed charges,2706,75,,,percent of total billed charges,75% of total billed charges,73.66,3499.76,
PF TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS,78000512P,CDM,975,RC,24357,HCPCS,Outpatient,,,2115,1586.25,,1945.8,92,,,percent of total billed charges,92% of total billed charges,33.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1966.95,93,,,percent of total billed charges,93% of total billed charges,1903.5,90,,,percent of total billed charges,90% of total billed charges,1903.5,90,,,percent of total billed charges,90% of total billed charges,2051.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2051.55,97,,,percent of total billed charges,97% of total billed charges,1586.25,75,,,percent of total billed charges,75% of total billed charges,2030.4,96,,,percent of total billed charges,96% of total billed charges,33.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1586.25,75,,,percent of total billed charges,75% of total billed charges,1586.25,75,,,percent of total billed charges,75% of total billed charges,33.63,2051.55,
PF TENOTOMY ELBOW LATERAL/MEDIAL DEBRIDEMENT OPEN,78000513P,CDM,975,RC,24358,HCPCS,Outpatient,,,2483,1862.25,,2284.36,92,,,percent of total billed charges,92% of total billed charges,53.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2309.19,93,,,percent of total billed charges,93% of total billed charges,2234.7,90,,,percent of total billed charges,90% of total billed charges,2234.7,90,,,percent of total billed charges,90% of total billed charges,2408.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2408.51,97,,,percent of total billed charges,97% of total billed charges,1862.25,75,,,percent of total billed charges,75% of total billed charges,2383.68,96,,,percent of total billed charges,96% of total billed charges,53.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1862.25,75,,,percent of total billed charges,75% of total billed charges,1862.25,75,,,percent of total billed charges,75% of total billed charges,53.67,2408.51,
PF TENOTOMY ELBOW LATERAL/MEDIAL DEBRIDE OPEN TENDON REPAIR,78000514P,CDM,975,RC,24359,HCPCS,Outpatient,,,3127,2345.25,,2876.84,92,,,percent of total billed charges,92% of total billed charges,70.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2908.11,93,,,percent of total billed charges,93% of total billed charges,2814.3,90,,,percent of total billed charges,90% of total billed charges,2814.3,90,,,percent of total billed charges,90% of total billed charges,3033.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3033.19,97,,,percent of total billed charges,97% of total billed charges,2345.25,75,,,percent of total billed charges,75% of total billed charges,3001.92,96,,,percent of total billed charges,96% of total billed charges,70.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2345.25,75,,,percent of total billed charges,75% of total billed charges,2345.25,75,,,percent of total billed charges,75% of total billed charges,70.77,3033.19,
PF DECOMPRESSION FASCIOTOMY FOREARM W/BRACH ARTERY EXPLORE,78000515P,CDM,975,RC,24495,HCPCS,Outpatient,,,2972,2229,,2734.24,92,,,percent of total billed charges,92% of total billed charges,78.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2763.96,93,,,percent of total billed charges,93% of total billed charges,2674.8,90,,,percent of total billed charges,90% of total billed charges,2674.8,90,,,percent of total billed charges,90% of total billed charges,2882.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,78.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2882.84,97,,,percent of total billed charges,97% of total billed charges,2229,75,,,percent of total billed charges,75% of total billed charges,2853.12,96,,,percent of total billed charges,96% of total billed charges,78.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2229,75,,,percent of total billed charges,75% of total billed charges,2229,75,,,percent of total billed charges,75% of total billed charges,78.75,2882.84,
PF CLOSED TX HUMERAL SHAFT FRACTURE W/O MANIPULATION,78000516P,CDM,975,RC,24500,HCPCS,Outpatient,,,1293,969.75,,1189.56,92,,,percent of total billed charges,92% of total billed charges,30.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1202.49,93,,,percent of total billed charges,93% of total billed charges,1163.7,90,,,percent of total billed charges,90% of total billed charges,1163.7,90,,,percent of total billed charges,90% of total billed charges,1254.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1254.21,97,,,percent of total billed charges,97% of total billed charges,969.75,75,,,percent of total billed charges,75% of total billed charges,1241.28,96,,,percent of total billed charges,96% of total billed charges,30.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,969.75,75,,,percent of total billed charges,75% of total billed charges,969.75,75,,,percent of total billed charges,75% of total billed charges,30.78,1254.21,
PF CLOSED TX HUMERAL SHAFT FX W/MANIP W/WO SKELETAL TRACTION,78000518P,CDM,975,RC,24505,HCPCS,Outpatient,,,1765,1323.75,,1623.8,92,,,percent of total billed charges,92% of total billed charges,46.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1641.45,93,,,percent of total billed charges,93% of total billed charges,1588.5,90,,,percent of total billed charges,90% of total billed charges,1588.5,90,,,percent of total billed charges,90% of total billed charges,1712.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1712.05,97,,,percent of total billed charges,97% of total billed charges,1323.75,75,,,percent of total billed charges,75% of total billed charges,1694.4,96,,,percent of total billed charges,96% of total billed charges,46.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1323.75,75,,,percent of total billed charges,75% of total billed charges,1323.75,75,,,percent of total billed charges,75% of total billed charges,46.8,1712.05,
PF OPEN TX HUMERAL SHAFT FX W/PLATE SCREWS,78000520P,CDM,975,RC,24515,HCPCS,Outpatient,,,3939,2954.25,,3623.88,92,,,percent of total billed charges,92% of total billed charges,96.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3663.27,93,,,percent of total billed charges,93% of total billed charges,3545.1,90,,,percent of total billed charges,90% of total billed charges,3545.1,90,,,percent of total billed charges,90% of total billed charges,3820.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,96.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3820.83,97,,,percent of total billed charges,97% of total billed charges,2954.25,75,,,percent of total billed charges,75% of total billed charges,3781.44,96,,,percent of total billed charges,96% of total billed charges,96.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2954.25,75,,,percent of total billed charges,75% of total billed charges,2954.25,75,,,percent of total billed charges,75% of total billed charges,96.95,3820.83,
PF TX HUMERAL SHAFT FX W/INSERT INTRAMEDULLARY IMPLANT,78000522P,CDM,975,RC,24516,HCPCS,Outpatient,,,4091,3068.25,,3763.72,92,,,percent of total billed charges,92% of total billed charges,96.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3804.63,93,,,percent of total billed charges,93% of total billed charges,3681.9,90,,,percent of total billed charges,90% of total billed charges,3681.9,90,,,percent of total billed charges,90% of total billed charges,3968.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,96.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3968.27,97,,,percent of total billed charges,97% of total billed charges,3068.25,75,,,percent of total billed charges,75% of total billed charges,3927.36,96,,,percent of total billed charges,96% of total billed charges,96.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3068.25,75,,,percent of total billed charges,75% of total billed charges,3068.25,75,,,percent of total billed charges,75% of total billed charges,96.97,3968.27,
PF CLOSED TX SUPRA/TRANSCONDYLAR HUMERAL FX W/WO MANIP,78000524P,CDM,975,RC,24530,HCPCS,Outpatient,,,1488,1116,,1368.96,92,,,percent of total billed charges,92% of total billed charges,32.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1383.84,93,,,percent of total billed charges,93% of total billed charges,1339.2,90,,,percent of total billed charges,90% of total billed charges,1339.2,90,,,percent of total billed charges,90% of total billed charges,1443.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1443.36,97,,,percent of total billed charges,97% of total billed charges,1116,75,,,percent of total billed charges,75% of total billed charges,1428.48,96,,,percent of total billed charges,96% of total billed charges,32.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1116,75,,,percent of total billed charges,75% of total billed charges,1116,75,,,percent of total billed charges,75% of total billed charges,32.72,1443.36,
PF CLOSED TX SUPRA/TRANSCONDYLAR HUMERAL FX W/MANIP,78000526P,CDM,975,RC,24535,HCPCS,Outpatient,,,2228,1671,,2049.76,92,,,percent of total billed charges,92% of total billed charges,59.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2072.04,93,,,percent of total billed charges,93% of total billed charges,2005.2,90,,,percent of total billed charges,90% of total billed charges,2005.2,90,,,percent of total billed charges,90% of total billed charges,2161.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,59.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2161.16,97,,,percent of total billed charges,97% of total billed charges,1671,75,,,percent of total billed charges,75% of total billed charges,2138.88,96,,,percent of total billed charges,96% of total billed charges,59.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1671,75,,,percent of total billed charges,75% of total billed charges,1671,75,,,percent of total billed charges,75% of total billed charges,59.96,2161.16,
PF PERQ SKELETAL FIXATION SUPRA/TRANSCONDYLAR HUMERAL FX,78000528P,CDM,975,RC,24538,HCPCS,Outpatient,,,3882,2911.5,,3571.44,92,,,percent of total billed charges,92% of total billed charges,82.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3610.26,93,,,percent of total billed charges,93% of total billed charges,3493.8,90,,,percent of total billed charges,90% of total billed charges,3493.8,90,,,percent of total billed charges,90% of total billed charges,3765.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,82.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3765.54,97,,,percent of total billed charges,97% of total billed charges,2911.5,75,,,percent of total billed charges,75% of total billed charges,3726.72,96,,,percent of total billed charges,96% of total billed charges,82.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2911.5,75,,,percent of total billed charges,75% of total billed charges,2911.5,75,,,percent of total billed charges,75% of total billed charges,82.48,3765.54,
PF OP TX HUMERAL SUPRACONDYLAR FX W/O EXTENSION,78002895P,CDM,975,RC,24545,HCPCS,Outpatient,,,1798,1348.5,,1654.16,92,,,percent of total billed charges,92% of total billed charges,104.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1672.14,93,,,percent of total billed charges,93% of total billed charges,1618.2,90,,,percent of total billed charges,90% of total billed charges,1618.2,90,,,percent of total billed charges,90% of total billed charges,1744.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,104.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1744.06,97,,,percent of total billed charges,97% of total billed charges,1348.5,75,,,percent of total billed charges,75% of total billed charges,1726.08,96,,,percent of total billed charges,96% of total billed charges,104.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1348.5,75,,,percent of total billed charges,75% of total billed charges,1348.5,75,,,percent of total billed charges,75% of total billed charges,104.28,1744.06,
PF OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/INTERNAL FIXATN,78000529P,CDM,975,RC,24546,HCPCS,Outpatient,,,5247,3935.25,,4827.24,92,,,percent of total billed charges,92% of total billed charges,116.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4879.71,93,,,percent of total billed charges,93% of total billed charges,4722.3,90,,,percent of total billed charges,90% of total billed charges,4722.3,90,,,percent of total billed charges,90% of total billed charges,5089.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,116.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5089.59,97,,,percent of total billed charges,97% of total billed charges,3935.25,75,,,percent of total billed charges,75% of total billed charges,5037.12,96,,,percent of total billed charges,96% of total billed charges,116.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3935.25,75,,,percent of total billed charges,75% of total billed charges,3935.25,75,,,percent of total billed charges,75% of total billed charges,116.95,5089.59,
PF CLOSED TX HUMERAL EPICONDYLAR FX MEDIAL/LATERAL W/O MANIP,78000531P,CDM,975,RC,24560,HCPCS,Outpatient,,,1227,920.25,,1128.84,92,,,percent of total billed charges,92% of total billed charges,26.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1141.11,93,,,percent of total billed charges,93% of total billed charges,1104.3,90,,,percent of total billed charges,90% of total billed charges,1104.3,90,,,percent of total billed charges,90% of total billed charges,1190.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1190.19,97,,,percent of total billed charges,97% of total billed charges,920.25,75,,,percent of total billed charges,75% of total billed charges,1177.92,96,,,percent of total billed charges,96% of total billed charges,26.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,920.25,75,,,percent of total billed charges,75% of total billed charges,920.25,75,,,percent of total billed charges,75% of total billed charges,26.64,1190.19,
PF PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ,78000532P,CDM,975,RC,24566,HCPCS,Outpatient,,,2998,2248.5,,2758.16,92,,,percent of total billed charges,92% of total billed charges,75.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2788.14,93,,,percent of total billed charges,93% of total billed charges,2698.2,90,,,percent of total billed charges,90% of total billed charges,2698.2,90,,,percent of total billed charges,90% of total billed charges,2908.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,75.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2908.06,97,,,percent of total billed charges,97% of total billed charges,2248.5,75,,,percent of total billed charges,75% of total billed charges,2878.08,96,,,percent of total billed charges,96% of total billed charges,75.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2248.5,75,,,percent of total billed charges,75% of total billed charges,2248.5,75,,,percent of total billed charges,75% of total billed charges,75.8,2908.06,
PF OPEN TX HUMERAL EPICONDYLAR FRACTURE W/INTERNAL FIXATION,78000533P,CDM,975,RC,24575,HCPCS,Outpatient,,,3309,2481.75,,3044.28,92,,,percent of total billed charges,92% of total billed charges,78.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3077.37,93,,,percent of total billed charges,93% of total billed charges,2978.1,90,,,percent of total billed charges,90% of total billed charges,2978.1,90,,,percent of total billed charges,90% of total billed charges,3209.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,78.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3209.73,97,,,percent of total billed charges,97% of total billed charges,2481.75,75,,,percent of total billed charges,75% of total billed charges,3176.64,96,,,percent of total billed charges,96% of total billed charges,78.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2481.75,75,,,percent of total billed charges,75% of total billed charges,2481.75,75,,,percent of total billed charges,75% of total billed charges,78.07,3209.73,
PF CLOSED TX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/O MANIP,78000535P,CDM,975,RC,24576,HCPCS,Outpatient,,,1225,918.75,,1127,92,,,percent of total billed charges,92% of total billed charges,27.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1139.25,93,,,percent of total billed charges,93% of total billed charges,1102.5,90,,,percent of total billed charges,90% of total billed charges,1102.5,90,,,percent of total billed charges,90% of total billed charges,1188.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1188.25,97,,,percent of total billed charges,97% of total billed charges,918.75,75,,,percent of total billed charges,75% of total billed charges,1176,96,,,percent of total billed charges,96% of total billed charges,27.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,918.75,75,,,percent of total billed charges,75% of total billed charges,918.75,75,,,percent of total billed charges,75% of total billed charges,27.88,1188.25,
PF CLOSED TX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANIP,78000536P,CDM,975,RC,24577,HCPCS,Outpatient,,,2011,1508.25,,1850.12,92,,,percent of total billed charges,92% of total billed charges,51.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1870.23,93,,,percent of total billed charges,93% of total billed charges,1809.9,90,,,percent of total billed charges,90% of total billed charges,1809.9,90,,,percent of total billed charges,90% of total billed charges,1950.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,51.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1950.67,97,,,percent of total billed charges,97% of total billed charges,1508.25,75,,,percent of total billed charges,75% of total billed charges,1930.56,96,,,percent of total billed charges,96% of total billed charges,51.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1508.25,75,,,percent of total billed charges,75% of total billed charges,1508.25,75,,,percent of total billed charges,75% of total billed charges,51.73,1950.67,
PF OPEN TX HUMERAL CONDYLAR FRACTURE,78000537P,CDM,975,RC,24579,HCPCS,Outpatient,,,3780,2835,,3477.6,92,,,percent of total billed charges,92% of total billed charges,90.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3515.4,93,,,percent of total billed charges,93% of total billed charges,3402,90,,,percent of total billed charges,90% of total billed charges,3402,90,,,percent of total billed charges,90% of total billed charges,3666.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,90.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3666.6,97,,,percent of total billed charges,97% of total billed charges,2835,75,,,percent of total billed charges,75% of total billed charges,3628.8,96,,,percent of total billed charges,96% of total billed charges,90.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2835,75,,,percent of total billed charges,75% of total billed charges,2835,75,,,percent of total billed charges,75% of total billed charges,90.78,3666.6,
PF OPEN TX PERIARTICULAR FX /DISLOCATION ELBOW,78000539P,CDM,975,RC,24586,HCPCS,Outpatient,,,5078,3808.5,,4671.76,92,,,percent of total billed charges,92% of total billed charges,123.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4722.54,93,,,percent of total billed charges,93% of total billed charges,4570.2,90,,,percent of total billed charges,90% of total billed charges,4570.2,90,,,percent of total billed charges,90% of total billed charges,4925.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,123.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4925.66,97,,,percent of total billed charges,97% of total billed charges,3808.5,75,,,percent of total billed charges,75% of total billed charges,4874.88,96,,,percent of total billed charges,96% of total billed charges,123.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3808.5,75,,,percent of total billed charges,75% of total billed charges,3808.5,75,,,percent of total billed charges,75% of total billed charges,123.51,4925.66,
PF TREATMENT CLOSED ELBOW DISLOCATION W/O ANES,78000541P,CDM,975,RC,24600,HCPCS,Outpatient,,,1322,991.5,,1216.24,92,,,percent of total billed charges,92% of total billed charges,36.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1229.46,93,,,percent of total billed charges,93% of total billed charges,1189.8,90,,,percent of total billed charges,90% of total billed charges,1189.8,90,,,percent of total billed charges,90% of total billed charges,1282.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,36.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1282.34,97,,,percent of total billed charges,97% of total billed charges,991.5,75,,,percent of total billed charges,75% of total billed charges,1269.12,96,,,percent of total billed charges,96% of total billed charges,36.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,991.5,75,,,percent of total billed charges,75% of total billed charges,991.5,75,,,percent of total billed charges,75% of total billed charges,36.96,1282.34,
PF TREATMENT CLOSED ELBOW DISLOCATION REQ ANESTH,78000543P,CDM,975,RC,24605,HCPCS,Outpatient,,,1861,1395.75,,1712.12,92,,,percent of total billed charges,92% of total billed charges,48.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1730.73,93,,,percent of total billed charges,93% of total billed charges,1674.9,90,,,percent of total billed charges,90% of total billed charges,1674.9,90,,,percent of total billed charges,90% of total billed charges,1805.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,48.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1805.17,97,,,percent of total billed charges,97% of total billed charges,1395.75,75,,,percent of total billed charges,75% of total billed charges,1786.56,96,,,percent of total billed charges,96% of total billed charges,48.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1395.75,75,,,percent of total billed charges,75% of total billed charges,1395.75,75,,,percent of total billed charges,75% of total billed charges,48.43,1805.17,
PF CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANIP,78000545P,CDM,975,RC,24620,HCPCS,Outpatient,,,2268,1701,,2086.56,92,,,percent of total billed charges,92% of total billed charges,61.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2109.24,93,,,percent of total billed charges,93% of total billed charges,2041.2,90,,,percent of total billed charges,90% of total billed charges,2041.2,90,,,percent of total billed charges,90% of total billed charges,2199.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2199.96,97,,,percent of total billed charges,97% of total billed charges,1701,75,,,percent of total billed charges,75% of total billed charges,2177.28,96,,,percent of total billed charges,96% of total billed charges,61.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1701,75,,,percent of total billed charges,75% of total billed charges,1701,75,,,percent of total billed charges,75% of total billed charges,61.51,2199.96,
PF OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW,78000546P,CDM,975,RC,24635,HCPCS,Outpatient,,,4109,3081.75,,3780.28,92,,,percent of total billed charges,92% of total billed charges,70.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3821.37,93,,,percent of total billed charges,93% of total billed charges,3698.1,90,,,percent of total billed charges,90% of total billed charges,3698.1,90,,,percent of total billed charges,90% of total billed charges,3985.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3985.73,97,,,percent of total billed charges,97% of total billed charges,3081.75,75,,,percent of total billed charges,75% of total billed charges,3944.64,96,,,percent of total billed charges,96% of total billed charges,70.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3081.75,75,,,percent of total billed charges,75% of total billed charges,3081.75,75,,,percent of total billed charges,75% of total billed charges,70.92,3985.73,
PF CLOSED TX RADIAL HEAD SUBLXTJ CHLD NURSEMAID ELBOW W/MANI,78000548P,CDM,975,RC,24640,HCPCS,Outpatient,,,310,232.5,,285.2,92,,,percent of total billed charges,92% of total billed charges,5.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.3,93,,,percent of total billed charges,93% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,300.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.7,97,,,percent of total billed charges,97% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,297.6,96,,,percent of total billed charges,96% of total billed charges,5.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,232.5,75,,,percent of total billed charges,75% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,5.23,300.7,
PF CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION,78000550P,CDM,975,RC,24650,HCPCS,Outpatient,,,999,749.25,,919.08,92,,,percent of total billed charges,92% of total billed charges,21.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,929.07,93,,,percent of total billed charges,93% of total billed charges,899.1,90,,,percent of total billed charges,90% of total billed charges,899.1,90,,,percent of total billed charges,90% of total billed charges,969.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,969.03,97,,,percent of total billed charges,97% of total billed charges,749.25,75,,,percent of total billed charges,75% of total billed charges,959.04,96,,,percent of total billed charges,96% of total billed charges,21.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,749.25,75,,,percent of total billed charges,75% of total billed charges,749.25,75,,,percent of total billed charges,75% of total billed charges,21.11,969.03,
PF CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION,78000552P,CDM,975,RC,24655,HCPCS,Outpatient,,,1566,1174.5,,1440.72,92,,,percent of total billed charges,92% of total billed charges,40.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1456.38,93,,,percent of total billed charges,93% of total billed charges,1409.4,90,,,percent of total billed charges,90% of total billed charges,1409.4,90,,,percent of total billed charges,90% of total billed charges,1519.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1519.02,97,,,percent of total billed charges,97% of total billed charges,1174.5,75,,,percent of total billed charges,75% of total billed charges,1503.36,96,,,percent of total billed charges,96% of total billed charges,40.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1174.5,75,,,percent of total billed charges,75% of total billed charges,1174.5,75,,,percent of total billed charges,75% of total billed charges,40.34,1519.02,
PF OPEN TX RADIAL HEAD/NECK FRACTURE,78000554P,CDM,975,RC,24665,HCPCS,Outpatient,,,2884,2163,,2653.28,92,,,percent of total billed charges,92% of total billed charges,67.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2682.12,93,,,percent of total billed charges,93% of total billed charges,2595.6,90,,,percent of total billed charges,90% of total billed charges,2595.6,90,,,percent of total billed charges,90% of total billed charges,2797.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,67.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2797.48,97,,,percent of total billed charges,97% of total billed charges,2163,75,,,percent of total billed charges,75% of total billed charges,2768.64,96,,,percent of total billed charges,96% of total billed charges,67.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2163,75,,,percent of total billed charges,75% of total billed charges,2163,75,,,percent of total billed charges,75% of total billed charges,67.6,2797.48,
PF CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANIP,78000556P,CDM,975,RC,24670,HCPCS,Outpatient,,,1041,780.75,,957.72,92,,,percent of total billed charges,92% of total billed charges,24.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,968.13,93,,,percent of total billed charges,93% of total billed charges,936.9,90,,,percent of total billed charges,90% of total billed charges,936.9,90,,,percent of total billed charges,90% of total billed charges,1009.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1009.77,97,,,percent of total billed charges,97% of total billed charges,780.75,75,,,percent of total billed charges,75% of total billed charges,999.36,96,,,percent of total billed charges,96% of total billed charges,24.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,780.75,75,,,percent of total billed charges,75% of total billed charges,780.75,75,,,percent of total billed charges,75% of total billed charges,24.04,1009.77,
PF CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANIP,78000558P,CDM,975,RC,24675,HCPCS,Outpatient,,,1636,1227,,1505.12,92,,,percent of total billed charges,92% of total billed charges,41.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1521.48,93,,,percent of total billed charges,93% of total billed charges,1472.4,90,,,percent of total billed charges,90% of total billed charges,1472.4,90,,,percent of total billed charges,90% of total billed charges,1586.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1586.92,97,,,percent of total billed charges,97% of total billed charges,1227,75,,,percent of total billed charges,75% of total billed charges,1570.56,96,,,percent of total billed charges,96% of total billed charges,41.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1227,75,,,percent of total billed charges,75% of total billed charges,1227,75,,,percent of total billed charges,75% of total billed charges,41.78,1586.92,
PF OPEN TX ULNAR FRACTURE PROXIMAL END,78000560P,CDM,975,RC,24685,HCPCS,Outpatient,,,3199,2399.25,,2943.08,92,,,percent of total billed charges,92% of total billed charges,68.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2975.07,93,,,percent of total billed charges,93% of total billed charges,2879.1,90,,,percent of total billed charges,90% of total billed charges,2879.1,90,,,percent of total billed charges,90% of total billed charges,3103.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,68.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3103.03,97,,,percent of total billed charges,97% of total billed charges,2399.25,75,,,percent of total billed charges,75% of total billed charges,3071.04,96,,,percent of total billed charges,96% of total billed charges,68.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2399.25,75,,,percent of total billed charges,75% of total billed charges,2399.25,75,,,percent of total billed charges,75% of total billed charges,68.29,3103.03,
PF UNLISTED PROCEDURE HUMERUS/ELBOW,78000562P,CDM,975,RC,24999,HCPCS,Outpatient,,,341,255.75,,313.72,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,317.13,93,,,percent of total billed charges,93% of total billed charges,306.9,90,,,percent of total billed charges,90% of total billed charges,306.9,90,,,percent of total billed charges,90% of total billed charges,330.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,330.77,97,,,percent of total billed charges,97% of total billed charges,255.75,75,,,percent of total billed charges,75% of total billed charges,327.36,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,255.75,75,,,percent of total billed charges,75% of total billed charges,255.75,75,,,percent of total billed charges,75% of total billed charges,255.75,330.77,
PF INCISION EXTENSOR TENDON SHEATH WRIST,78000564P,CDM,975,RC,25000,HCPCS,Outpatient,,,2141,1605.75,,1969.72,92,,,percent of total billed charges,92% of total billed charges,30.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1991.13,93,,,percent of total billed charges,93% of total billed charges,1926.9,90,,,percent of total billed charges,90% of total billed charges,1926.9,90,,,percent of total billed charges,90% of total billed charges,2076.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2076.77,97,,,percent of total billed charges,97% of total billed charges,1605.75,75,,,percent of total billed charges,75% of total billed charges,2055.36,96,,,percent of total billed charges,96% of total billed charges,30.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1605.75,75,,,percent of total billed charges,75% of total billed charges,1605.75,75,,,percent of total billed charges,75% of total billed charges,30.74,2076.77,
PF DECOMPRESSION FASCIOTOMY FOREARM WRIST FLEXOR/EXTENSOR,78000566P,CDM,975,RC,25024,HCPCS,Outpatient,,,2961,2220.75,,2724.12,92,,,percent of total billed charges,92% of total billed charges,86.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2753.73,93,,,percent of total billed charges,93% of total billed charges,2664.9,90,,,percent of total billed charges,90% of total billed charges,2664.9,90,,,percent of total billed charges,90% of total billed charges,2872.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,86.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2872.17,97,,,percent of total billed charges,97% of total billed charges,2220.75,75,,,percent of total billed charges,75% of total billed charges,2842.56,96,,,percent of total billed charges,96% of total billed charges,86.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2220.75,75,,,percent of total billed charges,75% of total billed charges,2220.75,75,,,percent of total billed charges,75% of total billed charges,86.14,2872.17,
PF INCISION  DRAIN FOREARM WRIST DEEP ABSCESS/HEMATOMA,78000567P,CDM,975,RC,25028,HCPCS,Outpatient,,,2017,1512.75,,1855.64,92,,,percent of total billed charges,92% of total billed charges,53.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1875.81,93,,,percent of total billed charges,93% of total billed charges,1815.3,90,,,percent of total billed charges,90% of total billed charges,1815.3,90,,,percent of total billed charges,90% of total billed charges,1956.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1956.49,97,,,percent of total billed charges,97% of total billed charges,1512.75,75,,,percent of total billed charges,75% of total billed charges,1936.32,96,,,percent of total billed charges,96% of total billed charges,53.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1512.75,75,,,percent of total billed charges,75% of total billed charges,1512.75,75,,,percent of total billed charges,75% of total billed charges,53.73,1956.49,
PF INCISION DEEP BONE CORTEX FOREARM/WRIST,78000568P,CDM,975,RC,25035,HCPCS,Outpatient,,,3301,2475.75,,3036.92,92,,,percent of total billed charges,92% of total billed charges,63.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3069.93,93,,,percent of total billed charges,93% of total billed charges,2970.9,90,,,percent of total billed charges,90% of total billed charges,2970.9,90,,,percent of total billed charges,90% of total billed charges,3201.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,63.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3201.97,97,,,percent of total billed charges,97% of total billed charges,2475.75,75,,,percent of total billed charges,75% of total billed charges,3168.96,96,,,percent of total billed charges,96% of total billed charges,63.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2475.75,75,,,percent of total billed charges,75% of total billed charges,2475.75,75,,,percent of total billed charges,75% of total billed charges,63.61,3201.97,
PF EXCISION TUMOR SOFT TISSUE FOREARM WRIST SUBQ <3CM,78000569P,CDM,975,RC,25075,HCPCS,Outpatient,,,843,632.25,,775.56,92,,,percent of total billed charges,92% of total billed charges,32.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,783.99,93,,,percent of total billed charges,93% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,817.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,817.71,97,,,percent of total billed charges,97% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,809.28,96,,,percent of total billed charges,96% of total billed charges,32.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,632.25,75,,,percent of total billed charges,75% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,32.54,817.71,
PF EXCISION TUMOR SOFT TISSUE FOREARM WRIST SUBFASC <3CM,78000571P,CDM,975,RC,25076,HCPCS,Outpatient,,,2555,1916.25,,2350.6,92,,,percent of total billed charges,92% of total billed charges,53.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2376.15,93,,,percent of total billed charges,93% of total billed charges,2299.5,90,,,percent of total billed charges,90% of total billed charges,2299.5,90,,,percent of total billed charges,90% of total billed charges,2478.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2478.35,97,,,percent of total billed charges,97% of total billed charges,1916.25,75,,,percent of total billed charges,75% of total billed charges,2452.8,96,,,percent of total billed charges,96% of total billed charges,53.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1916.25,75,,,percent of total billed charges,75% of total billed charges,1916.25,75,,,percent of total billed charges,75% of total billed charges,53.77,2478.35,
PF ARTHROTOMY DISTAL RADIOULNAR JOINT REPAIR CARTILAGE,78000573P,CDM,975,RC,25107,HCPCS,Outpatient,,,3367,2525.25,,3097.64,92,,,percent of total billed charges,92% of total billed charges,60.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3131.31,93,,,percent of total billed charges,93% of total billed charges,3030.3,90,,,percent of total billed charges,90% of total billed charges,3030.3,90,,,percent of total billed charges,90% of total billed charges,3265.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,60.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3265.99,97,,,percent of total billed charges,97% of total billed charges,2525.25,75,,,percent of total billed charges,75% of total billed charges,3232.32,96,,,percent of total billed charges,96% of total billed charges,60.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2525.25,75,,,percent of total billed charges,75% of total billed charges,2525.25,75,,,percent of total billed charges,75% of total billed charges,60.84,3265.99,
PF EXCISE LESION OF TENDON SHEATH FOREARM/WRIST,78002893P,CDM,975,RC,25110,HCPCS,Outpatient,,,685,513.75,,630.2,92,,,percent of total billed charges,92% of total billed charges,33.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,637.05,93,,,percent of total billed charges,93% of total billed charges,616.5,90,,,percent of total billed charges,90% of total billed charges,616.5,90,,,percent of total billed charges,90% of total billed charges,664.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.45,97,,,percent of total billed charges,97% of total billed charges,513.75,75,,,percent of total billed charges,75% of total billed charges,657.6,96,,,percent of total billed charges,96% of total billed charges,33.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,513.75,75,,,percent of total billed charges,75% of total billed charges,513.75,75,,,percent of total billed charges,75% of total billed charges,33.16,664.45,
PF EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY,78000575P,CDM,975,RC,25111,HCPCS,Outpatient,,,1807,1355.25,,1662.44,92,,,percent of total billed charges,92% of total billed charges,30,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1680.51,93,,,percent of total billed charges,93% of total billed charges,1626.3,90,,,percent of total billed charges,90% of total billed charges,1626.3,90,,,percent of total billed charges,90% of total billed charges,1752.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1752.79,97,,,percent of total billed charges,97% of total billed charges,1355.25,75,,,percent of total billed charges,75% of total billed charges,1734.72,96,,,percent of total billed charges,96% of total billed charges,30,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1355.25,75,,,percent of total billed charges,75% of total billed charges,1355.25,75,,,percent of total billed charges,75% of total billed charges,30,1752.79,
PF EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT,78000577P,CDM,975,RC,25112,HCPCS,Outpatient,,,2027,1520.25,,1864.84,92,,,percent of total billed charges,92% of total billed charges,38.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1885.11,93,,,percent of total billed charges,93% of total billed charges,1824.3,90,,,percent of total billed charges,90% of total billed charges,1824.3,90,,,percent of total billed charges,90% of total billed charges,1966.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,38.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1966.19,97,,,percent of total billed charges,97% of total billed charges,1520.25,75,,,percent of total billed charges,75% of total billed charges,1945.92,96,,,percent of total billed charges,96% of total billed charges,38.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1520.25,75,,,percent of total billed charges,75% of total billed charges,1520.25,75,,,percent of total billed charges,75% of total billed charges,38.27,1966.19,
PF RADICAL EXC BURSA SYNOVIA WRST FOREARM TENDON SHTH FLEXOR,78000579P,CDM,975,RC,25115,HCPCS,Outpatient,,,3956,2967,,3639.52,92,,,percent of total billed charges,92% of total billed charges,78.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3679.08,93,,,percent of total billed charges,93% of total billed charges,3560.4,90,,,percent of total billed charges,90% of total billed charges,3560.4,90,,,percent of total billed charges,90% of total billed charges,3837.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,78.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3837.32,97,,,percent of total billed charges,97% of total billed charges,2967,75,,,percent of total billed charges,75% of total billed charges,3797.76,96,,,percent of total billed charges,96% of total billed charges,78.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2967,75,,,percent of total billed charges,75% of total billed charges,2967,75,,,percent of total billed charges,75% of total billed charges,78.08,3837.32,
PF SYNOVECTOMY EXTENSOR TENDON SHEATH WRIST SINGLE COMPARTME,78002881P,CDM,975,RC,25118,HCPCS,Outpatient,,,777,582.75,,714.84,92,,,percent of total billed charges,92% of total billed charges,36.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,722.61,93,,,percent of total billed charges,93% of total billed charges,699.3,90,,,percent of total billed charges,90% of total billed charges,699.3,90,,,percent of total billed charges,90% of total billed charges,753.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,36.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,753.69,97,,,percent of total billed charges,97% of total billed charges,582.75,75,,,percent of total billed charges,75% of total billed charges,745.92,96,,,percent of total billed charges,96% of total billed charges,36.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,582.75,75,,,percent of total billed charges,75% of total billed charges,582.75,75,,,percent of total billed charges,75% of total billed charges,36.64,753.69,
PF EXCISION CURETTAGE BONE CYST/TUMOR CARPL BONES W/AUTOGRFT,78000580P,CDM,975,RC,25135,HCPCS,Outpatient,,,2956,2217,,2719.52,92,,,percent of total billed charges,92% of total billed charges,59.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2749.08,93,,,percent of total billed charges,93% of total billed charges,2660.4,90,,,percent of total billed charges,90% of total billed charges,2660.4,90,,,percent of total billed charges,90% of total billed charges,2867.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,59.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2867.32,97,,,percent of total billed charges,97% of total billed charges,2217,75,,,percent of total billed charges,75% of total billed charges,2837.76,96,,,percent of total billed charges,96% of total billed charges,59.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2217,75,,,percent of total billed charges,75% of total billed charges,2217,75,,,percent of total billed charges,75% of total billed charges,59.69,2867.32,
PF EXCISION DISTAL ULNA PARTIAL/COMPLETE,78000582P,CDM,975,RC,25240,HCPCS,Outpatient,,,2418,1813.5,,2224.56,92,,,percent of total billed charges,92% of total billed charges,42.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2248.74,93,,,percent of total billed charges,93% of total billed charges,2176.2,90,,,percent of total billed charges,90% of total billed charges,2176.2,90,,,percent of total billed charges,90% of total billed charges,2345.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,42.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2345.46,97,,,percent of total billed charges,97% of total billed charges,1813.5,75,,,percent of total billed charges,75% of total billed charges,2321.28,96,,,percent of total billed charges,96% of total billed charges,42.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1813.5,75,,,percent of total billed charges,75% of total billed charges,1813.5,75,,,percent of total billed charges,75% of total billed charges,42.9,2345.46,
PF INJECTION WRIST ARTHROGRAPHY,78000583P,CDM,975,RC,25246,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.35,93,,,percent of total billed charges,93% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,189.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.15,97,,,percent of total billed charges,97% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,187.2,96,,,percent of total billed charges,96% of total billed charges,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.25,75,,,percent of total billed charges,75% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,6.55,189.15,
PF EXPLORATION W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST,78000587P,CDM,975,RC,25248,HCPCS,Outpatient,,,1956,1467,,1799.52,92,,,percent of total billed charges,92% of total billed charges,45.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1819.08,93,,,percent of total billed charges,93% of total billed charges,1760.4,90,,,percent of total billed charges,90% of total billed charges,1760.4,90,,,percent of total billed charges,90% of total billed charges,1897.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1897.32,97,,,percent of total billed charges,97% of total billed charges,1467,75,,,percent of total billed charges,75% of total billed charges,1877.76,96,,,percent of total billed charges,96% of total billed charges,45.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1467,75,,,percent of total billed charges,75% of total billed charges,1467,75,,,percent of total billed charges,75% of total billed charges,45.91,1897.32,
PF REPAIR TENDON/MUSCLE FLEXOR FOREARM WRIST PRIMARY EACH,78000589P,CDM,975,RC,25260,HCPCS,Outpatient,,,3310,2482.5,,3045.2,92,,,percent of total billed charges,92% of total billed charges,64.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3078.3,93,,,percent of total billed charges,93% of total billed charges,2979,90,,,percent of total billed charges,90% of total billed charges,2979,90,,,percent of total billed charges,90% of total billed charges,3210.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,64.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3210.7,97,,,percent of total billed charges,97% of total billed charges,2482.5,75,,,percent of total billed charges,75% of total billed charges,3177.6,96,,,percent of total billed charges,96% of total billed charges,64.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2482.5,75,,,percent of total billed charges,75% of total billed charges,2482.5,75,,,percent of total billed charges,75% of total billed charges,64.1,3210.7,
PF REPAIR TENDON/MUSCLE EXTENSOR FOREARM WRIST PRIMARY EACH,78000590P,CDM,975,RC,25270,HCPCS,Outpatient,,,2836,2127,,2609.12,92,,,percent of total billed charges,92% of total billed charges,50,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2637.48,93,,,percent of total billed charges,93% of total billed charges,2552.4,90,,,percent of total billed charges,90% of total billed charges,2552.4,90,,,percent of total billed charges,90% of total billed charges,2750.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2750.92,97,,,percent of total billed charges,97% of total billed charges,2127,75,,,percent of total billed charges,75% of total billed charges,2722.56,96,,,percent of total billed charges,96% of total billed charges,50,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2127,75,,,percent of total billed charges,75% of total billed charges,2127,75,,,percent of total billed charges,75% of total billed charges,50,2750.92,
PF REPAIR TENDON/MUSCLE EXTENSOR FOREARM WRIST SECOND EACH,78000591P,CDM,975,RC,25272,HCPCS,Outpatient,,,3031,2273.25,,2788.52,92,,,percent of total billed charges,92% of total billed charges,60.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2818.83,93,,,percent of total billed charges,93% of total billed charges,2727.9,90,,,percent of total billed charges,90% of total billed charges,2727.9,90,,,percent of total billed charges,90% of total billed charges,2940.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,60.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2940.07,97,,,percent of total billed charges,97% of total billed charges,2273.25,75,,,percent of total billed charges,75% of total billed charges,2909.76,96,,,percent of total billed charges,96% of total billed charges,60.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2273.25,75,,,percent of total billed charges,75% of total billed charges,2273.25,75,,,percent of total billed charges,75% of total billed charges,60.43,2940.07,
PF TENOTOMY FOREARM WRIST SINGLE EACH TENDON,78000592P,CDM,975,RC,25290,HCPCS,Outpatient,,,2406,1804.5,,2213.52,92,,,percent of total billed charges,92% of total billed charges,43.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2237.58,93,,,percent of total billed charges,93% of total billed charges,2165.4,90,,,percent of total billed charges,90% of total billed charges,2165.4,90,,,percent of total billed charges,90% of total billed charges,2333.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2333.82,97,,,percent of total billed charges,97% of total billed charges,1804.5,75,,,percent of total billed charges,75% of total billed charges,2309.76,96,,,percent of total billed charges,96% of total billed charges,43.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1804.5,75,,,percent of total billed charges,75% of total billed charges,1804.5,75,,,percent of total billed charges,75% of total billed charges,43.36,2333.82,
PF TENOLYSIS FLEXOR/EXTENSOR TENDON FOREARM WRIST EACH,78000593P,CDM,975,RC,25295,HCPCS,Outpatient,,,2673,2004.75,,2459.16,92,,,percent of total billed charges,92% of total billed charges,53.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2485.89,93,,,percent of total billed charges,93% of total billed charges,2405.7,90,,,percent of total billed charges,90% of total billed charges,2405.7,90,,,percent of total billed charges,90% of total billed charges,2592.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2592.81,97,,,percent of total billed charges,97% of total billed charges,2004.75,75,,,percent of total billed charges,75% of total billed charges,2566.08,96,,,percent of total billed charges,96% of total billed charges,53.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2004.75,75,,,percent of total billed charges,75% of total billed charges,2004.75,75,,,percent of total billed charges,75% of total billed charges,53.03,2592.81,
PF OSTEOTOMY RADIUS DISTAL THIRD,78000594P,CDM,975,RC,25350,HCPCS,Outpatient,,,3599,2699.25,,3311.08,92,,,percent of total billed charges,92% of total billed charges,70.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3347.07,93,,,percent of total billed charges,93% of total billed charges,3239.1,90,,,percent of total billed charges,90% of total billed charges,3239.1,90,,,percent of total billed charges,90% of total billed charges,3491.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3491.03,97,,,percent of total billed charges,97% of total billed charges,2699.25,75,,,percent of total billed charges,75% of total billed charges,3455.04,96,,,percent of total billed charges,96% of total billed charges,70.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2699.25,75,,,percent of total billed charges,75% of total billed charges,2699.25,75,,,percent of total billed charges,75% of total billed charges,70.32,3491.03,
PF REPAIR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT,78000596P,CDM,975,RC,25405,HCPCS,Outpatient,,,5140,3855,,4728.8,92,,,percent of total billed charges,92% of total billed charges,114.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4780.2,93,,,percent of total billed charges,93% of total billed charges,4626,90,,,percent of total billed charges,90% of total billed charges,4626,90,,,percent of total billed charges,90% of total billed charges,4985.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,114.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4985.8,97,,,percent of total billed charges,97% of total billed charges,3855,75,,,percent of total billed charges,75% of total billed charges,4934.4,96,,,percent of total billed charges,96% of total billed charges,114.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3855,75,,,percent of total billed charges,75% of total billed charges,3855,75,,,percent of total billed charges,75% of total billed charges,114.47,4985.8,
PF REPAIR NONUNION SCAPHOID CARPAL BONE,78000598P,CDM,975,RC,25440,HCPCS,Outpatient,,,3833,2874.75,,3526.36,92,,,percent of total billed charges,92% of total billed charges,82.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3564.69,93,,,percent of total billed charges,93% of total billed charges,3449.7,90,,,percent of total billed charges,90% of total billed charges,3449.7,90,,,percent of total billed charges,90% of total billed charges,3718.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,82.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3718.01,97,,,percent of total billed charges,97% of total billed charges,2874.75,75,,,percent of total billed charges,75% of total billed charges,3679.68,96,,,percent of total billed charges,96% of total billed charges,82.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2874.75,75,,,percent of total billed charges,75% of total billed charges,2874.75,75,,,percent of total billed charges,75% of total billed charges,82.24,3718.01,
PF ARTHROPLASTY INTERPOSPOSITION INTERCARPAL/METACARPAL JNTS,78000600P,CDM,975,RC,25447,HCPCS,Outpatient,,,3956,2967,,3639.52,92,,,percent of total billed charges,92% of total billed charges,86.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3679.08,93,,,percent of total billed charges,93% of total billed charges,3560.4,90,,,percent of total billed charges,90% of total billed charges,3560.4,90,,,percent of total billed charges,90% of total billed charges,3837.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,86.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3837.32,97,,,percent of total billed charges,97% of total billed charges,2967,75,,,percent of total billed charges,75% of total billed charges,3797.76,96,,,percent of total billed charges,96% of total billed charges,86.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2967,75,,,percent of total billed charges,75% of total billed charges,2967,75,,,percent of total billed charges,75% of total billed charges,86.38,3837.32,
PF CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION,78000601P,CDM,975,RC,25500,HCPCS,Outpatient,,,990,742.5,,910.8,92,,,percent of total billed charges,92% of total billed charges,22.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,920.7,93,,,percent of total billed charges,93% of total billed charges,891,90,,,percent of total billed charges,90% of total billed charges,891,90,,,percent of total billed charges,90% of total billed charges,960.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,960.3,97,,,percent of total billed charges,97% of total billed charges,742.5,75,,,percent of total billed charges,75% of total billed charges,950.4,96,,,percent of total billed charges,96% of total billed charges,22.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,742.5,75,,,percent of total billed charges,75% of total billed charges,742.5,75,,,percent of total billed charges,75% of total billed charges,22.9,960.3,
PF CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION,78000603P,CDM,975,RC,25505,HCPCS,Outpatient,,,2024,1518,,1862.08,92,,,percent of total billed charges,92% of total billed charges,47.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1882.32,93,,,percent of total billed charges,93% of total billed charges,1821.6,90,,,percent of total billed charges,90% of total billed charges,1821.6,90,,,percent of total billed charges,90% of total billed charges,1963.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,47.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1963.28,97,,,percent of total billed charges,97% of total billed charges,1518,75,,,percent of total billed charges,75% of total billed charges,1943.04,96,,,percent of total billed charges,96% of total billed charges,47.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1518,75,,,percent of total billed charges,75% of total billed charges,1518,75,,,percent of total billed charges,75% of total billed charges,47.15,1963.28,
PF OPEN TX RADIAL SHAFT FRACTURE,78000605P,CDM,975,RC,25515,HCPCS,Outpatient,,,3073,2304.75,,2827.16,92,,,percent of total billed charges,92% of total billed charges,70.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2857.89,93,,,percent of total billed charges,93% of total billed charges,2765.7,90,,,percent of total billed charges,90% of total billed charges,2765.7,90,,,percent of total billed charges,90% of total billed charges,2980.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2980.81,97,,,percent of total billed charges,97% of total billed charges,2304.75,75,,,percent of total billed charges,75% of total billed charges,2950.08,96,,,percent of total billed charges,96% of total billed charges,70.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2304.75,75,,,percent of total billed charges,75% of total billed charges,2304.75,75,,,percent of total billed charges,75% of total billed charges,70.79,2980.81,
PF CL TX RADIAL SHAFT FX  CL TX DISLC DISTAL RADIOULNAR JNT,78000607P,CDM,975,RC,25520,HCPCS,Outpatient,,,2363,1772.25,,2173.96,92,,,percent of total billed charges,92% of total billed charges,55.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2197.59,93,,,percent of total billed charges,93% of total billed charges,2126.7,90,,,percent of total billed charges,90% of total billed charges,2126.7,90,,,percent of total billed charges,90% of total billed charges,2292.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,55.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2292.11,97,,,percent of total billed charges,97% of total billed charges,1772.25,75,,,percent of total billed charges,75% of total billed charges,2268.48,96,,,percent of total billed charges,96% of total billed charges,55.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1772.25,75,,,percent of total billed charges,75% of total billed charges,1772.25,75,,,percent of total billed charges,75% of total billed charges,55.73,2292.11,
PF OPEN RADIAL SHAFT FX CLOSED RADIAL/ULNAR JOINT DISLOCATE,78000608P,CDM,975,RC,25525,HCPCS,Outpatient,,,3838,2878.5,,3530.96,92,,,percent of total billed charges,92% of total billed charges,84.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3569.34,93,,,percent of total billed charges,93% of total billed charges,3454.2,90,,,percent of total billed charges,90% of total billed charges,3454.2,90,,,percent of total billed charges,90% of total billed charges,3722.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,84.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3722.86,97,,,percent of total billed charges,97% of total billed charges,2878.5,75,,,percent of total billed charges,75% of total billed charges,3684.48,96,,,percent of total billed charges,96% of total billed charges,84.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2878.5,75,,,percent of total billed charges,75% of total billed charges,2878.5,75,,,percent of total billed charges,75% of total billed charges,84.68,3722.86,
PF CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION,78000610P,CDM,975,RC,25530,HCPCS,Outpatient,,,1007,755.25,,926.44,92,,,percent of total billed charges,92% of total billed charges,20.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,936.51,93,,,percent of total billed charges,93% of total billed charges,906.3,90,,,percent of total billed charges,90% of total billed charges,906.3,90,,,percent of total billed charges,90% of total billed charges,976.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,976.79,97,,,percent of total billed charges,97% of total billed charges,755.25,75,,,percent of total billed charges,75% of total billed charges,966.72,96,,,percent of total billed charges,96% of total billed charges,20.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,755.25,75,,,percent of total billed charges,75% of total billed charges,755.25,75,,,percent of total billed charges,75% of total billed charges,20.47,976.79,
PF CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION,78000612P,CDM,975,RC,25535,HCPCS,Outpatient,,,2965,2223.75,,2727.8,92,,,percent of total billed charges,92% of total billed charges,45.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2757.45,93,,,percent of total billed charges,93% of total billed charges,2668.5,90,,,percent of total billed charges,90% of total billed charges,2668.5,90,,,percent of total billed charges,90% of total billed charges,2876.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2876.05,97,,,percent of total billed charges,97% of total billed charges,2223.75,75,,,percent of total billed charges,75% of total billed charges,2846.4,96,,,percent of total billed charges,96% of total billed charges,45.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2223.75,75,,,percent of total billed charges,75% of total billed charges,2223.75,75,,,percent of total billed charges,75% of total billed charges,45.37,2876.05,
PF OPEN TX OF ULNAR SHAFT FRACTURE,78000614P,CDM,975,RC,25545,HCPCS,Outpatient,,,2965,2223.75,,2727.8,92,,,percent of total billed charges,92% of total billed charges,64.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2757.45,93,,,percent of total billed charges,93% of total billed charges,2668.5,90,,,percent of total billed charges,90% of total billed charges,2668.5,90,,,percent of total billed charges,90% of total billed charges,2876.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,64.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2876.05,97,,,percent of total billed charges,97% of total billed charges,2223.75,75,,,percent of total billed charges,75% of total billed charges,2846.4,96,,,percent of total billed charges,96% of total billed charges,64.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2223.75,75,,,percent of total billed charges,75% of total billed charges,2223.75,75,,,percent of total billed charges,75% of total billed charges,64.33,2876.05,
PF CLOSED TX RADIAL  ULNAR SHAFT FRACTURE W/O MANIPULATION,78000616P,CDM,975,RC,25560,HCPCS,Outpatient,,,1035,776.25,,952.2,92,,,percent of total billed charges,92% of total billed charges,23.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,962.55,93,,,percent of total billed charges,93% of total billed charges,931.5,90,,,percent of total billed charges,90% of total billed charges,931.5,90,,,percent of total billed charges,90% of total billed charges,1003.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1003.95,97,,,percent of total billed charges,97% of total billed charges,776.25,75,,,percent of total billed charges,75% of total billed charges,993.6,96,,,percent of total billed charges,96% of total billed charges,23.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,776.25,75,,,percent of total billed charges,75% of total billed charges,776.25,75,,,percent of total billed charges,75% of total billed charges,23.21,1003.95,
PF CLOSED TX RADIAL  ULNAR SHAFT FRACTURES W/MANIPULATION,78000618P,CDM,975,RC,25565,HCPCS,Outpatient,,,2112,1584,,1943.04,92,,,percent of total billed charges,92% of total billed charges,49.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1964.16,93,,,percent of total billed charges,93% of total billed charges,1900.8,90,,,percent of total billed charges,90% of total billed charges,1900.8,90,,,percent of total billed charges,90% of total billed charges,2048.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,49.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2048.64,97,,,percent of total billed charges,97% of total billed charges,1584,75,,,percent of total billed charges,75% of total billed charges,2027.52,96,,,percent of total billed charges,96% of total billed charges,49.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1584,75,,,percent of total billed charges,75% of total billed charges,1584,75,,,percent of total billed charges,75% of total billed charges,49.41,2048.64,
PF OPEN TX RADIAL  ULNAR SHAFT FX W/FIXATION,78000620P,CDM,975,RC,25574,HCPCS,Outpatient,,,2973,2229.75,,2735.16,92,,,percent of total billed charges,92% of total billed charges,71.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2764.89,93,,,percent of total billed charges,93% of total billed charges,2675.7,90,,,percent of total billed charges,90% of total billed charges,2675.7,90,,,percent of total billed charges,90% of total billed charges,2883.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,71.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2883.81,97,,,percent of total billed charges,97% of total billed charges,2229.75,75,,,percent of total billed charges,75% of total billed charges,2854.08,96,,,percent of total billed charges,96% of total billed charges,71.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2229.75,75,,,percent of total billed charges,75% of total billed charges,2229.75,75,,,percent of total billed charges,75% of total billed charges,71.48,2883.81,
PF OPEN TX RADIAL  ULNAR SHAFT FX W/FIXATION,78000622P,CDM,975,RC,25575,HCPCS,Outpatient,,,4149,3111.75,,3817.08,92,,,percent of total billed charges,92% of total billed charges,98.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3858.57,93,,,percent of total billed charges,93% of total billed charges,3734.1,90,,,percent of total billed charges,90% of total billed charges,3734.1,90,,,percent of total billed charges,90% of total billed charges,4024.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,98.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4024.53,97,,,percent of total billed charges,97% of total billed charges,3111.75,75,,,percent of total billed charges,75% of total billed charges,3983.04,96,,,percent of total billed charges,96% of total billed charges,98.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3111.75,75,,,percent of total billed charges,75% of total billed charges,3111.75,75,,,percent of total billed charges,75% of total billed charges,98.36,4024.53,
PF CLOSED TX DISTAL RADIAL FX/EPIPHYSL SEP W/O MANIP,78000624P,CDM,975,RC,25600,HCPCS,Outpatient,,,402,301.5,,369.84,92,,,percent of total billed charges,92% of total billed charges,26.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,373.86,93,,,percent of total billed charges,93% of total billed charges,361.8,90,,,percent of total billed charges,90% of total billed charges,361.8,90,,,percent of total billed charges,90% of total billed charges,389.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,389.94,97,,,percent of total billed charges,97% of total billed charges,301.5,75,,,percent of total billed charges,75% of total billed charges,385.92,96,,,percent of total billed charges,96% of total billed charges,26.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,301.5,75,,,percent of total billed charges,75% of total billed charges,301.5,75,,,percent of total billed charges,75% of total billed charges,26.36,389.94,
PF CL TX DISTAL RADIAL FRACTURE W/MANIPULATION,78000626P,CDM,975,RC,25605,HCPCS,Outpatient,,,2248,1686,,2068.16,92,,,percent of total billed charges,92% of total billed charges,52.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2090.64,93,,,percent of total billed charges,93% of total billed charges,2023.2,90,,,percent of total billed charges,90% of total billed charges,2023.2,90,,,percent of total billed charges,90% of total billed charges,2180.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,52.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2180.56,97,,,percent of total billed charges,97% of total billed charges,1686,75,,,percent of total billed charges,75% of total billed charges,2158.08,96,,,percent of total billed charges,96% of total billed charges,52.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1686,75,,,percent of total billed charges,75% of total billed charges,1686,75,,,percent of total billed charges,75% of total billed charges,52.93,2180.56,
PF PERQ SKELETAL FIXION DISTAL RADIAL FX/EPIPHYSEAL SEPERATN,78000628P,CDM,975,RC,25606,HCPCS,Outpatient,,,2828,2121,,2601.76,92,,,percent of total billed charges,92% of total billed charges,69.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2630.04,93,,,percent of total billed charges,93% of total billed charges,2545.2,90,,,percent of total billed charges,90% of total billed charges,2545.2,90,,,percent of total billed charges,90% of total billed charges,2743.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,69.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2743.16,97,,,percent of total billed charges,97% of total billed charges,2121,75,,,percent of total billed charges,75% of total billed charges,2714.88,96,,,percent of total billed charges,96% of total billed charges,69.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2121,75,,,percent of total billed charges,75% of total billed charges,2121,75,,,percent of total billed charges,75% of total billed charges,69.15,2743.16,
PF OP TX DISTAL RADIAL EXTRA-ARTICULAR FX OR EPIPHYSEAL SEP,78000629P,CDM,975,RC,25607,HCPCS,Outpatient,,,3271,2453.25,,3009.32,92,,,percent of total billed charges,92% of total billed charges,76.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3042.03,93,,,percent of total billed charges,93% of total billed charges,2943.9,90,,,percent of total billed charges,90% of total billed charges,2943.9,90,,,percent of total billed charges,90% of total billed charges,3172.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3172.87,97,,,percent of total billed charges,97% of total billed charges,2453.25,75,,,percent of total billed charges,75% of total billed charges,3140.16,96,,,percent of total billed charges,96% of total billed charges,76.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2453.25,75,,,percent of total billed charges,75% of total billed charges,2453.25,75,,,percent of total billed charges,75% of total billed charges,76.74,3172.87,
PF OP TX DISTAL RADIAL EXTRA-ARTICULAR FX EPIPHYSEAL 2 FRAG,78000631P,CDM,975,RC,25608,HCPCS,Outpatient,,,2203,1652.25,,2026.76,92,,,percent of total billed charges,92% of total billed charges,88.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2048.79,93,,,percent of total billed charges,93% of total billed charges,1982.7,90,,,percent of total billed charges,90% of total billed charges,1982.7,90,,,percent of total billed charges,90% of total billed charges,2136.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,88.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2136.91,97,,,percent of total billed charges,97% of total billed charges,1652.25,75,,,percent of total billed charges,75% of total billed charges,2114.88,96,,,percent of total billed charges,96% of total billed charges,88.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1652.25,75,,,percent of total billed charges,75% of total billed charges,1652.25,75,,,percent of total billed charges,75% of total billed charges,88.18,2136.91,
PF OP TX DISTAL RADIAL EXTRA-ARTICULAR FX EPIPHYSEAL 3 FRAG,78000633P,CDM,975,RC,25609,HCPCS,Outpatient,,,3967,2975.25,,3649.64,92,,,percent of total billed charges,92% of total billed charges,112.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3689.31,93,,,percent of total billed charges,93% of total billed charges,3570.3,90,,,percent of total billed charges,90% of total billed charges,3570.3,90,,,percent of total billed charges,90% of total billed charges,3847.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,112.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3847.99,97,,,percent of total billed charges,97% of total billed charges,2975.25,75,,,percent of total billed charges,75% of total billed charges,3808.32,96,,,percent of total billed charges,96% of total billed charges,112.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2975.25,75,,,percent of total billed charges,75% of total billed charges,2975.25,75,,,percent of total billed charges,75% of total billed charges,112.18,3847.99,
PF CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANIP,78000635P,CDM,975,RC,25622,HCPCS,Outpatient,,,467,350.25,,429.64,92,,,percent of total billed charges,92% of total billed charges,24.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,434.31,93,,,percent of total billed charges,93% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,452.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,452.99,97,,,percent of total billed charges,97% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,448.32,96,,,percent of total billed charges,96% of total billed charges,24.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,350.25,75,,,percent of total billed charges,75% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,24.64,452.99,
PF CLOSED TX CARPAL BONE FX W/O MANIP EACH BONE,78000637P,CDM,975,RC,25630,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,25.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,25.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,25.99,729.44,
PF CLOSED TREATMENT ULNAR STYLOID FRACTURE,78000639P,CDM,975,RC,25650,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,28.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,28.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,28.11,455.9,
PF PERCUTANEOUS SKELETAL FIXATION ULNAR STYLOID FRACTURE,78000641P,CDM,975,RC,25651,HCPCS,Outpatient,,,1978,1483.5,,1819.76,92,,,percent of total billed charges,92% of total billed charges,48.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1839.54,93,,,percent of total billed charges,93% of total billed charges,1780.2,90,,,percent of total billed charges,90% of total billed charges,1780.2,90,,,percent of total billed charges,90% of total billed charges,1918.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,48.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1918.66,97,,,percent of total billed charges,97% of total billed charges,1483.5,75,,,percent of total billed charges,75% of total billed charges,1898.88,96,,,percent of total billed charges,96% of total billed charges,48.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1483.5,75,,,percent of total billed charges,75% of total billed charges,1483.5,75,,,percent of total billed charges,75% of total billed charges,48.32,1918.66,
PF OPEN TREATMENT OF ULNAR STYLOID FRACTURE,78002886P,CDM,975,RC,25652,HCPCS,Outpatient,,,1257,942.75,,1156.44,92,,,percent of total billed charges,92% of total billed charges,65.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1169.01,93,,,percent of total billed charges,93% of total billed charges,1131.3,90,,,percent of total billed charges,90% of total billed charges,1131.3,90,,,percent of total billed charges,90% of total billed charges,1219.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,65.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1219.29,97,,,percent of total billed charges,97% of total billed charges,942.75,75,,,percent of total billed charges,75% of total billed charges,1206.72,96,,,percent of total billed charges,96% of total billed charges,65.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,942.75,75,,,percent of total billed charges,75% of total billed charges,942.75,75,,,percent of total billed charges,75% of total billed charges,65.07,1219.29,
PF CLOSED TX RADIO/INTERCARPAL DISLOCATION W/MANIP,78000642P,CDM,975,RC,25660,HCPCS,Outpatient,,,1699,1274.25,,1563.08,92,,,percent of total billed charges,92% of total billed charges,44.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1580.07,93,,,percent of total billed charges,93% of total billed charges,1529.1,90,,,percent of total billed charges,90% of total billed charges,1529.1,90,,,percent of total billed charges,90% of total billed charges,1648.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,44.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1648.03,97,,,percent of total billed charges,97% of total billed charges,1274.25,75,,,percent of total billed charges,75% of total billed charges,1631.04,96,,,percent of total billed charges,96% of total billed charges,44.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1274.25,75,,,percent of total billed charges,75% of total billed charges,1274.25,75,,,percent of total billed charges,75% of total billed charges,44.24,1648.03,
PF PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION,78000644P,CDM,975,RC,25671,HCPCS,Outpatient,,,2337,1752.75,,2150.04,92,,,percent of total billed charges,92% of total billed charges,55.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2173.41,93,,,percent of total billed charges,93% of total billed charges,2103.3,90,,,percent of total billed charges,90% of total billed charges,2103.3,90,,,percent of total billed charges,90% of total billed charges,2266.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,55.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2266.89,97,,,percent of total billed charges,97% of total billed charges,1752.75,75,,,percent of total billed charges,75% of total billed charges,2243.52,96,,,percent of total billed charges,96% of total billed charges,55.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1752.75,75,,,percent of total billed charges,75% of total billed charges,1752.75,75,,,percent of total billed charges,75% of total billed charges,55.02,2266.89,
PF CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ,78000645P,CDM,975,RC,25675,HCPCS,Outpatient,,,1670,1252.5,,1536.4,92,,,percent of total billed charges,92% of total billed charges,42.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1553.1,93,,,percent of total billed charges,93% of total billed charges,1503,90,,,percent of total billed charges,90% of total billed charges,1503,90,,,percent of total billed charges,90% of total billed charges,1619.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,42.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1619.9,97,,,percent of total billed charges,97% of total billed charges,1252.5,75,,,percent of total billed charges,75% of total billed charges,1603.2,96,,,percent of total billed charges,96% of total billed charges,42.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1252.5,75,,,percent of total billed charges,75% of total billed charges,1252.5,75,,,percent of total billed charges,75% of total billed charges,42.73,1619.9,
PF CLOSED TX TRANS-SCAPHOPRILUNAR TYPE FX DISLOCATION W/MANI,78000647P,CDM,975,RC,25680,HCPCS,Outpatient,,,1425,1068.75,,1311,92,,,percent of total billed charges,92% of total billed charges,53.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1325.25,93,,,percent of total billed charges,93% of total billed charges,1282.5,90,,,percent of total billed charges,90% of total billed charges,1282.5,90,,,percent of total billed charges,90% of total billed charges,1382.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1382.25,97,,,percent of total billed charges,97% of total billed charges,1068.75,75,,,percent of total billed charges,75% of total billed charges,1368,96,,,percent of total billed charges,96% of total billed charges,53.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1068.75,75,,,percent of total billed charges,75% of total billed charges,1068.75,75,,,percent of total billed charges,75% of total billed charges,53.56,1382.25,
PF DRAINAGE FINGER ABSCESS SIMPLE,78000649P,CDM,975,RC,26010,HCPCS,Outpatient,,,586,439.5,,539.12,92,,,percent of total billed charges,92% of total billed charges,12.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,544.98,93,,,percent of total billed charges,93% of total billed charges,527.4,90,,,percent of total billed charges,90% of total billed charges,527.4,90,,,percent of total billed charges,90% of total billed charges,568.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,568.42,97,,,percent of total billed charges,97% of total billed charges,439.5,75,,,percent of total billed charges,75% of total billed charges,562.56,96,,,percent of total billed charges,96% of total billed charges,12.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,439.5,75,,,percent of total billed charges,75% of total billed charges,439.5,75,,,percent of total billed charges,75% of total billed charges,12.27,568.42,
PF DRAINAGE FINGER ABSCESS COMPLICATED,78000651P,CDM,975,RC,26011,HCPCS,Outpatient,,,1274,955.5,,1172.08,92,,,percent of total billed charges,92% of total billed charges,17.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1184.82,93,,,percent of total billed charges,93% of total billed charges,1146.6,90,,,percent of total billed charges,90% of total billed charges,1146.6,90,,,percent of total billed charges,90% of total billed charges,1235.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1235.78,97,,,percent of total billed charges,97% of total billed charges,955.5,75,,,percent of total billed charges,75% of total billed charges,1223.04,96,,,percent of total billed charges,96% of total billed charges,17.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,955.5,75,,,percent of total billed charges,75% of total billed charges,955.5,75,,,percent of total billed charges,75% of total billed charges,17.6,1235.78,
PF DRAINAGE OF PALMAR BURSA SINGLE BURSA,78000653P,CDM,975,RC,26025,HCPCS,Outpatient,,,2014,1510.5,,1852.88,92,,,percent of total billed charges,92% of total billed charges,42.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1873.02,93,,,percent of total billed charges,93% of total billed charges,1812.6,90,,,percent of total billed charges,90% of total billed charges,1812.6,90,,,percent of total billed charges,90% of total billed charges,1953.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,42.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1953.58,97,,,percent of total billed charges,97% of total billed charges,1510.5,75,,,percent of total billed charges,75% of total billed charges,1933.44,96,,,percent of total billed charges,96% of total billed charges,42.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1510.5,75,,,percent of total billed charges,75% of total billed charges,1510.5,75,,,percent of total billed charges,75% of total billed charges,42.18,1953.58,
PF DECOMPRESSIVE FASCIOTOMY HAND,78000655P,CDM,975,RC,26037,HCPCS,Outpatient,,,2585,1938.75,,2378.2,92,,,percent of total billed charges,92% of total billed charges,59.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2404.05,93,,,percent of total billed charges,93% of total billed charges,2326.5,90,,,percent of total billed charges,90% of total billed charges,2326.5,90,,,percent of total billed charges,90% of total billed charges,2507.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,59.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2507.45,97,,,percent of total billed charges,97% of total billed charges,1938.75,75,,,percent of total billed charges,75% of total billed charges,2481.6,96,,,percent of total billed charges,96% of total billed charges,59.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1938.75,75,,,percent of total billed charges,75% of total billed charges,1938.75,75,,,percent of total billed charges,75% of total billed charges,59.59,2507.45,
PF FASCIOTOMY PALMAR PERCUTANEOUS,78000657P,CDM,975,RC,26040,HCPCS,Outpatient,,,1613,1209.75,,1483.96,92,,,percent of total billed charges,92% of total billed charges,28.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1500.09,93,,,percent of total billed charges,93% of total billed charges,1451.7,90,,,percent of total billed charges,90% of total billed charges,1451.7,90,,,percent of total billed charges,90% of total billed charges,1564.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1564.61,97,,,percent of total billed charges,97% of total billed charges,1209.75,75,,,percent of total billed charges,75% of total billed charges,1548.48,96,,,percent of total billed charges,96% of total billed charges,28.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1209.75,75,,,percent of total billed charges,75% of total billed charges,1209.75,75,,,percent of total billed charges,75% of total billed charges,28.59,1564.61,
PF FASCIOTOMY PALMAR OPEN PARTIAL,78000658P,CDM,975,RC,26045,HCPCS,Outpatient,,,2411,1808.25,,2218.12,92,,,percent of total billed charges,92% of total billed charges,47.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2242.23,93,,,percent of total billed charges,93% of total billed charges,2169.9,90,,,percent of total billed charges,90% of total billed charges,2169.9,90,,,percent of total billed charges,90% of total billed charges,2338.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,47.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2338.67,97,,,percent of total billed charges,97% of total billed charges,1808.25,75,,,percent of total billed charges,75% of total billed charges,2314.56,96,,,percent of total billed charges,96% of total billed charges,47.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1808.25,75,,,percent of total billed charges,75% of total billed charges,1808.25,75,,,percent of total billed charges,75% of total billed charges,47.35,2338.67,
PF TENDON SHEATH INCISION,78000659P,CDM,960,RC,26055,HCPCS,Outpatient,,,578,433.5,,531.76,92,,,percent of total billed charges,92% of total billed charges,26.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,537.54,93,,,percent of total billed charges,93% of total billed charges,520.2,90,,,percent of total billed charges,90% of total billed charges,520.2,90,,,percent of total billed charges,90% of total billed charges,560.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,560.66,97,,,percent of total billed charges,97% of total billed charges,433.5,75,,,percent of total billed charges,75% of total billed charges,554.88,96,,,percent of total billed charges,96% of total billed charges,26.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,433.5,75,,,percent of total billed charges,75% of total billed charges,433.5,75,,,percent of total billed charges,75% of total billed charges,26.34,560.66,
PF TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT,78000660P,CDM,975,RC,26060,HCPCS,Outpatient,,,1284,963,,1181.28,92,,,percent of total billed charges,92% of total billed charges,22.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1194.12,93,,,percent of total billed charges,93% of total billed charges,1155.6,90,,,percent of total billed charges,90% of total billed charges,1155.6,90,,,percent of total billed charges,90% of total billed charges,1245.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1245.48,97,,,percent of total billed charges,97% of total billed charges,963,75,,,percent of total billed charges,75% of total billed charges,1232.64,96,,,percent of total billed charges,96% of total billed charges,22.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,963,75,,,percent of total billed charges,75% of total billed charges,963,75,,,percent of total billed charges,75% of total billed charges,22.35,1245.48,
PF ARTHROTOMY W/EXPLORE DRN REMOVE LOOSE FB METAPHAL EA JNT,78000661P,CDM,975,RC,26075,HCPCS,Outpatient,,,1580,1185,,1453.6,92,,,percent of total billed charges,92% of total billed charges,32.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1469.4,93,,,percent of total billed charges,93% of total billed charges,1422,90,,,percent of total billed charges,90% of total billed charges,1422,90,,,percent of total billed charges,90% of total billed charges,1532.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1532.6,97,,,percent of total billed charges,97% of total billed charges,1185,75,,,percent of total billed charges,75% of total billed charges,1516.8,96,,,percent of total billed charges,96% of total billed charges,32.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1185,75,,,percent of total billed charges,75% of total billed charges,1185,75,,,percent of total billed charges,75% of total billed charges,32.08,1532.6,
PF ARTHROTOMY W/EXPLORE DRN REMOVE LOOSE FB INTERPHAL EA JNT,78000662P,CDM,975,RC,26080,HCPCS,Outpatient,,,1901,1425.75,,1748.92,92,,,percent of total billed charges,92% of total billed charges,37.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1767.93,93,,,percent of total billed charges,93% of total billed charges,1710.9,90,,,percent of total billed charges,90% of total billed charges,1710.9,90,,,percent of total billed charges,90% of total billed charges,1843.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1843.97,97,,,percent of total billed charges,97% of total billed charges,1425.75,75,,,percent of total billed charges,75% of total billed charges,1824.96,96,,,percent of total billed charges,96% of total billed charges,37.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1425.75,75,,,percent of total billed charges,75% of total billed charges,1425.75,75,,,percent of total billed charges,75% of total billed charges,37.2,1843.97,
PF ARTHROTOMY WITH BIOPSY CARPOMETACARPAL JOINT EACH,78000663P,CDM,975,RC,26100,HCPCS,Outpatient,,,1524,1143,,1402.08,92,,,percent of total billed charges,92% of total billed charges,33.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1417.32,93,,,percent of total billed charges,93% of total billed charges,1371.6,90,,,percent of total billed charges,90% of total billed charges,1371.6,90,,,percent of total billed charges,90% of total billed charges,1478.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1478.28,97,,,percent of total billed charges,97% of total billed charges,1143,75,,,percent of total billed charges,75% of total billed charges,1463.04,96,,,percent of total billed charges,96% of total billed charges,33.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1143,75,,,percent of total billed charges,75% of total billed charges,1143,75,,,percent of total billed charges,75% of total billed charges,33.23,1478.28,
PF ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH,78000664P,CDM,975,RC,26110,HCPCS,Outpatient,,,1541,1155.75,,1417.72,92,,,percent of total billed charges,92% of total billed charges,30.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1433.13,93,,,percent of total billed charges,93% of total billed charges,1386.9,90,,,percent of total billed charges,90% of total billed charges,1386.9,90,,,percent of total billed charges,90% of total billed charges,1494.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1494.77,97,,,percent of total billed charges,97% of total billed charges,1155.75,75,,,percent of total billed charges,75% of total billed charges,1479.36,96,,,percent of total billed charges,96% of total billed charges,30.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1155.75,75,,,percent of total billed charges,75% of total billed charges,1155.75,75,,,percent of total billed charges,75% of total billed charges,30.54,1494.77,
PF EXCISION TUMOR HAND/FINGER SUBQ 1.5CM/>,78000665P,CDM,975,RC,26111,HCPCS,Outpatient,,,2297,1722.75,,2113.24,92,,,percent of total billed charges,92% of total billed charges,43.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2136.21,93,,,percent of total billed charges,93% of total billed charges,2067.3,90,,,percent of total billed charges,90% of total billed charges,2067.3,90,,,percent of total billed charges,90% of total billed charges,2228.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2228.09,97,,,percent of total billed charges,97% of total billed charges,1722.75,75,,,percent of total billed charges,75% of total billed charges,2205.12,96,,,percent of total billed charges,96% of total billed charges,43.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1722.75,75,,,percent of total billed charges,75% of total billed charges,1722.75,75,,,percent of total billed charges,75% of total billed charges,43.11,2228.09,
PF EXCISION TUMOR HAND/FINGER SUBFASCIAL 1.5CM/>,78000667P,CDM,975,RC,26113,HCPCS,Outpatient,,,2835,2126.25,,2608.2,92,,,percent of total billed charges,92% of total billed charges,55.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2636.55,93,,,percent of total billed charges,93% of total billed charges,2551.5,90,,,percent of total billed charges,90% of total billed charges,2551.5,90,,,percent of total billed charges,90% of total billed charges,2749.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,55.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2749.95,97,,,percent of total billed charges,97% of total billed charges,2126.25,75,,,percent of total billed charges,75% of total billed charges,2721.6,96,,,percent of total billed charges,96% of total billed charges,55.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2126.25,75,,,percent of total billed charges,75% of total billed charges,2126.25,75,,,percent of total billed charges,75% of total billed charges,55.58,2749.95,
PF EXCISION TUMOR/VASC MALFORM SOFT TISSUE HAND FINGER <1.5C,78000669P,CDM,975,RC,26115,HCPCS,Outpatient,,,1965,1473.75,,1807.8,92,,,percent of total billed charges,92% of total billed charges,32.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1827.45,93,,,percent of total billed charges,93% of total billed charges,1768.5,90,,,percent of total billed charges,90% of total billed charges,1768.5,90,,,percent of total billed charges,90% of total billed charges,1906.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1906.05,97,,,percent of total billed charges,97% of total billed charges,1473.75,75,,,percent of total billed charges,75% of total billed charges,1886.4,96,,,percent of total billed charges,96% of total billed charges,32.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1473.75,75,,,percent of total billed charges,75% of total billed charges,1473.75,75,,,percent of total billed charges,75% of total billed charges,32.08,1906.05,
PF FASCIECTOMY PALM ONLY,78000671P,CDM,975,RC,26123,HCPCS,Outpatient,,,4108,3081,,3779.36,92,,,percent of total billed charges,92% of total billed charges,85.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3820.44,93,,,percent of total billed charges,93% of total billed charges,3697.2,90,,,percent of total billed charges,90% of total billed charges,3697.2,90,,,percent of total billed charges,90% of total billed charges,3984.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,85.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3984.76,97,,,percent of total billed charges,97% of total billed charges,3081,75,,,percent of total billed charges,75% of total billed charges,3943.68,96,,,percent of total billed charges,96% of total billed charges,85.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3081,75,,,percent of total billed charges,75% of total billed charges,3081,75,,,percent of total billed charges,75% of total billed charges,85.01,3984.76,
PF SYNOVECTOMY CARPOMETACARPAL JOINT,78000672P,CDM,975,RC,26130,HCPCS,Outpatient,,,2395,1796.25,,2203.4,92,,,percent of total billed charges,92% of total billed charges,48.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2227.35,93,,,percent of total billed charges,93% of total billed charges,2155.5,90,,,percent of total billed charges,90% of total billed charges,2155.5,90,,,percent of total billed charges,90% of total billed charges,2323.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,48.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2323.15,97,,,percent of total billed charges,97% of total billed charges,1796.25,75,,,percent of total billed charges,75% of total billed charges,2299.2,96,,,percent of total billed charges,96% of total billed charges,48.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1796.25,75,,,percent of total billed charges,75% of total billed charges,1796.25,75,,,percent of total billed charges,75% of total billed charges,48.35,2323.15,
PF EXCISION LESION TENDON SHEATH/JOINT CAPSULE HAND FINGER,78000673P,CDM,975,RC,26160,HCPCS,Outpatient,,,2120,1590,,1950.4,92,,,percent of total billed charges,92% of total billed charges,29.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1971.6,93,,,percent of total billed charges,93% of total billed charges,1908,90,,,percent of total billed charges,90% of total billed charges,1908,90,,,percent of total billed charges,90% of total billed charges,2056.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2056.4,97,,,percent of total billed charges,97% of total billed charges,1590,75,,,percent of total billed charges,75% of total billed charges,2035.2,96,,,percent of total billed charges,96% of total billed charges,29.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1590,75,,,percent of total billed charges,75% of total billed charges,1590,75,,,percent of total billed charges,75% of total billed charges,29.66,2056.4,
PF PARTIAL EXCISION BONE METACARPAL,78000675P,CDM,975,RC,26230,HCPCS,Outpatient,,,3898,2923.5,,3586.16,92,,,percent of total billed charges,92% of total billed charges,50.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3625.14,93,,,percent of total billed charges,93% of total billed charges,3508.2,90,,,percent of total billed charges,90% of total billed charges,3508.2,90,,,percent of total billed charges,90% of total billed charges,3781.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3781.06,97,,,percent of total billed charges,97% of total billed charges,2923.5,75,,,percent of total billed charges,75% of total billed charges,3742.08,96,,,percent of total billed charges,96% of total billed charges,50.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2923.5,75,,,percent of total billed charges,75% of total billed charges,2923.5,75,,,percent of total billed charges,75% of total billed charges,50.99,3781.06,
PF PARTIAL EXCISION DISTAL PHALANX FINGER,78000676P,CDM,975,RC,26236,HCPCS,Outpatient,,,2059,1544.25,,1894.28,92,,,percent of total billed charges,92% of total billed charges,44.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1914.87,93,,,percent of total billed charges,93% of total billed charges,1853.1,90,,,percent of total billed charges,90% of total billed charges,1853.1,90,,,percent of total billed charges,90% of total billed charges,1997.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,44.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1997.23,97,,,percent of total billed charges,97% of total billed charges,1544.25,75,,,percent of total billed charges,75% of total billed charges,1976.64,96,,,percent of total billed charges,96% of total billed charges,44.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1544.25,75,,,percent of total billed charges,75% of total billed charges,1544.25,75,,,percent of total billed charges,75% of total billed charges,44.37,1997.23,
PF MANIPULATION FINGER JOINT UNDER ANES EACH JOINT,78000677P,CDM,975,RC,26340,HCPCS,Outpatient,,,1158,868.5,,1065.36,92,,,percent of total billed charges,92% of total billed charges,26.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1076.94,93,,,percent of total billed charges,93% of total billed charges,1042.2,90,,,percent of total billed charges,90% of total billed charges,1042.2,90,,,percent of total billed charges,90% of total billed charges,1123.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1123.26,97,,,percent of total billed charges,97% of total billed charges,868.5,75,,,percent of total billed charges,75% of total billed charges,1111.68,96,,,percent of total billed charges,96% of total billed charges,26.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,868.5,75,,,percent of total billed charges,75% of total billed charges,868.5,75,,,percent of total billed charges,75% of total billed charges,26.82,1123.26,
PF RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDN,78000678P,CDM,975,RC,26350,HCPCS,Outpatient,,,3547,2660.25,,3263.24,92,,,percent of total billed charges,92% of total billed charges,58.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3298.71,93,,,percent of total billed charges,93% of total billed charges,3192.3,90,,,percent of total billed charges,90% of total billed charges,3192.3,90,,,percent of total billed charges,90% of total billed charges,3440.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,58.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3440.59,97,,,percent of total billed charges,97% of total billed charges,2660.25,75,,,percent of total billed charges,75% of total billed charges,3405.12,96,,,percent of total billed charges,96% of total billed charges,58.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2660.25,75,,,percent of total billed charges,75% of total billed charges,2660.25,75,,,percent of total billed charges,75% of total billed charges,58.7,3440.59,
PF RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDN,78000679P,CDM,975,RC,26356,HCPCS,Outpatient,,,4569,3426.75,,4203.48,92,,,percent of total billed charges,92% of total billed charges,76.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4249.17,93,,,percent of total billed charges,93% of total billed charges,4112.1,90,,,percent of total billed charges,90% of total billed charges,4112.1,90,,,percent of total billed charges,90% of total billed charges,4431.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4431.93,97,,,percent of total billed charges,97% of total billed charges,3426.75,75,,,percent of total billed charges,75% of total billed charges,4386.24,96,,,percent of total billed charges,96% of total billed charges,76.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3426.75,75,,,percent of total billed charges,75% of total billed charges,3426.75,75,,,percent of total billed charges,75% of total billed charges,76.47,4431.93,
PF RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN,78000680P,CDM,975,RC,26370,HCPCS,Outpatient,,,3626,2719.5,,3335.92,92,,,percent of total billed charges,92% of total billed charges,64.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3372.18,93,,,percent of total billed charges,93% of total billed charges,3263.4,90,,,percent of total billed charges,90% of total billed charges,3263.4,90,,,percent of total billed charges,90% of total billed charges,3517.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,64.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3517.22,97,,,percent of total billed charges,97% of total billed charges,2719.5,75,,,percent of total billed charges,75% of total billed charges,3480.96,96,,,percent of total billed charges,96% of total billed charges,64.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2719.5,75,,,percent of total billed charges,75% of total billed charges,2719.5,75,,,percent of total billed charges,75% of total billed charges,64.54,3517.22,
PF REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH,78000681P,CDM,975,RC,26410,HCPCS,Outpatient,,,2630,1972.5,,2419.6,92,,,percent of total billed charges,92% of total billed charges,46.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2445.9,93,,,percent of total billed charges,93% of total billed charges,2367,90,,,percent of total billed charges,90% of total billed charges,2367,90,,,percent of total billed charges,90% of total billed charges,2551.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2551.1,97,,,percent of total billed charges,97% of total billed charges,1972.5,75,,,percent of total billed charges,75% of total billed charges,2524.8,96,,,percent of total billed charges,96% of total billed charges,46.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1972.5,75,,,percent of total billed charges,75% of total billed charges,1972.5,75,,,percent of total billed charges,75% of total billed charges,46.02,2551.1,
PF REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH,78000683P,CDM,975,RC,26418,HCPCS,Outpatient,,,2633,1974.75,,2422.36,92,,,percent of total billed charges,92% of total billed charges,45.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2448.69,93,,,percent of total billed charges,93% of total billed charges,2369.7,90,,,percent of total billed charges,90% of total billed charges,2369.7,90,,,percent of total billed charges,90% of total billed charges,2554.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2554.01,97,,,percent of total billed charges,97% of total billed charges,1974.75,75,,,percent of total billed charges,75% of total billed charges,2527.68,96,,,percent of total billed charges,96% of total billed charges,45.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1974.75,75,,,percent of total billed charges,75% of total billed charges,1974.75,75,,,percent of total billed charges,75% of total billed charges,45.24,2554.01,
PF REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH,78000685P,CDM,975,RC,26420,HCPCS,Outpatient,,,3339,2504.25,,3071.88,92,,,percent of total billed charges,92% of total billed charges,61.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3105.27,93,,,percent of total billed charges,93% of total billed charges,3005.1,90,,,percent of total billed charges,90% of total billed charges,3005.1,90,,,percent of total billed charges,90% of total billed charges,3238.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3238.83,97,,,percent of total billed charges,97% of total billed charges,2504.25,75,,,percent of total billed charges,75% of total billed charges,3205.44,96,,,percent of total billed charges,96% of total billed charges,61.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2504.25,75,,,percent of total billed charges,75% of total billed charges,2504.25,75,,,percent of total billed charges,75% of total billed charges,61.79,3238.83,
PF REALIGNMENT EXTENSOR TENDON HAND EACH TENDON,78000687P,CDM,975,RC,26437,HCPCS,Outpatient,,,2786,2089.5,,2563.12,92,,,percent of total billed charges,92% of total billed charges,54.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2590.98,93,,,percent of total billed charges,93% of total billed charges,2507.4,90,,,percent of total billed charges,90% of total billed charges,2507.4,90,,,percent of total billed charges,90% of total billed charges,2702.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,54.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2702.42,97,,,percent of total billed charges,97% of total billed charges,2089.5,75,,,percent of total billed charges,75% of total billed charges,2674.56,96,,,percent of total billed charges,96% of total billed charges,54.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2089.5,75,,,percent of total billed charges,75% of total billed charges,2089.5,75,,,percent of total billed charges,75% of total billed charges,54.28,2702.42,
PF TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON,78000688P,CDM,975,RC,26440,HCPCS,Outpatient,,,4014,3010.5,,3692.88,92,,,percent of total billed charges,92% of total billed charges,49.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3733.02,93,,,percent of total billed charges,93% of total billed charges,3612.6,90,,,percent of total billed charges,90% of total billed charges,3612.6,90,,,percent of total billed charges,90% of total billed charges,3893.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,49.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3893.58,97,,,percent of total billed charges,97% of total billed charges,3010.5,75,,,percent of total billed charges,75% of total billed charges,3853.44,96,,,percent of total billed charges,96% of total billed charges,49.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3010.5,75,,,percent of total billed charges,75% of total billed charges,3010.5,75,,,percent of total billed charges,75% of total billed charges,49.07,3893.58,
PF TENOTOMY FLEXOR PALM OPEN EACH TENDON,78000690P,CDM,975,RC,26450,HCPCS,Outpatient,,,3898,2923.5,,3586.16,92,,,percent of total billed charges,92% of total billed charges,35.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3625.14,93,,,percent of total billed charges,93% of total billed charges,3508.2,90,,,percent of total billed charges,90% of total billed charges,3508.2,90,,,percent of total billed charges,90% of total billed charges,3781.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,35.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3781.06,97,,,percent of total billed charges,97% of total billed charges,2923.5,75,,,percent of total billed charges,75% of total billed charges,3742.08,96,,,percent of total billed charges,96% of total billed charges,35.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2923.5,75,,,percent of total billed charges,75% of total billed charges,2923.5,75,,,percent of total billed charges,75% of total billed charges,35.84,3781.06,
PF TENOTOMY FLEXOR FINGER OPEN EACH TENDON,78000691P,CDM,975,RC,26455,HCPCS,Outpatient,,,1776,1332,,1633.92,92,,,percent of total billed charges,92% of total billed charges,35.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1651.68,93,,,percent of total billed charges,93% of total billed charges,1598.4,90,,,percent of total billed charges,90% of total billed charges,1598.4,90,,,percent of total billed charges,90% of total billed charges,1722.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,35.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1722.72,97,,,percent of total billed charges,97% of total billed charges,1332,75,,,percent of total billed charges,75% of total billed charges,1704.96,96,,,percent of total billed charges,96% of total billed charges,35.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1332,75,,,percent of total billed charges,75% of total billed charges,1332,75,,,percent of total billed charges,75% of total billed charges,35.73,1722.72,
PF TRANSFER/TRANSPLANT TENDON CARPOMETACARPAL EACH TENDON,78000692P,CDM,975,RC,26480,HCPCS,Outpatient,,,1814,1360.5,,1668.88,92,,,percent of total billed charges,92% of total billed charges,62.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1687.02,93,,,percent of total billed charges,93% of total billed charges,1632.6,90,,,percent of total billed charges,90% of total billed charges,1632.6,90,,,percent of total billed charges,90% of total billed charges,1759.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,62.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1759.58,97,,,percent of total billed charges,97% of total billed charges,1360.5,75,,,percent of total billed charges,75% of total billed charges,1741.44,96,,,percent of total billed charges,96% of total billed charges,62.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1360.5,75,,,percent of total billed charges,75% of total billed charges,1360.5,75,,,percent of total billed charges,75% of total billed charges,62.46,1759.58,
PF ARTHROPLASTY INTERPHALANGEAL JOINT W/PROSTHETIC EACH,78000693P,CDM,975,RC,26536,HCPCS,Outpatient,,,3239,2429.25,,2979.88,92,,,percent of total billed charges,92% of total billed charges,59.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3012.27,93,,,percent of total billed charges,93% of total billed charges,2915.1,90,,,percent of total billed charges,90% of total billed charges,2915.1,90,,,percent of total billed charges,90% of total billed charges,3141.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,59.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3141.83,97,,,percent of total billed charges,97% of total billed charges,2429.25,75,,,percent of total billed charges,75% of total billed charges,3109.44,96,,,percent of total billed charges,96% of total billed charges,59.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2429.25,75,,,percent of total billed charges,75% of total billed charges,2429.25,75,,,percent of total billed charges,75% of total billed charges,59.59,3141.83,
PF REPAIR COLLATERAL LIGAMENT META/INTERPHALANGEAL JOINT,78000694P,CDM,975,RC,26540,HCPCS,Outpatient,,,4312,3234,,3967.04,92,,,percent of total billed charges,92% of total billed charges,58.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4010.16,93,,,percent of total billed charges,93% of total billed charges,3880.8,90,,,percent of total billed charges,90% of total billed charges,3880.8,90,,,percent of total billed charges,90% of total billed charges,4182.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,58.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4182.64,97,,,percent of total billed charges,97% of total billed charges,3234,75,,,percent of total billed charges,75% of total billed charges,4139.52,96,,,percent of total billed charges,96% of total billed charges,58.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3234,75,,,percent of total billed charges,75% of total billed charges,3234,75,,,percent of total billed charges,75% of total billed charges,58.4,4182.64,
PF RECONSTRUCT COLLATERAL LIGAMENT METACARP JOINT SINGLE,78000695P,CDM,975,RC,26542,HCPCS,Outpatient,,,3651,2738.25,,3358.92,92,,,percent of total billed charges,92% of total billed charges,60.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3395.43,93,,,percent of total billed charges,93% of total billed charges,3285.9,90,,,percent of total billed charges,90% of total billed charges,3285.9,90,,,percent of total billed charges,90% of total billed charges,3541.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,60.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3541.47,97,,,percent of total billed charges,97% of total billed charges,2738.25,75,,,percent of total billed charges,75% of total billed charges,3504.96,96,,,percent of total billed charges,96% of total billed charges,60.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2738.25,75,,,percent of total billed charges,75% of total billed charges,2738.25,75,,,percent of total billed charges,75% of total billed charges,60.28,3541.47,
PF REPAIR NON-UNION METACARPAL OR PHALANX,78000696P,CDM,975,RC,26546,HCPCS,Outpatient,,,4081,3060.75,,3754.52,92,,,percent of total billed charges,92% of total billed charges,91.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3795.33,93,,,percent of total billed charges,93% of total billed charges,3672.9,90,,,percent of total billed charges,90% of total billed charges,3672.9,90,,,percent of total billed charges,90% of total billed charges,3958.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,91.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3958.57,97,,,percent of total billed charges,97% of total billed charges,3060.75,75,,,percent of total billed charges,75% of total billed charges,3917.76,96,,,percent of total billed charges,96% of total billed charges,91.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3060.75,75,,,percent of total billed charges,75% of total billed charges,3060.75,75,,,percent of total billed charges,75% of total billed charges,91.88,3958.57,
PF OSTEOTOMY METACARPAL EACH,78000698P,CDM,975,RC,26565,HCPCS,Outpatient,,,3233,2424.75,,2974.36,92,,,percent of total billed charges,92% of total billed charges,60.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3006.69,93,,,percent of total billed charges,93% of total billed charges,2909.7,90,,,percent of total billed charges,90% of total billed charges,2909.7,90,,,percent of total billed charges,90% of total billed charges,3136.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,60.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3136.01,97,,,percent of total billed charges,97% of total billed charges,2424.75,75,,,percent of total billed charges,75% of total billed charges,3103.68,96,,,percent of total billed charges,96% of total billed charges,60.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2424.75,75,,,percent of total billed charges,75% of total billed charges,2424.75,75,,,percent of total billed charges,75% of total billed charges,60.14,3136.01,
PF OSTEOTOMY PHALANX FINGER EACH,78000700P,CDM,975,RC,26567,HCPCS,Outpatient,,,3256,2442,,2995.52,92,,,percent of total billed charges,92% of total billed charges,60.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3028.08,93,,,percent of total billed charges,93% of total billed charges,2930.4,90,,,percent of total billed charges,90% of total billed charges,2930.4,90,,,percent of total billed charges,90% of total billed charges,3158.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,60.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3158.32,97,,,percent of total billed charges,97% of total billed charges,2442,75,,,percent of total billed charges,75% of total billed charges,3125.76,96,,,percent of total billed charges,96% of total billed charges,60.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2442,75,,,percent of total billed charges,75% of total billed charges,2442,75,,,percent of total billed charges,75% of total billed charges,60.99,3158.32,
PF OSTEOPLASTY LENGTHENING METACARPAL/PHALANX,78000701P,CDM,975,RC,26568,HCPCS,Outpatient,,,4002,3001.5,,3681.84,92,,,percent of total billed charges,92% of total billed charges,84.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3721.86,93,,,percent of total billed charges,93% of total billed charges,3601.8,90,,,percent of total billed charges,90% of total billed charges,3601.8,90,,,percent of total billed charges,90% of total billed charges,3881.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,84.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3881.94,97,,,percent of total billed charges,97% of total billed charges,3001.5,75,,,percent of total billed charges,75% of total billed charges,3841.92,96,,,percent of total billed charges,96% of total billed charges,84.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3001.5,75,,,percent of total billed charges,75% of total billed charges,3001.5,75,,,percent of total billed charges,75% of total billed charges,84.02,3881.94,
PF CLOSED TX METACARPAL FX W/O MANIPULATION EACH BONE,78000702P,CDM,975,RC,26600,HCPCS,Outpatient,,,1103,827.25,,1014.76,92,,,percent of total billed charges,92% of total billed charges,23.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1025.79,93,,,percent of total billed charges,93% of total billed charges,992.7,90,,,percent of total billed charges,90% of total billed charges,992.7,90,,,percent of total billed charges,90% of total billed charges,1069.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1069.91,97,,,percent of total billed charges,97% of total billed charges,827.25,75,,,percent of total billed charges,75% of total billed charges,1058.88,96,,,percent of total billed charges,96% of total billed charges,23.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,827.25,75,,,percent of total billed charges,75% of total billed charges,827.25,75,,,percent of total billed charges,75% of total billed charges,23.94,1069.91,
PF CLOSED TX METACARPAL FX W/MANIPULATION EACH BONE,78000704P,CDM,975,RC,26605,HCPCS,Outpatient,,,1177,882.75,,1082.84,92,,,percent of total billed charges,92% of total billed charges,26.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1094.61,93,,,percent of total billed charges,93% of total billed charges,1059.3,90,,,percent of total billed charges,90% of total billed charges,1059.3,90,,,percent of total billed charges,90% of total billed charges,1141.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1141.69,97,,,percent of total billed charges,97% of total billed charges,882.75,75,,,percent of total billed charges,75% of total billed charges,1129.92,96,,,percent of total billed charges,96% of total billed charges,26.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,882.75,75,,,percent of total billed charges,75% of total billed charges,882.75,75,,,percent of total billed charges,75% of total billed charges,26.72,1141.69,
PF CLOSED TX METACARPAL FX W/MANIP W/XTRNL FIXATION EACH,780007060P,CDM,975,RC,26607,HCPCS,Outpatient,,,772,579,,710.24,92,,,percent of total billed charges,92% of total billed charges,49.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717.96,93,,,percent of total billed charges,93% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,748.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,49.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,748.84,97,,,percent of total billed charges,97% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,741.12,96,,,percent of total billed charges,96% of total billed charges,49.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,579,75,,,percent of total billed charges,75% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,49.13,748.84,
PF PERQ SKELETAL FIXATION METACARPAL FX EACH BONE,78000708P,CDM,975,RC,26608,HCPCS,Outpatient,,,2328,1746,,2141.76,92,,,percent of total billed charges,92% of total billed charges,46.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2165.04,93,,,percent of total billed charges,93% of total billed charges,2095.2,90,,,percent of total billed charges,90% of total billed charges,2095.2,90,,,percent of total billed charges,90% of total billed charges,2258.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2258.16,97,,,percent of total billed charges,97% of total billed charges,1746,75,,,percent of total billed charges,75% of total billed charges,2234.88,96,,,percent of total billed charges,96% of total billed charges,46.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1746,75,,,percent of total billed charges,75% of total billed charges,1746,75,,,percent of total billed charges,75% of total billed charges,46.65,2258.16,
PF OPEN TX METACARPAL FRACTURE SINGLE EACH BONE,78000709P,CDM,975,RC,26615,HCPCS,Outpatient,,,2225,1668.75,,2047,92,,,percent of total billed charges,92% of total billed charges,56.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2069.25,93,,,percent of total billed charges,93% of total billed charges,2002.5,90,,,percent of total billed charges,90% of total billed charges,2002.5,90,,,percent of total billed charges,90% of total billed charges,2158.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,56.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2158.25,97,,,percent of total billed charges,97% of total billed charges,1668.75,75,,,percent of total billed charges,75% of total billed charges,2136,96,,,percent of total billed charges,96% of total billed charges,56.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1668.75,75,,,percent of total billed charges,75% of total billed charges,1668.75,75,,,percent of total billed charges,75% of total billed charges,56.91,2158.25,
PF CLOSED TX CARPO/METACARPAL DISLOCATION THUMB W/MANIP,78000710P,CDM,975,RC,26641,HCPCS,Outpatient,,,1244,933,,1144.48,92,,,percent of total billed charges,92% of total billed charges,37.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1156.92,93,,,percent of total billed charges,93% of total billed charges,1119.6,90,,,percent of total billed charges,90% of total billed charges,1119.6,90,,,percent of total billed charges,90% of total billed charges,1206.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1206.68,97,,,percent of total billed charges,97% of total billed charges,933,75,,,percent of total billed charges,75% of total billed charges,1194.24,96,,,percent of total billed charges,96% of total billed charges,37.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,933,75,,,percent of total billed charges,75% of total billed charges,933,75,,,percent of total billed charges,75% of total billed charges,37.05,1206.68,
PF CLOSED TX CARPO/METACARPAL FX DISLOCATION THUMB W/MANI,78000712P,CDM,975,RC,26645,HCPCS,Outpatient,,,1420,1065,,1306.4,92,,,percent of total billed charges,92% of total billed charges,39.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1320.6,93,,,percent of total billed charges,93% of total billed charges,1278,90,,,percent of total billed charges,90% of total billed charges,1278,90,,,percent of total billed charges,90% of total billed charges,1377.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,39.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1377.4,97,,,percent of total billed charges,97% of total billed charges,1065,75,,,percent of total billed charges,75% of total billed charges,1363.2,96,,,percent of total billed charges,96% of total billed charges,39.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1065,75,,,percent of total billed charges,75% of total billed charges,1065,75,,,percent of total billed charges,75% of total billed charges,39.92,1377.4,
PF PERQ SKELETAL FIXTN CARPO/METACARP FX DISLC THUMB W/MANIP,78000714P,CDM,975,RC,26650,HCPCS,Outpatient,,,2016,1512,,1854.72,92,,,percent of total billed charges,92% of total billed charges,45.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1874.88,93,,,percent of total billed charges,93% of total billed charges,1814.4,90,,,percent of total billed charges,90% of total billed charges,1814.4,90,,,percent of total billed charges,90% of total billed charges,1955.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1955.52,97,,,percent of total billed charges,97% of total billed charges,1512,75,,,percent of total billed charges,75% of total billed charges,1935.36,96,,,percent of total billed charges,96% of total billed charges,45.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1512,75,,,percent of total billed charges,75% of total billed charges,1512,75,,,percent of total billed charges,75% of total billed charges,45.28,1955.52,
PF CLOSED TX CARPO/METACARPL DISLC THUMB MANIP EA W/O ANE,78000715P,CDM,975,RC,26670,HCPCS,Outpatient,,,1021,765.75,,939.32,92,,,percent of total billed charges,92% of total billed charges,32.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.53,93,,,percent of total billed charges,93% of total billed charges,918.9,90,,,percent of total billed charges,90% of total billed charges,918.9,90,,,percent of total billed charges,90% of total billed charges,990.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,990.37,97,,,percent of total billed charges,97% of total billed charges,765.75,75,,,percent of total billed charges,75% of total billed charges,980.16,96,,,percent of total billed charges,96% of total billed charges,32.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,765.75,75,,,percent of total billed charges,75% of total billed charges,765.75,75,,,percent of total billed charges,75% of total billed charges,32.17,990.37,
PF CLOSED TX CARPO/METACARPL DISLC THUMB MANIP EACH JNT W,78000717P,CDM,975,RC,26675,HCPCS,Outpatient,,,1886,1414.5,,1735.12,92,,,percent of total billed charges,92% of total billed charges,42.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1753.98,93,,,percent of total billed charges,93% of total billed charges,1697.4,90,,,percent of total billed charges,90% of total billed charges,1697.4,90,,,percent of total billed charges,90% of total billed charges,1829.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,42.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1829.42,97,,,percent of total billed charges,97% of total billed charges,1414.5,75,,,percent of total billed charges,75% of total billed charges,1810.56,96,,,percent of total billed charges,96% of total billed charges,42.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1414.5,75,,,percent of total billed charges,75% of total billed charges,1414.5,75,,,percent of total billed charges,75% of total billed charges,42.51,1829.42,
PF PERQ SKELETAL FIX CARPO/METCRPL DISLC THUMB W/MANIP EA JT,78000719P,CDM,975,RC,26676,HCPCS,Outpatient,,,1943,1457.25,,1787.56,92,,,percent of total billed charges,92% of total billed charges,48.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1806.99,93,,,percent of total billed charges,93% of total billed charges,1748.7,90,,,percent of total billed charges,90% of total billed charges,1748.7,90,,,percent of total billed charges,90% of total billed charges,1884.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,48.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1884.71,97,,,percent of total billed charges,97% of total billed charges,1457.25,75,,,percent of total billed charges,75% of total billed charges,1865.28,96,,,percent of total billed charges,96% of total billed charges,48.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1457.25,75,,,percent of total billed charges,75% of total billed charges,1457.25,75,,,percent of total billed charges,75% of total billed charges,48.19,1884.71,
PF OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB,78000720P,CDM,975,RC,26685,HCPCS,Outpatient,,,2296,1722,,2112.32,92,,,percent of total billed charges,92% of total billed charges,53.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2135.28,93,,,percent of total billed charges,93% of total billed charges,2066.4,90,,,percent of total billed charges,90% of total billed charges,2066.4,90,,,percent of total billed charges,90% of total billed charges,2227.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2227.12,97,,,percent of total billed charges,97% of total billed charges,1722,75,,,percent of total billed charges,75% of total billed charges,2204.16,96,,,percent of total billed charges,96% of total billed charges,53.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1722,75,,,percent of total billed charges,75% of total billed charges,1722,75,,,percent of total billed charges,75% of total billed charges,53.41,2227.12,
PF CLOSED TX METACARPOPHALANGEAL DISLOCATION W/MANIP W/O ANE,78000721P,CDM,975,RC,26700,HCPCS,Outpatient,,,1208,906,,1111.36,92,,,percent of total billed charges,92% of total billed charges,31.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1123.44,93,,,percent of total billed charges,93% of total billed charges,1087.2,90,,,percent of total billed charges,90% of total billed charges,1087.2,90,,,percent of total billed charges,90% of total billed charges,1171.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,31.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1171.76,97,,,percent of total billed charges,97% of total billed charges,906,75,,,percent of total billed charges,75% of total billed charges,1159.68,96,,,percent of total billed charges,96% of total billed charges,31.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,906,75,,,percent of total billed charges,75% of total billed charges,906,75,,,percent of total billed charges,75% of total billed charges,31.9,1171.76,
PF CLOSED TX METACARPOPHALANGEAL DISLOCATION W/MANIP W/ANES,78000723P,CDM,975,RC,26705,HCPCS,Outpatient,,,1505,1128.75,,1384.6,92,,,percent of total billed charges,92% of total billed charges,38.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1399.65,93,,,percent of total billed charges,93% of total billed charges,1354.5,90,,,percent of total billed charges,90% of total billed charges,1354.5,90,,,percent of total billed charges,90% of total billed charges,1459.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,38.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1459.85,97,,,percent of total billed charges,97% of total billed charges,1128.75,75,,,percent of total billed charges,75% of total billed charges,1444.8,96,,,percent of total billed charges,96% of total billed charges,38.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1128.75,75,,,percent of total billed charges,75% of total billed charges,1128.75,75,,,percent of total billed charges,75% of total billed charges,38.9,1459.85,
PF OPEN TX METACARPOPHALANGEAL DISLOCATION,78000725P,CDM,975,RC,26715,HCPCS,Outpatient,,,2037,1527.75,,1874.04,92,,,percent of total billed charges,92% of total billed charges,56.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1894.41,93,,,percent of total billed charges,93% of total billed charges,1833.3,90,,,percent of total billed charges,90% of total billed charges,1833.3,90,,,percent of total billed charges,90% of total billed charges,1975.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,56.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1975.89,97,,,percent of total billed charges,97% of total billed charges,1527.75,75,,,percent of total billed charges,75% of total billed charges,1955.52,96,,,percent of total billed charges,96% of total billed charges,56.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1527.75,75,,,percent of total billed charges,75% of total billed charges,1527.75,75,,,percent of total billed charges,75% of total billed charges,56.84,1975.89,
PF CLOSED TX PHALANGEAL FX PROX/MIDDLE FINGER THUMB W/O MANP,78000726P,CDM,975,RC,26720,HCPCS,Outpatient,,,728,546,,669.76,92,,,percent of total billed charges,92% of total billed charges,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,677.04,93,,,percent of total billed charges,93% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,706.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,706.16,97,,,percent of total billed charges,97% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,698.88,96,,,percent of total billed charges,96% of total billed charges,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546,75,,,percent of total billed charges,75% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,16.36,706.16,
PF CLOSED TX PHALANGEAL SHAFT FX PROX/MIDDLE W/MANIP,78000728P,CDM,975,RC,26725,HCPCS,Outpatient,,,1192,894,,1096.64,92,,,percent of total billed charges,92% of total billed charges,29.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1108.56,93,,,percent of total billed charges,93% of total billed charges,1072.8,90,,,percent of total billed charges,90% of total billed charges,1072.8,90,,,percent of total billed charges,90% of total billed charges,1156.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1156.24,97,,,percent of total billed charges,97% of total billed charges,894,75,,,percent of total billed charges,75% of total billed charges,1144.32,96,,,percent of total billed charges,96% of total billed charges,29.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,894,75,,,percent of total billed charges,75% of total billed charges,894,75,,,percent of total billed charges,75% of total billed charges,29.69,1156.24,
PF PERQ SKELETAL FIXATION PHLNGL SHFT FX PROX/MIDDLE PX/F/T,78000730P,CDM,975,RC,26727,HCPCS,Outpatient,,,1989,1491.75,,1829.88,92,,,percent of total billed charges,92% of total billed charges,45.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1849.77,93,,,percent of total billed charges,93% of total billed charges,1790.1,90,,,percent of total billed charges,90% of total billed charges,1790.1,90,,,percent of total billed charges,90% of total billed charges,1929.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1929.33,97,,,percent of total billed charges,97% of total billed charges,1491.75,75,,,percent of total billed charges,75% of total billed charges,1909.44,96,,,percent of total billed charges,96% of total billed charges,45.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1491.75,75,,,percent of total billed charges,75% of total billed charges,1491.75,75,,,percent of total billed charges,75% of total billed charges,45.32,1929.33,
PF CLOSED TX FINGER FX W/O MANIP EACH,78000731P,CDM,975,RC,26740,HCPCS,Outpatient,,,881,660.75,,810.52,92,,,percent of total billed charges,92% of total billed charges,18.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,819.33,93,,,percent of total billed charges,93% of total billed charges,792.9,90,,,percent of total billed charges,90% of total billed charges,792.9,90,,,percent of total billed charges,90% of total billed charges,854.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,854.57,97,,,percent of total billed charges,97% of total billed charges,660.75,75,,,percent of total billed charges,75% of total billed charges,845.76,96,,,percent of total billed charges,96% of total billed charges,18.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,660.75,75,,,percent of total billed charges,75% of total billed charges,660.75,75,,,percent of total billed charges,75% of total billed charges,18.57,854.57,
PF CLOSED TX ARTICULAR FX META/INTERPHALANGEAL JNT W/MANP EA,78000733P,CDM,975,RC,26742,HCPCS,Outpatient,,,1410,1057.5,,1297.2,92,,,percent of total billed charges,92% of total billed charges,33.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1311.3,93,,,percent of total billed charges,93% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,1269,90,,,percent of total billed charges,90% of total billed charges,1367.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1367.7,97,,,percent of total billed charges,97% of total billed charges,1057.5,75,,,percent of total billed charges,75% of total billed charges,1353.6,96,,,percent of total billed charges,96% of total billed charges,33.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1057.5,75,,,percent of total billed charges,75% of total billed charges,1057.5,75,,,percent of total billed charges,75% of total billed charges,33.17,1367.7,
PF OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA,78000735P,CDM,975,RC,26746,HCPCS,Outpatient,,,2517,1887.75,,2315.64,92,,,percent of total billed charges,92% of total billed charges,75.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2340.81,93,,,percent of total billed charges,93% of total billed charges,2265.3,90,,,percent of total billed charges,90% of total billed charges,2265.3,90,,,percent of total billed charges,90% of total billed charges,2441.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,75.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2441.49,97,,,percent of total billed charges,97% of total billed charges,1887.75,75,,,percent of total billed charges,75% of total billed charges,2416.32,96,,,percent of total billed charges,96% of total billed charges,75.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1887.75,75,,,percent of total billed charges,75% of total billed charges,1887.75,75,,,percent of total billed charges,75% of total billed charges,75.91,2441.49,
PF CLOSED TX DISTAL PHLNGL FX FINGR OR THUMB W/O MANIP EACH,78000736P,CDM,975,RC,26750,HCPCS,Outpatient,,,732,549,,673.44,92,,,percent of total billed charges,92% of total billed charges,16.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,680.76,93,,,percent of total billed charges,93% of total billed charges,658.8,90,,,percent of total billed charges,90% of total billed charges,658.8,90,,,percent of total billed charges,90% of total billed charges,710.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,710.04,97,,,percent of total billed charges,97% of total billed charges,549,75,,,percent of total billed charges,75% of total billed charges,702.72,96,,,percent of total billed charges,96% of total billed charges,16.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,549,75,,,percent of total billed charges,75% of total billed charges,549,75,,,percent of total billed charges,75% of total billed charges,16.4,710.04,
PF CLOSED TX DISTAL PHALANGEAL FX FINGER THUMB W/MANIP EA,78000738P,CDM,975,RC,26755,HCPCS,Outpatient,,,1073,804.75,,987.16,92,,,percent of total billed charges,92% of total billed charges,27.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,997.89,93,,,percent of total billed charges,93% of total billed charges,965.7,90,,,percent of total billed charges,90% of total billed charges,965.7,90,,,percent of total billed charges,90% of total billed charges,1040.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.81,97,,,percent of total billed charges,97% of total billed charges,804.75,75,,,percent of total billed charges,75% of total billed charges,1030.08,96,,,percent of total billed charges,96% of total billed charges,27.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,804.75,75,,,percent of total billed charges,75% of total billed charges,804.75,75,,,percent of total billed charges,75% of total billed charges,27.22,1040.81,
PF PERQ SKELETAL FIXATION DISTAL PHLNGL FX FINGER/THUMB EA,78000740P,CDM,975,RC,26756,HCPCS,Outpatient,,,1625,1218.75,,1495,92,,,percent of total billed charges,92% of total billed charges,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1511.25,93,,,percent of total billed charges,93% of total billed charges,1462.5,90,,,percent of total billed charges,90% of total billed charges,1462.5,90,,,percent of total billed charges,90% of total billed charges,1576.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1576.25,97,,,percent of total billed charges,97% of total billed charges,1218.75,75,,,percent of total billed charges,75% of total billed charges,1560,96,,,percent of total billed charges,96% of total billed charges,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1218.75,75,,,percent of total billed charges,75% of total billed charges,1218.75,75,,,percent of total billed charges,75% of total billed charges,38.95,1576.25,
PF OPEN TX DISTAL PHALANGEAL FRACTURE EACH,78000741P,CDM,975,RC,26765,HCPCS,Outpatient,,,1880,1410,,1729.6,92,,,percent of total billed charges,92% of total billed charges,48.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1748.4,93,,,percent of total billed charges,93% of total billed charges,1692,90,,,percent of total billed charges,90% of total billed charges,1692,90,,,percent of total billed charges,90% of total billed charges,1823.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,48.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1823.6,97,,,percent of total billed charges,97% of total billed charges,1410,75,,,percent of total billed charges,75% of total billed charges,1804.8,96,,,percent of total billed charges,96% of total billed charges,48.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1410,75,,,percent of total billed charges,75% of total billed charges,1410,75,,,percent of total billed charges,75% of total billed charges,48.47,1823.6,
PF CLOSED TX INTERPHALANGEAL JOINT DISLOC W/MANIP W/ANESTH,78000742P,CDM,975,RC,26775,HCPCS,Outpatient,,,1289,966.75,,1185.88,92,,,percent of total billed charges,92% of total billed charges,32.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1198.77,93,,,percent of total billed charges,93% of total billed charges,1160.1,90,,,percent of total billed charges,90% of total billed charges,1160.1,90,,,percent of total billed charges,90% of total billed charges,1250.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1250.33,97,,,percent of total billed charges,97% of total billed charges,966.75,75,,,percent of total billed charges,75% of total billed charges,1237.44,96,,,percent of total billed charges,96% of total billed charges,32.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,966.75,75,,,percent of total billed charges,75% of total billed charges,966.75,75,,,percent of total billed charges,75% of total billed charges,32.84,1250.33,
PF OPEN TX INTERPHALANGEAL JOINT DISLOCATION,78000744P,CDM,975,RC,26785,HCPCS,Outpatient,,,2025,1518.75,,1863,92,,,percent of total billed charges,92% of total billed charges,53.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1883.25,93,,,percent of total billed charges,93% of total billed charges,1822.5,90,,,percent of total billed charges,90% of total billed charges,1822.5,90,,,percent of total billed charges,90% of total billed charges,1964.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1964.25,97,,,percent of total billed charges,97% of total billed charges,1518.75,75,,,percent of total billed charges,75% of total billed charges,1944,96,,,percent of total billed charges,96% of total billed charges,53.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1518.75,75,,,percent of total billed charges,75% of total billed charges,1518.75,75,,,percent of total billed charges,75% of total billed charges,53.5,1964.25,
PF ARTHRODESIS CARPO/METACARPAL JOINT THUMB W/WO INT FIXATN,78000746P,CDM,975,RC,26841,HCPCS,Outpatient,,,3193,2394.75,,2937.56,92,,,percent of total billed charges,92% of total billed charges,66.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2969.49,93,,,percent of total billed charges,93% of total billed charges,2873.7,90,,,percent of total billed charges,90% of total billed charges,2873.7,90,,,percent of total billed charges,90% of total billed charges,3097.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,66.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3097.21,97,,,percent of total billed charges,97% of total billed charges,2394.75,75,,,percent of total billed charges,75% of total billed charges,3065.28,96,,,percent of total billed charges,96% of total billed charges,66.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2394.75,75,,,percent of total billed charges,75% of total billed charges,2394.75,75,,,percent of total billed charges,75% of total billed charges,66.21,3097.21,
PF AMPUTATION FINGER THUMB SINGLE W/DIRECT CLOSURE,78000747P,CDM,975,RC,26951,HCPCS,Outpatient,,,4014,3010.5,,3692.88,92,,,percent of total billed charges,92% of total billed charges,57.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3733.02,93,,,percent of total billed charges,93% of total billed charges,3612.6,90,,,percent of total billed charges,90% of total billed charges,3612.6,90,,,percent of total billed charges,90% of total billed charges,3893.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,57.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3893.58,97,,,percent of total billed charges,97% of total billed charges,3010.5,75,,,percent of total billed charges,75% of total billed charges,3853.44,96,,,percent of total billed charges,96% of total billed charges,57.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3010.5,75,,,percent of total billed charges,75% of total billed charges,3010.5,75,,,percent of total billed charges,75% of total billed charges,57.18,3893.58,
PF AMPUTATION FINGER OR THUMB W/LOCAL ADVANCEMENT FLAPS,78000748P,CDM,975,RC,26952,HCPCS,Outpatient,,,3123,2342.25,,2873.16,92,,,percent of total billed charges,92% of total billed charges,57.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2904.39,93,,,percent of total billed charges,93% of total billed charges,2810.7,90,,,percent of total billed charges,90% of total billed charges,2810.7,90,,,percent of total billed charges,90% of total billed charges,3029.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,57.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3029.31,97,,,percent of total billed charges,97% of total billed charges,2342.25,75,,,percent of total billed charges,75% of total billed charges,2998.08,96,,,percent of total billed charges,96% of total billed charges,57.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2342.25,75,,,percent of total billed charges,75% of total billed charges,2342.25,75,,,percent of total billed charges,75% of total billed charges,57.3,3029.31,
PF HANDS OR FINGER PROCEDURE,78000749P,CDM,960,RC,26989,HCPCS,Outpatient,,,217,162.75,,199.64,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,201.81,93,,,percent of total billed charges,93% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,210.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,210.49,97,,,percent of total billed charges,97% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,208.32,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,162.75,75,,,percent of total billed charges,75% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,162.75,210.49,
PF ID PELVIS OR HIP JOINT AREA DEEP ABSCESS/HEMATOMA,78000751P,CDM,975,RC,26990,HCPCS,Outpatient,,,2585,1938.75,,2378.2,92,,,percent of total billed charges,92% of total billed charges,69.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2404.05,93,,,percent of total billed charges,93% of total billed charges,2326.5,90,,,percent of total billed charges,90% of total billed charges,2326.5,90,,,percent of total billed charges,90% of total billed charges,2507.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,69.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2507.45,97,,,percent of total billed charges,97% of total billed charges,1938.75,75,,,percent of total billed charges,75% of total billed charges,2481.6,96,,,percent of total billed charges,96% of total billed charges,69.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1938.75,75,,,percent of total billed charges,75% of total billed charges,1938.75,75,,,percent of total billed charges,75% of total billed charges,69.65,2507.45,
PF I and D PELVIS/HIP JOINT AREA INFECTED BURSA,78000753P,CDM,975,RC,26991,HCPCS,Outpatient,,,2269,1701.75,,2087.48,92,,,percent of total billed charges,92% of total billed charges,59.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2110.17,93,,,percent of total billed charges,93% of total billed charges,2042.1,90,,,percent of total billed charges,90% of total billed charges,2042.1,90,,,percent of total billed charges,90% of total billed charges,2200.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,59.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2200.93,97,,,percent of total billed charges,97% of total billed charges,1701.75,75,,,percent of total billed charges,75% of total billed charges,2178.24,96,,,percent of total billed charges,96% of total billed charges,59.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1701.75,75,,,percent of total billed charges,75% of total billed charges,1701.75,75,,,percent of total billed charges,75% of total billed charges,59.18,2200.93,
PF INCISION BONE CORTEX PELVIS  and / HIP JOINT,78000755P,CDM,975,RC,26992,HCPCS,Outpatient,,,3928,2946,,3613.76,92,,,percent of total billed charges,92% of total billed charges,110.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3653.04,93,,,percent of total billed charges,93% of total billed charges,3535.2,90,,,percent of total billed charges,90% of total billed charges,3535.2,90,,,percent of total billed charges,90% of total billed charges,3810.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,110.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3810.16,97,,,percent of total billed charges,97% of total billed charges,2946,75,,,percent of total billed charges,75% of total billed charges,3770.88,96,,,percent of total billed charges,96% of total billed charges,110.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2946,75,,,percent of total billed charges,75% of total billed charges,2946,75,,,percent of total billed charges,75% of total billed charges,110.35,3810.16,
PF BIOPSY SOFT TISSUE PELVIS/HIP SUPERFICIAL,78002867P,CDM,975,RC,27040,HCPCS,Outpatient,,,396,297,,364.32,92,,,percent of total billed charges,92% of total billed charges,19.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,368.28,93,,,percent of total billed charges,93% of total billed charges,356.4,90,,,percent of total billed charges,90% of total billed charges,356.4,90,,,percent of total billed charges,90% of total billed charges,384.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,384.12,97,,,percent of total billed charges,97% of total billed charges,297,75,,,percent of total billed charges,75% of total billed charges,380.16,96,,,percent of total billed charges,96% of total billed charges,19.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297,75,,,percent of total billed charges,75% of total billed charges,297,75,,,percent of total billed charges,75% of total billed charges,19.37,384.12,
PF EXCISE TUMOR SOFT TISSUE PELVIS and HIP SUBQ 3CM/>,78000756P,CDM,975,RC,27043,HCPCS,Outpatient,,,1247,935.25,,1147.24,92,,,percent of total billed charges,92% of total billed charges,61.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1159.71,93,,,percent of total billed charges,93% of total billed charges,1122.3,90,,,percent of total billed charges,90% of total billed charges,1122.3,90,,,percent of total billed charges,90% of total billed charges,1209.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1209.59,97,,,percent of total billed charges,97% of total billed charges,935.25,75,,,percent of total billed charges,75% of total billed charges,1197.12,96,,,percent of total billed charges,96% of total billed charges,61.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,935.25,75,,,percent of total billed charges,75% of total billed charges,935.25,75,,,percent of total billed charges,75% of total billed charges,61.14,1209.59,
PF RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS,78000758P,CDM,975,RC,27086,HCPCS,Outpatient,,,657,492.75,,604.44,92,,,percent of total billed charges,92% of total billed charges,16.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,611.01,93,,,percent of total billed charges,93% of total billed charges,591.3,90,,,percent of total billed charges,90% of total billed charges,591.3,90,,,percent of total billed charges,90% of total billed charges,637.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,637.29,97,,,percent of total billed charges,97% of total billed charges,492.75,75,,,percent of total billed charges,75% of total billed charges,630.72,96,,,percent of total billed charges,96% of total billed charges,16.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,492.75,75,,,percent of total billed charges,75% of total billed charges,492.75,75,,,percent of total billed charges,75% of total billed charges,16.78,637.29,
PF REMOVAL FOREIGN BODY PELVIS/HIP DEEP,78000760P,CDM,975,RC,27087,HCPCS,Outpatient,,,2419,1814.25,,2225.48,92,,,percent of total billed charges,92% of total billed charges,76.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2249.67,93,,,percent of total billed charges,93% of total billed charges,2177.1,90,,,percent of total billed charges,90% of total billed charges,2177.1,90,,,percent of total billed charges,90% of total billed charges,2346.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2346.43,97,,,percent of total billed charges,97% of total billed charges,1814.25,75,,,percent of total billed charges,75% of total billed charges,2322.24,96,,,percent of total billed charges,96% of total billed charges,76.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1814.25,75,,,percent of total billed charges,75% of total billed charges,1814.25,75,,,percent of total billed charges,75% of total billed charges,76.85,2346.43,
PF INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA,78002199P,CDM,975,RC,27093,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.54,93,,,percent of total billed charges,93% of total billed charges,160.2,90,,,percent of total billed charges,90% of total billed charges,160.2,90,,,percent of total billed charges,90% of total billed charges,172.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.66,97,,,percent of total billed charges,97% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges,170.88,96,,,percent of total billed charges,96% of total billed charges,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,133.5,75,,,percent of total billed charges,75% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges,6.38,172.66,
PF INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA,78000762P,CDM,975,RC,27095,HCPCS,Outpatient,,,228,171,,209.76,92,,,percent of total billed charges,92% of total billed charges,8.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,212.04,93,,,percent of total billed charges,93% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,221.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,221.16,97,,,percent of total billed charges,97% of total billed charges,171,75,,,percent of total billed charges,75% of total billed charges,218.88,96,,,percent of total billed charges,96% of total billed charges,8.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,171,75,,,percent of total billed charges,75% of total billed charges,171,75,,,percent of total billed charges,75% of total billed charges,8.77,221.16,
PF INJECTION SI JOINT ARTHRGRPHY and /ANES/STEROID W/IMA,78000764P,CDM,975,RC,27096,HCPCS,Outpatient,,,246,184.5,,226.32,92,,,percent of total billed charges,92% of total billed charges,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.78,93,,,percent of total billed charges,93% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,238.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,238.62,97,,,percent of total billed charges,97% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges,236.16,96,,,percent of total billed charges,96% of total billed charges,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.5,75,,,percent of total billed charges,75% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges,6.64,238.62,
PF HEMIARTHROPLASTY HIP PARTIAL,78000768P,CDM,975,RC,27125,HCPCS,Outpatient,,,6588,4941,,6060.96,92,,,percent of total billed charges,92% of total billed charges,131.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6126.84,93,,,percent of total billed charges,93% of total billed charges,5929.2,90,,,percent of total billed charges,90% of total billed charges,5929.2,90,,,percent of total billed charges,90% of total billed charges,6390.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,131.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6390.36,97,,,percent of total billed charges,97% of total billed charges,4941,75,,,percent of total billed charges,75% of total billed charges,6324.48,96,,,percent of total billed charges,96% of total billed charges,131.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4941,75,,,percent of total billed charges,75% of total billed charges,4941,75,,,percent of total billed charges,75% of total billed charges,131.79,6390.36,
PF ARTHROPLASTY ACETABULAR/PROXIMAL FEMORAL PROSTH REPLACE,78000770P,CDM,975,RC,27130,HCPCS,Outpatient,,,9677,7257.75,,8902.84,92,,,percent of total billed charges,92% of total billed charges,153.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,8999.61,93,,,percent of total billed charges,93% of total billed charges,8709.3,90,,,percent of total billed charges,90% of total billed charges,8709.3,90,,,percent of total billed charges,90% of total billed charges,9386.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,153.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,9386.69,97,,,percent of total billed charges,97% of total billed charges,7257.75,75,,,percent of total billed charges,75% of total billed charges,9289.92,96,,,percent of total billed charges,96% of total billed charges,153.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7257.75,75,,,percent of total billed charges,75% of total billed charges,7257.75,75,,,percent of total billed charges,75% of total billed charges,153.8,9386.69,
PF CLOSED TX PELVIC RING FX W/O MANIPULATION,78000772P,CDM,975,RC,27197,HCPCS,Outpatient,,,2046,1534.5,,1882.32,92,,,percent of total billed charges,92% of total billed charges,13.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1902.78,93,,,percent of total billed charges,93% of total billed charges,1841.4,90,,,percent of total billed charges,90% of total billed charges,1841.4,90,,,percent of total billed charges,90% of total billed charges,1984.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1984.62,97,,,percent of total billed charges,97% of total billed charges,1534.5,75,,,percent of total billed charges,75% of total billed charges,1964.16,96,,,percent of total billed charges,96% of total billed charges,13.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1534.5,75,,,percent of total billed charges,75% of total billed charges,1534.5,75,,,percent of total billed charges,75% of total billed charges,13.06,1984.62,
PF CLOSED TREATMENT COCCYGEAL FRACTURE,78000774P,CDM,975,RC,27200,HCPCS,Outpatient,,,426,319.5,,391.92,92,,,percent of total billed charges,92% of total billed charges,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,396.18,93,,,percent of total billed charges,93% of total billed charges,383.4,90,,,percent of total billed charges,90% of total billed charges,383.4,90,,,percent of total billed charges,90% of total billed charges,413.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.22,97,,,percent of total billed charges,97% of total billed charges,319.5,75,,,percent of total billed charges,75% of total billed charges,408.96,96,,,percent of total billed charges,96% of total billed charges,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,319.5,75,,,percent of total billed charges,75% of total billed charges,319.5,75,,,percent of total billed charges,75% of total billed charges,17.19,413.22,
PF PERCUTANEOUS SKELETAL FIXTN PELVIC BONE FX/DLOC,78002078P,CDM,975,RC,27216,HCPCS,Outpatient,,,5891,4418.25,,5419.72,92,,,percent of total billed charges,92% of total billed charges,74.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5478.63,93,,,percent of total billed charges,93% of total billed charges,5301.9,90,,,percent of total billed charges,90% of total billed charges,5301.9,90,,,percent of total billed charges,90% of total billed charges,5714.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,74.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5714.27,97,,,percent of total billed charges,97% of total billed charges,4418.25,75,,,percent of total billed charges,75% of total billed charges,5655.36,96,,,percent of total billed charges,96% of total billed charges,74.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4418.25,75,,,percent of total billed charges,75% of total billed charges,4418.25,75,,,percent of total billed charges,75% of total billed charges,74.56,5714.27,
PF CLOSED TX ACETABULUM HIP/SOCKET FX W/O MANIPULATION,78000776P,CDM,975,RC,27220,HCPCS,Outpatient,,,2228,1671,,2049.76,92,,,percent of total billed charges,92% of total billed charges,45.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2072.04,93,,,percent of total billed charges,93% of total billed charges,2005.2,90,,,percent of total billed charges,90% of total billed charges,2005.2,90,,,percent of total billed charges,90% of total billed charges,2161.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2161.16,97,,,percent of total billed charges,97% of total billed charges,1671,75,,,percent of total billed charges,75% of total billed charges,2138.88,96,,,percent of total billed charges,96% of total billed charges,45.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1671,75,,,percent of total billed charges,75% of total billed charges,1671,75,,,percent of total billed charges,75% of total billed charges,45.46,2161.16,
PF CLOSED TX FEMORAL FX PROX END NECK W/O MANIPULATION,78000778P,CDM,975,RC,27230,HCPCS,Outpatient,,,2128,1596,,1957.76,92,,,percent of total billed charges,92% of total billed charges,49.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1979.04,93,,,percent of total billed charges,93% of total billed charges,1915.2,90,,,percent of total billed charges,90% of total billed charges,1915.2,90,,,percent of total billed charges,90% of total billed charges,2064.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,49.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2064.16,97,,,percent of total billed charges,97% of total billed charges,1596,75,,,percent of total billed charges,75% of total billed charges,2042.88,96,,,percent of total billed charges,96% of total billed charges,49.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1596,75,,,percent of total billed charges,75% of total billed charges,1596,75,,,percent of total billed charges,75% of total billed charges,49.78,2064.16,
PF CLOSED TX FEMORAL FX PROX END NECK W/MANIPULATION,78000780P,CDM,975,RC,27232,HCPCS,Outpatient,,,3399,2549.25,,3127.08,92,,,percent of total billed charges,92% of total billed charges,90.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3161.07,93,,,percent of total billed charges,93% of total billed charges,3059.1,90,,,percent of total billed charges,90% of total billed charges,3059.1,90,,,percent of total billed charges,90% of total billed charges,3297.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,90.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3297.03,97,,,percent of total billed charges,97% of total billed charges,2549.25,75,,,percent of total billed charges,75% of total billed charges,3263.04,96,,,percent of total billed charges,96% of total billed charges,90.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2549.25,75,,,percent of total billed charges,75% of total billed charges,2549.25,75,,,percent of total billed charges,75% of total billed charges,90.12,3297.03,
PF PERQ SKELETAL FIXATION FEMORAL FX PROX END NECK,78000781P,CDM,975,RC,27235,HCPCS,Outpatient,,,5571,4178.25,,5125.32,92,,,percent of total billed charges,92% of total billed charges,103.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5181.03,93,,,percent of total billed charges,93% of total billed charges,5013.9,90,,,percent of total billed charges,90% of total billed charges,5013.9,90,,,percent of total billed charges,90% of total billed charges,5403.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,103.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5403.87,97,,,percent of total billed charges,97% of total billed charges,4178.25,75,,,percent of total billed charges,75% of total billed charges,5348.16,96,,,percent of total billed charges,96% of total billed charges,103.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4178.25,75,,,percent of total billed charges,75% of total billed charges,4178.25,75,,,percent of total billed charges,75% of total billed charges,103.19,5403.87,
PF OPEN TX FEMORAL FX PROX END NECK INTERNAL FIXATION,78000782P,CDM,975,RC,27236,HCPCS,Outpatient,,,6333,4749.75,,5826.36,92,,,percent of total billed charges,92% of total billed charges,139.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5889.69,93,,,percent of total billed charges,93% of total billed charges,5699.7,90,,,percent of total billed charges,90% of total billed charges,5699.7,90,,,percent of total billed charges,90% of total billed charges,6143.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,139.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6143.01,97,,,percent of total billed charges,97% of total billed charges,4749.75,75,,,percent of total billed charges,75% of total billed charges,6079.68,96,,,percent of total billed charges,96% of total billed charges,139.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4749.75,75,,,percent of total billed charges,75% of total billed charges,4749.75,75,,,percent of total billed charges,75% of total billed charges,139.09,6143.01,
PF CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ,78000784P,CDM,975,RC,27238,HCPCS,Outpatient,,,2096,1572,,1928.32,92,,,percent of total billed charges,92% of total billed charges,48.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1949.28,93,,,percent of total billed charges,93% of total billed charges,1886.4,90,,,percent of total billed charges,90% of total billed charges,1886.4,90,,,percent of total billed charges,90% of total billed charges,2033.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,48.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2033.12,97,,,percent of total billed charges,97% of total billed charges,1572,75,,,percent of total billed charges,75% of total billed charges,2012.16,96,,,percent of total billed charges,96% of total billed charges,48.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1572,75,,,percent of total billed charges,75% of total billed charges,1572,75,,,percent of total billed charges,75% of total billed charges,48.84,2033.12,
PF CLOSED TX INTER/SUBTROCHANTERIC FEMORAL FX W/MANIP,78000786P,CDM,975,RC,27240,HCPCS,Outpatient,,,4291,3218.25,,3947.72,92,,,percent of total billed charges,92% of total billed charges,109.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3990.63,93,,,percent of total billed charges,93% of total billed charges,3861.9,90,,,percent of total billed charges,90% of total billed charges,3861.9,90,,,percent of total billed charges,90% of total billed charges,4162.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4162.27,97,,,percent of total billed charges,97% of total billed charges,3218.25,75,,,percent of total billed charges,75% of total billed charges,4119.36,96,,,percent of total billed charges,96% of total billed charges,109.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3218.25,75,,,percent of total billed charges,75% of total billed charges,3218.25,75,,,percent of total billed charges,75% of total billed charges,109.4,4162.27,
PF TX FEMORAL FRACTURE WITH SCREW/PLATE IMPLANT,78000787P,CDM,975,RC,27244,HCPCS,Outpatient,,,6120,4590,,5630.4,92,,,percent of total billed charges,92% of total billed charges,143.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5691.6,93,,,percent of total billed charges,93% of total billed charges,5508,90,,,percent of total billed charges,90% of total billed charges,5508,90,,,percent of total billed charges,90% of total billed charges,5936.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,143.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5936.4,97,,,percent of total billed charges,97% of total billed charges,4590,75,,,percent of total billed charges,75% of total billed charges,5875.2,96,,,percent of total billed charges,96% of total billed charges,143.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4590,75,,,percent of total billed charges,75% of total billed charges,4590,75,,,percent of total billed charges,75% of total billed charges,143.51,5936.4,
PF TX FEMORAL FRACTURE W/INTRAMEDULLARY IMPLANT,78000789P,CDM,975,RC,27245,HCPCS,Outpatient,,,7058,5293.5,,6493.36,92,,,percent of total billed charges,92% of total billed charges,142.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6563.94,93,,,percent of total billed charges,93% of total billed charges,6352.2,90,,,percent of total billed charges,90% of total billed charges,6352.2,90,,,percent of total billed charges,90% of total billed charges,6846.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,142.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6846.26,97,,,percent of total billed charges,97% of total billed charges,5293.5,75,,,percent of total billed charges,75% of total billed charges,6775.68,96,,,percent of total billed charges,96% of total billed charges,142.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5293.5,75,,,percent of total billed charges,75% of total billed charges,5293.5,75,,,percent of total billed charges,75% of total billed charges,142.91,6846.26,
PF CLOSED TX GREATER TROCHANTERIC FX W/O MANIP,78000791P,CDM,975,RC,27246,HCPCS,Outpatient,,,1036,777,,953.12,92,,,percent of total billed charges,92% of total billed charges,40.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,963.48,93,,,percent of total billed charges,93% of total billed charges,932.4,90,,,percent of total billed charges,90% of total billed charges,932.4,90,,,percent of total billed charges,90% of total billed charges,1004.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1004.92,97,,,percent of total billed charges,97% of total billed charges,777,75,,,percent of total billed charges,75% of total billed charges,994.56,96,,,percent of total billed charges,96% of total billed charges,40.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,777,75,,,percent of total billed charges,75% of total billed charges,777,75,,,percent of total billed charges,75% of total billed charges,40.58,1004.92,
PF OPEN TX GREATER TROCHANTERIC FRACTURE,78000793P,CDM,975,RC,27248,HCPCS,Outpatient,,,3641,2730.75,,3349.72,92,,,percent of total billed charges,92% of total billed charges,85.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3386.13,93,,,percent of total billed charges,93% of total billed charges,3276.9,90,,,percent of total billed charges,90% of total billed charges,3276.9,90,,,percent of total billed charges,90% of total billed charges,3531.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,85.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3531.77,97,,,percent of total billed charges,97% of total billed charges,2730.75,75,,,percent of total billed charges,75% of total billed charges,3495.36,96,,,percent of total billed charges,96% of total billed charges,85.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2730.75,75,,,percent of total billed charges,75% of total billed charges,2730.75,75,,,percent of total billed charges,75% of total billed charges,85.9,3531.77,
PF CLOSED TX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA,78000795P,CDM,975,RC,27250,HCPCS,Outpatient,,,720,540,,662.4,92,,,percent of total billed charges,92% of total billed charges,27.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,669.6,93,,,percent of total billed charges,93% of total billed charges,648,90,,,percent of total billed charges,90% of total billed charges,648,90,,,percent of total billed charges,90% of total billed charges,698.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,698.4,97,,,percent of total billed charges,97% of total billed charges,540,75,,,percent of total billed charges,75% of total billed charges,691.2,96,,,percent of total billed charges,96% of total billed charges,27.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,540,75,,,percent of total billed charges,75% of total billed charges,540,75,,,percent of total billed charges,75% of total billed charges,27.62,698.4,
PF CLOSED TX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA,78000797P,CDM,975,RC,27252,HCPCS,Outpatient,,,2968,2226,,2730.56,92,,,percent of total billed charges,92% of total billed charges,87.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2760.24,93,,,percent of total billed charges,93% of total billed charges,2671.2,90,,,percent of total billed charges,90% of total billed charges,2671.2,90,,,percent of total billed charges,90% of total billed charges,2878.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,87.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2878.96,97,,,percent of total billed charges,97% of total billed charges,2226,75,,,percent of total billed charges,75% of total billed charges,2849.28,96,,,percent of total billed charges,96% of total billed charges,87.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2226,75,,,percent of total billed charges,75% of total billed charges,2226,75,,,percent of total billed charges,75% of total billed charges,87.44,2878.96,
PF TREAT SPONTANEOUS HIP DISLOCATION W/O MANIP ANESTH,78000799P,CDM,975,RC,27256,HCPCS,Outpatient,,,935,701.25,,860.2,92,,,percent of total billed charges,92% of total billed charges,33.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,869.55,93,,,percent of total billed charges,93% of total billed charges,841.5,90,,,percent of total billed charges,90% of total billed charges,841.5,90,,,percent of total billed charges,90% of total billed charges,906.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,906.95,97,,,percent of total billed charges,97% of total billed charges,701.25,75,,,percent of total billed charges,75% of total billed charges,897.6,96,,,percent of total billed charges,96% of total billed charges,33.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,701.25,75,,,percent of total billed charges,75% of total billed charges,701.25,75,,,percent of total billed charges,75% of total billed charges,33.33,906.95,
PF TREAT SPONTANEOUS HIP DISLOCATION W/MANIP ANESTH,78000801P,CDM,975,RC,27257,HCPCS,Outpatient,,,1420,1065,,1306.4,92,,,percent of total billed charges,92% of total billed charges,43.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1320.6,93,,,percent of total billed charges,93% of total billed charges,1278,90,,,percent of total billed charges,90% of total billed charges,1278,90,,,percent of total billed charges,90% of total billed charges,1377.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1377.4,97,,,percent of total billed charges,97% of total billed charges,1065,75,,,percent of total billed charges,75% of total billed charges,1363.2,96,,,percent of total billed charges,96% of total billed charges,43.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1065,75,,,percent of total billed charges,75% of total billed charges,1065,75,,,percent of total billed charges,75% of total billed charges,43.23,1377.4,
PF CLOSED TX POST HIP ARTHROPLASTY DISLC W/O ANES,78000803P,CDM,975,RC,27265,HCPCS,Outpatient,,,1588,1191,,1460.96,92,,,percent of total billed charges,92% of total billed charges,44.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1476.84,93,,,percent of total billed charges,93% of total billed charges,1429.2,90,,,percent of total billed charges,90% of total billed charges,1429.2,90,,,percent of total billed charges,90% of total billed charges,1540.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,44.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1540.36,97,,,percent of total billed charges,97% of total billed charges,1191,75,,,percent of total billed charges,75% of total billed charges,1524.48,96,,,percent of total billed charges,96% of total billed charges,44.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1191,75,,,percent of total billed charges,75% of total billed charges,1191,75,,,percent of total billed charges,75% of total billed charges,44.96,1540.36,
PF CLOSED TX POST HIP ARTHROPLASTY DISLC REQ ANES,78000805P,CDM,975,RC,27266,HCPCS,Outpatient,,,2288,1716,,2104.96,92,,,percent of total billed charges,92% of total billed charges,63.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2127.84,93,,,percent of total billed charges,93% of total billed charges,2059.2,90,,,percent of total billed charges,90% of total billed charges,2059.2,90,,,percent of total billed charges,90% of total billed charges,2219.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,63.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2219.36,97,,,percent of total billed charges,97% of total billed charges,1716,75,,,percent of total billed charges,75% of total billed charges,2196.48,96,,,percent of total billed charges,96% of total billed charges,63.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1716,75,,,percent of total billed charges,75% of total billed charges,1716,75,,,percent of total billed charges,75% of total billed charges,63.61,2219.36,
PF ID DEEP ABSCESS BURSA/HEMATOMA THIGH/KNEE REGION,78000807P,CDM,975,RC,27301,HCPCS,Outpatient,,,2617,1962.75,,2407.64,92,,,percent of total billed charges,92% of total billed charges,57.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2433.81,93,,,percent of total billed charges,93% of total billed charges,2355.3,90,,,percent of total billed charges,90% of total billed charges,2355.3,90,,,percent of total billed charges,90% of total billed charges,2538.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,57.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2538.49,97,,,percent of total billed charges,97% of total billed charges,1962.75,75,,,percent of total billed charges,75% of total billed charges,2512.32,96,,,percent of total billed charges,96% of total billed charges,57.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1962.75,75,,,percent of total billed charges,75% of total billed charges,1962.75,75,,,percent of total billed charges,75% of total billed charges,57.17,2538.49,
PF INCISION DEEP W/OPENING OF BONE CORTEX FEMUR OR KNEE,78000809P,CDM,975,RC,27303,HCPCS,Outpatient,,,3190,2392.5,,2934.8,92,,,percent of total billed charges,92% of total billed charges,70.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2966.7,93,,,percent of total billed charges,93% of total billed charges,2871,90,,,percent of total billed charges,90% of total billed charges,2871,90,,,percent of total billed charges,90% of total billed charges,3094.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3094.3,97,,,percent of total billed charges,97% of total billed charges,2392.5,75,,,percent of total billed charges,75% of total billed charges,3062.4,96,,,percent of total billed charges,96% of total billed charges,70.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2392.5,75,,,percent of total billed charges,75% of total billed charges,2392.5,75,,,percent of total billed charges,75% of total billed charges,70.5,3094.3,
PF ARTHROTOMY KNEE W/EXPLORE DRAINAGE OR REMOVAL OF FB,78000811P,CDM,975,RC,27310,HCPCS,Outpatient,,,3776,2832,,3473.92,92,,,percent of total billed charges,92% of total billed charges,81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3511.68,93,,,percent of total billed charges,93% of total billed charges,3398.4,90,,,percent of total billed charges,90% of total billed charges,3398.4,90,,,percent of total billed charges,90% of total billed charges,3662.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3662.72,97,,,percent of total billed charges,97% of total billed charges,2832,75,,,percent of total billed charges,75% of total billed charges,3624.96,96,,,percent of total billed charges,96% of total billed charges,81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2832,75,,,percent of total billed charges,75% of total billed charges,2832,75,,,percent of total billed charges,75% of total billed charges,81,3662.72,
PF BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL,78000813P,CDM,975,RC,27323,HCPCS,Outpatient,,,1055,791.25,,970.6,92,,,percent of total billed charges,92% of total billed charges,15.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,981.15,93,,,percent of total billed charges,93% of total billed charges,949.5,90,,,percent of total billed charges,90% of total billed charges,949.5,90,,,percent of total billed charges,90% of total billed charges,1023.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1023.35,97,,,percent of total billed charges,97% of total billed charges,791.25,75,,,percent of total billed charges,75% of total billed charges,1012.8,96,,,percent of total billed charges,96% of total billed charges,15.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,791.25,75,,,percent of total billed charges,75% of total billed charges,791.25,75,,,percent of total billed charges,75% of total billed charges,15.58,1023.35,
PF BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP,78000815P,CDM,975,RC,27324,HCPCS,Outpatient,,,1945,1458.75,,1789.4,92,,,percent of total billed charges,92% of total billed charges,45.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1808.85,93,,,percent of total billed charges,93% of total billed charges,1750.5,90,,,percent of total billed charges,90% of total billed charges,1750.5,90,,,percent of total billed charges,90% of total billed charges,1886.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1886.65,97,,,percent of total billed charges,97% of total billed charges,1458.75,75,,,percent of total billed charges,75% of total billed charges,1867.2,96,,,percent of total billed charges,96% of total billed charges,45.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1458.75,75,,,percent of total billed charges,75% of total billed charges,1458.75,75,,,percent of total billed charges,75% of total billed charges,45.91,1886.65,
PF EXCISE TUMOR SOFT TISSUE THIGH/KNEE SUBFASCIAL <5CM,78000817P,CDM,975,RC,27328,HCPCS,Outpatient,,,2282,1711.5,,2099.44,92,,,percent of total billed charges,92% of total billed charges,75.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2122.26,93,,,percent of total billed charges,93% of total billed charges,2053.8,90,,,percent of total billed charges,90% of total billed charges,2053.8,90,,,percent of total billed charges,90% of total billed charges,2213.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,75.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2213.54,97,,,percent of total billed charges,97% of total billed charges,1711.5,75,,,percent of total billed charges,75% of total billed charges,2190.72,96,,,percent of total billed charges,96% of total billed charges,75.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1711.5,75,,,percent of total billed charges,75% of total billed charges,1711.5,75,,,percent of total billed charges,75% of total billed charges,75.52,2213.54,
PF ARTHROTOMY KNEE W/SYNOVIAL BIOPSY ONLY,78000819P,CDM,975,RC,27330,HCPCS,Outpatient,,,2705,2028.75,,2488.6,92,,,percent of total billed charges,92% of total billed charges,43.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2515.65,93,,,percent of total billed charges,93% of total billed charges,2434.5,90,,,percent of total billed charges,90% of total billed charges,2434.5,90,,,percent of total billed charges,90% of total billed charges,2623.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2623.85,97,,,percent of total billed charges,97% of total billed charges,2028.75,75,,,percent of total billed charges,75% of total billed charges,2596.8,96,,,percent of total billed charges,96% of total billed charges,43.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2028.75,75,,,percent of total billed charges,75% of total billed charges,2028.75,75,,,percent of total billed charges,75% of total billed charges,43.99,2623.85,
PF ARTHROTOMY KNEE W/JOINT EXPLORE OR REMOVAL OF FB,78000821P,CDM,975,RC,27331,HCPCS,Outpatient,,,1092,819,,1004.64,92,,,percent of total billed charges,92% of total billed charges,50.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1015.56,93,,,percent of total billed charges,93% of total billed charges,982.8,90,,,percent of total billed charges,90% of total billed charges,982.8,90,,,percent of total billed charges,90% of total billed charges,1059.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1059.24,97,,,percent of total billed charges,97% of total billed charges,819,75,,,percent of total billed charges,75% of total billed charges,1048.32,96,,,percent of total billed charges,96% of total billed charges,50.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,819,75,,,percent of total billed charges,75% of total billed charges,819,75,,,percent of total billed charges,75% of total billed charges,50.18,1059.24,
PF EXCISON TUMOR SOFT TISSUE THIGH/KNEE SBQ 3 CM/>,78000823P,CDM,975,RC,27337,HCPCS,Outpatient,,,887,665.25,,816.04,92,,,percent of total billed charges,92% of total billed charges,52.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,824.91,93,,,percent of total billed charges,93% of total billed charges,798.3,90,,,percent of total billed charges,90% of total billed charges,798.3,90,,,percent of total billed charges,90% of total billed charges,860.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,52.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,860.39,97,,,percent of total billed charges,97% of total billed charges,665.25,75,,,percent of total billed charges,75% of total billed charges,851.52,96,,,percent of total billed charges,96% of total billed charges,52.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,665.25,75,,,percent of total billed charges,75% of total billed charges,665.25,75,,,percent of total billed charges,75% of total billed charges,52.1,860.39,
PF EXCISION PREPATELLAR BURSA,78000825P,CDM,975,RC,27340,HCPCS,Outpatient,,,2045,1533.75,,1881.4,92,,,percent of total billed charges,92% of total billed charges,37.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1901.85,93,,,percent of total billed charges,93% of total billed charges,1840.5,90,,,percent of total billed charges,90% of total billed charges,1840.5,90,,,percent of total billed charges,90% of total billed charges,1983.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1983.65,97,,,percent of total billed charges,97% of total billed charges,1533.75,75,,,percent of total billed charges,75% of total billed charges,1963.2,96,,,percent of total billed charges,96% of total billed charges,37.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1533.75,75,,,percent of total billed charges,75% of total billed charges,1533.75,75,,,percent of total billed charges,75% of total billed charges,37.17,1983.65,
PF EXCISION SYNOVIAL CYST POPLITEAL SPACE,78000827P,CDM,975,RC,27345,HCPCS,Outpatient,,,2652,1989,,2439.84,92,,,percent of total billed charges,92% of total billed charges,50.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2466.36,93,,,percent of total billed charges,93% of total billed charges,2386.8,90,,,percent of total billed charges,90% of total billed charges,2386.8,90,,,percent of total billed charges,90% of total billed charges,2572.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2572.44,97,,,percent of total billed charges,97% of total billed charges,1989,75,,,percent of total billed charges,75% of total billed charges,2545.92,96,,,percent of total billed charges,96% of total billed charges,50.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1989,75,,,percent of total billed charges,75% of total billed charges,1989,75,,,percent of total billed charges,75% of total billed charges,50.25,2572.44,
PF EXCISION LESION MENISCUS/CAPSULE KNEE,78000829P,CDM,975,RC,27347,HCPCS,Outpatient,,,2942,2206.5,,2706.64,92,,,percent of total billed charges,92% of total billed charges,54.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2736.06,93,,,percent of total billed charges,93% of total billed charges,2647.8,90,,,percent of total billed charges,90% of total billed charges,2647.8,90,,,percent of total billed charges,90% of total billed charges,2853.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,54.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2853.74,97,,,percent of total billed charges,97% of total billed charges,2206.5,75,,,percent of total billed charges,75% of total billed charges,2824.32,96,,,percent of total billed charges,96% of total billed charges,54.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2206.5,75,,,percent of total billed charges,75% of total billed charges,2206.5,75,,,percent of total billed charges,75% of total billed charges,54.93,2853.74,
PF EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEM,78002844P,CDM,975,RC,27355,HCPCS,Outpatient,,,1529.5,1147.13,,1407.14,92,,,percent of total billed charges,92% of total billed charges,65.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1422.44,93,,,percent of total billed charges,93% of total billed charges,1376.55,90,,,percent of total billed charges,90% of total billed charges,1376.55,90,,,percent of total billed charges,90% of total billed charges,1483.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,65.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1483.62,97,,,percent of total billed charges,97% of total billed charges,1147.13,75,,,percent of total billed charges,75% of total billed charges,1468.32,96,,,percent of total billed charges,96% of total billed charges,65.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1147.13,75,,,percent of total billed charges,75% of total billed charges,1147.13,75,,,percent of total billed charges,75% of total billed charges,65.84,1483.62,
PF PARTIAL EXCISION BONE FEMUR PROX TIBIA AND/OR FIBULA,78000831P,CDM,975,RC,27360,HCPCS,Outpatient,,,3959,2969.25,,3642.28,92,,,percent of total billed charges,92% of total billed charges,94.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3681.87,93,,,percent of total billed charges,93% of total billed charges,3563.1,90,,,percent of total billed charges,90% of total billed charges,3563.1,90,,,percent of total billed charges,90% of total billed charges,3840.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,94.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3840.23,97,,,percent of total billed charges,97% of total billed charges,2969.25,75,,,percent of total billed charges,75% of total billed charges,3800.64,96,,,percent of total billed charges,96% of total billed charges,94.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2969.25,75,,,percent of total billed charges,75% of total billed charges,2969.25,75,,,percent of total billed charges,75% of total billed charges,94.72,3840.23,
PF INJECTION KNEE ARTHROGRAPHY,78000833P,CDM,975,RC,27369,HCPCS,Outpatient,,,227,170.25,,208.84,92,,,percent of total billed charges,92% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,211.11,93,,,percent of total billed charges,93% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,220.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,220.19,97,,,percent of total billed charges,97% of total billed charges,170.25,75,,,percent of total billed charges,75% of total billed charges,217.92,96,,,percent of total billed charges,96% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,170.25,75,,,percent of total billed charges,75% of total billed charges,170.25,75,,,percent of total billed charges,75% of total billed charges,3.81,220.19,
PF REMOVAL FOREIGN BODY DEEP THIGH/KNEE,78000837P,CDM,975,RC,27372,HCPCS,Outpatient,,,1913,1434.75,,1759.96,92,,,percent of total billed charges,92% of total billed charges,44.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1779.09,93,,,percent of total billed charges,93% of total billed charges,1721.7,90,,,percent of total billed charges,90% of total billed charges,1721.7,90,,,percent of total billed charges,90% of total billed charges,1855.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,44.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1855.61,97,,,percent of total billed charges,97% of total billed charges,1434.75,75,,,percent of total billed charges,75% of total billed charges,1836.48,96,,,percent of total billed charges,96% of total billed charges,44.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1434.75,75,,,percent of total billed charges,75% of total billed charges,1434.75,75,,,percent of total billed charges,75% of total billed charges,44.14,1855.61,
PF SUTURE INFRAPATELLAR TENDON PRIMARY,78000839P,CDM,975,RC,27380,HCPCS,Outpatient,,,3060,2295,,2815.2,92,,,percent of total billed charges,92% of total billed charges,62.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2845.8,93,,,percent of total billed charges,93% of total billed charges,2754,90,,,percent of total billed charges,90% of total billed charges,2754,90,,,percent of total billed charges,90% of total billed charges,2968.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,62.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2968.2,97,,,percent of total billed charges,97% of total billed charges,2295,75,,,percent of total billed charges,75% of total billed charges,2937.6,96,,,percent of total billed charges,96% of total billed charges,62.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2295,75,,,percent of total billed charges,75% of total billed charges,2295,75,,,percent of total billed charges,75% of total billed charges,62.82,2968.2,
PF SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY,78000842P,CDM,975,RC,27385,HCPCS,Outpatient,,,3539,2654.25,,3255.88,92,,,percent of total billed charges,92% of total billed charges,58.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3291.27,93,,,percent of total billed charges,93% of total billed charges,3185.1,90,,,percent of total billed charges,90% of total billed charges,3185.1,90,,,percent of total billed charges,90% of total billed charges,3432.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,58.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3432.83,97,,,percent of total billed charges,97% of total billed charges,2654.25,75,,,percent of total billed charges,75% of total billed charges,3397.44,96,,,percent of total billed charges,96% of total billed charges,58.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2654.25,75,,,percent of total billed charges,75% of total billed charges,2654.25,75,,,percent of total billed charges,75% of total billed charges,58.76,3432.83,
PF SUTURE QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ,78000844P,CDM,975,RC,27386,HCPCS,Outpatient,,,4430,3322.5,,4075.6,92,,,percent of total billed charges,92% of total billed charges,90.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4119.9,93,,,percent of total billed charges,93% of total billed charges,3987,90,,,percent of total billed charges,90% of total billed charges,3987,90,,,percent of total billed charges,90% of total billed charges,4297.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,90.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4297.1,97,,,percent of total billed charges,97% of total billed charges,3322.5,75,,,percent of total billed charges,75% of total billed charges,4252.8,96,,,percent of total billed charges,96% of total billed charges,90.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3322.5,75,,,percent of total billed charges,75% of total billed charges,3322.5,75,,,percent of total billed charges,75% of total billed charges,90.42,4297.1,
PF TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG,78000846P,CDM,975,RC,27391,HCPCS,Outpatient,,,2317,1737.75,,2131.64,92,,,percent of total billed charges,92% of total billed charges,61.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2154.81,93,,,percent of total billed charges,93% of total billed charges,2085.3,90,,,percent of total billed charges,90% of total billed charges,2085.3,90,,,percent of total billed charges,90% of total billed charges,2247.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2247.49,97,,,percent of total billed charges,97% of total billed charges,1737.75,75,,,percent of total billed charges,75% of total billed charges,2224.32,96,,,percent of total billed charges,96% of total billed charges,61.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1737.75,75,,,percent of total billed charges,75% of total billed charges,1737.75,75,,,percent of total billed charges,75% of total billed charges,61.88,2247.49,
PF ARTHROTOMY W/MENISCUS REPAIR KNEE,78000847P,CDM,975,RC,27403,HCPCS,Outpatient,,,3687,2765.25,,3392.04,92,,,percent of total billed charges,92% of total billed charges,70.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3428.91,93,,,percent of total billed charges,93% of total billed charges,3318.3,90,,,percent of total billed charges,90% of total billed charges,3318.3,90,,,percent of total billed charges,90% of total billed charges,3576.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3576.39,97,,,percent of total billed charges,97% of total billed charges,2765.25,75,,,percent of total billed charges,75% of total billed charges,3539.52,96,,,percent of total billed charges,96% of total billed charges,70.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2765.25,75,,,percent of total billed charges,75% of total billed charges,2765.25,75,,,percent of total billed charges,75% of total billed charges,70.4,3576.39,
PF RPR PRIMARY TORN LIGM and /CAPSULE KNEE COLLATRL,78000849P,CDM,975,RC,27405,HCPCS,Outpatient,,,3680,2760,,3385.6,92,,,percent of total billed charges,92% of total billed charges,73.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3422.4,93,,,percent of total billed charges,93% of total billed charges,3312,90,,,percent of total billed charges,90% of total billed charges,3312,90,,,percent of total billed charges,90% of total billed charges,3569.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,73.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3569.6,97,,,percent of total billed charges,97% of total billed charges,2760,75,,,percent of total billed charges,75% of total billed charges,3532.8,96,,,percent of total billed charges,96% of total billed charges,73.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2760,75,,,percent of total billed charges,75% of total billed charges,2760,75,,,percent of total billed charges,75% of total billed charges,73.1,3569.6,
PF REPAIR PRIMARY TORN LIGAMENT AND/OR CAPSULE KNEE CRUCIATE,78002834P,CDM,975,RC,27407,HCPCS,Outpatient,,,1996,1497,,1836.32,92,,,percent of total billed charges,92% of total billed charges,88.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1856.28,93,,,percent of total billed charges,93% of total billed charges,1796.4,90,,,percent of total billed charges,90% of total billed charges,1796.4,90,,,percent of total billed charges,90% of total billed charges,1936.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,88.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1936.12,97,,,percent of total billed charges,97% of total billed charges,1497,75,,,percent of total billed charges,75% of total billed charges,1916.16,96,,,percent of total billed charges,96% of total billed charges,88.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1497,75,,,percent of total billed charges,75% of total billed charges,1497,75,,,percent of total billed charges,75% of total billed charges,88.39,1936.12,
PF RPR 1 TORN LIGM and /CAPSL KNE COLTRL and CRUCIATE,78000851P,CDM,975,RC,27409,HCPCS,Outpatient,,,5558,4168.5,,5113.36,92,,,percent of total billed charges,92% of total billed charges,109.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5168.94,93,,,percent of total billed charges,93% of total billed charges,5002.2,90,,,percent of total billed charges,90% of total billed charges,5002.2,90,,,percent of total billed charges,90% of total billed charges,5391.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5391.26,97,,,percent of total billed charges,97% of total billed charges,4168.5,75,,,percent of total billed charges,75% of total billed charges,5335.68,96,,,percent of total billed charges,96% of total billed charges,109.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4168.5,75,,,percent of total billed charges,75% of total billed charges,4168.5,75,,,percent of total billed charges,75% of total billed charges,109.93,5391.26,
PF ANTERIOR TIBIAL TUBERCLEPLASTY,78000853P,CDM,975,RC,27418,HCPCS,Outpatient,,,4574,3430.5,,4208.08,92,,,percent of total billed charges,92% of total billed charges,87.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4253.82,93,,,percent of total billed charges,93% of total billed charges,4116.6,90,,,percent of total billed charges,90% of total billed charges,4116.6,90,,,percent of total billed charges,90% of total billed charges,4436.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,87.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4436.78,97,,,percent of total billed charges,97% of total billed charges,3430.5,75,,,percent of total billed charges,75% of total billed charges,4391.04,96,,,percent of total billed charges,96% of total billed charges,87.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3430.5,75,,,percent of total billed charges,75% of total billed charges,3430.5,75,,,percent of total billed charges,75% of total billed charges,87.83,4436.78,
PF ARHROPLASTY KNEE CONDYLE  and  PLATEAU MED/LAT COMPARTMENT,78000855P,CDM,975,RC,27422,HCPCS,Outpatient,,,4524,3393,,4162.08,92,,,percent of total billed charges,92% of total billed charges,81.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4207.32,93,,,percent of total billed charges,93% of total billed charges,4071.6,90,,,percent of total billed charges,90% of total billed charges,4071.6,90,,,percent of total billed charges,90% of total billed charges,4388.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,81.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4388.28,97,,,percent of total billed charges,97% of total billed charges,3393,75,,,percent of total billed charges,75% of total billed charges,4343.04,96,,,percent of total billed charges,96% of total billed charges,81.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3393,75,,,percent of total billed charges,75% of total billed charges,3393,75,,,percent of total billed charges,75% of total billed charges,81.85,4388.28,
PF LATERAL RETINACULAR RELEASE OPEN,78000857P,CDM,975,RC,27425,HCPCS,Outpatient,,,3663,2747.25,,3369.96,92,,,percent of total billed charges,92% of total billed charges,46.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3406.59,93,,,percent of total billed charges,93% of total billed charges,3296.7,90,,,percent of total billed charges,90% of total billed charges,3296.7,90,,,percent of total billed charges,90% of total billed charges,3553.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3553.11,97,,,percent of total billed charges,97% of total billed charges,2747.25,75,,,percent of total billed charges,75% of total billed charges,3516.48,96,,,percent of total billed charges,96% of total billed charges,46.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2747.25,75,,,percent of total billed charges,75% of total billed charges,2747.25,75,,,percent of total billed charges,75% of total billed charges,46.18,3553.11,
PF LIGAMENTOUS RECONSTRUCT KNEE EXTRA-ARTICULAR,78000858P,CDM,975,RC,27427,HCPCS,Outpatient,,,4356,3267,,4007.52,92,,,percent of total billed charges,92% of total billed charges,76.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4051.08,93,,,percent of total billed charges,93% of total billed charges,3920.4,90,,,percent of total billed charges,90% of total billed charges,3920.4,90,,,percent of total billed charges,90% of total billed charges,4225.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4225.32,97,,,percent of total billed charges,97% of total billed charges,3267,75,,,percent of total billed charges,75% of total billed charges,4181.76,96,,,percent of total billed charges,96% of total billed charges,76.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3267,75,,,percent of total billed charges,75% of total billed charges,3267,75,,,percent of total billed charges,75% of total billed charges,76.62,4225.32,
PF QUADRICEPSPLASTY,78000860P,CDM,975,RC,27430,HCPCS,Outpatient,,,4215,3161.25,,3877.8,92,,,percent of total billed charges,92% of total billed charges,82.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3919.95,93,,,percent of total billed charges,93% of total billed charges,3793.5,90,,,percent of total billed charges,90% of total billed charges,3793.5,90,,,percent of total billed charges,90% of total billed charges,4088.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,82.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4088.55,97,,,percent of total billed charges,97% of total billed charges,3161.25,75,,,percent of total billed charges,75% of total billed charges,4046.4,96,,,percent of total billed charges,96% of total billed charges,82.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3161.25,75,,,percent of total billed charges,75% of total billed charges,3161.25,75,,,percent of total billed charges,75% of total billed charges,82.43,4088.55,
PF ARHROPLASTY KNEE CONDYLE  PLATEAU MED/LAT COMPARTMENT,78000862P,CDM,975,RC,27446,HCPCS,Outpatient,,,9827,7370.25,,9040.84,92,,,percent of total billed charges,92% of total billed charges,135.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,9139.11,93,,,percent of total billed charges,93% of total billed charges,8844.3,90,,,percent of total billed charges,90% of total billed charges,8844.3,90,,,percent of total billed charges,90% of total billed charges,9532.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,135.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,9532.19,97,,,percent of total billed charges,97% of total billed charges,7370.25,75,,,percent of total billed charges,75% of total billed charges,9433.92,96,,,percent of total billed charges,96% of total billed charges,135.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7370.25,75,,,percent of total billed charges,75% of total billed charges,7370.25,75,,,percent of total billed charges,75% of total billed charges,135.04,9532.19,
PF ARTHROPLASTY KNEE CONDYLE  PLATEAU MEDIAL/LATERAL,78000864P,CDM,975,RC,27447,HCPCS,Outpatient,,,9827,7370.25,,9040.84,92,,,percent of total billed charges,92% of total billed charges,153.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,9139.11,93,,,percent of total billed charges,93% of total billed charges,8844.3,90,,,percent of total billed charges,90% of total billed charges,8844.3,90,,,percent of total billed charges,90% of total billed charges,9532.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,153.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,9532.19,97,,,percent of total billed charges,97% of total billed charges,7370.25,75,,,percent of total billed charges,75% of total billed charges,9433.92,96,,,percent of total billed charges,96% of total billed charges,153.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7370.25,75,,,percent of total billed charges,75% of total billed charges,7370.25,75,,,percent of total billed charges,75% of total billed charges,153.18,9532.19,
PF REPAIRR NON/MALUNION FEMUR DISTAL W/ILIAC BONE GRAFT,78000866P,CDM,975,RC,27472,HCPCS,Outpatient,,,6816,5112,,6270.72,92,,,percent of total billed charges,92% of total billed charges,148.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6338.88,93,,,percent of total billed charges,93% of total billed charges,6134.4,90,,,percent of total billed charges,90% of total billed charges,6134.4,90,,,percent of total billed charges,90% of total billed charges,6611.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,148.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6611.52,97,,,percent of total billed charges,97% of total billed charges,5112,75,,,percent of total billed charges,75% of total billed charges,6543.36,96,,,percent of total billed charges,96% of total billed charges,148.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5112,75,,,percent of total billed charges,75% of total billed charges,5112,75,,,percent of total billed charges,75% of total billed charges,148.34,6611.52,
PF REVSION TOTAL KNEE ARTHROPLASTY 1 COMPONENT,78000868P,CDM,975,RC,27486,HCPCS,Outpatient,,,8428,6321,,7753.76,92,,,percent of total billed charges,92% of total billed charges,166.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7838.04,93,,,percent of total billed charges,93% of total billed charges,7585.2,90,,,percent of total billed charges,90% of total billed charges,7585.2,90,,,percent of total billed charges,90% of total billed charges,8175.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,166.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,8175.16,97,,,percent of total billed charges,97% of total billed charges,6321,75,,,percent of total billed charges,75% of total billed charges,8090.88,96,,,percent of total billed charges,96% of total billed charges,166.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6321,75,,,percent of total billed charges,75% of total billed charges,6321,75,,,percent of total billed charges,75% of total billed charges,166.09,8175.16,
PF REVISION TOTAL KNEE ARTHROPLASTY,78002860P,CDM,975,RC,27487,HCPCS,Outpatient,,,4333,3249.75,,3986.36,92,,,percent of total billed charges,92% of total billed charges,211.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4029.69,93,,,percent of total billed charges,93% of total billed charges,3899.7,90,,,percent of total billed charges,90% of total billed charges,3899.7,90,,,percent of total billed charges,90% of total billed charges,4203.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,211.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4203.01,97,,,percent of total billed charges,97% of total billed charges,3249.75,75,,,percent of total billed charges,75% of total billed charges,4159.68,96,,,percent of total billed charges,96% of total billed charges,211.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3249.75,75,,,percent of total billed charges,75% of total billed charges,3249.75,75,,,percent of total billed charges,75% of total billed charges,211.94,4203.01,
PF REMOVAL OF TOTAL KNEE PROSTHESIS,78002852P,CDM,975,RC,27488,HCPCS,Outpatient,,,3579,2684.25,,3292.68,92,,,percent of total billed charges,92% of total billed charges,139.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3328.47,93,,,percent of total billed charges,93% of total billed charges,3221.1,90,,,percent of total billed charges,90% of total billed charges,3221.1,90,,,percent of total billed charges,90% of total billed charges,3471.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,139.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3471.63,97,,,percent of total billed charges,97% of total billed charges,2684.25,75,,,percent of total billed charges,75% of total billed charges,3435.84,96,,,percent of total billed charges,96% of total billed charges,139.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2684.25,75,,,percent of total billed charges,75% of total billed charges,2684.25,75,,,percent of total billed charges,75% of total billed charges,139.61,3471.63,
PF PROPHYLACTIC TX FEMUR,78000870P,CDM,975,RC,27495,HCPCS,Outpatient,,,5954,4465.5,,5477.68,92,,,percent of total billed charges,92% of total billed charges,131.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5537.22,93,,,percent of total billed charges,93% of total billed charges,5358.6,90,,,percent of total billed charges,90% of total billed charges,5358.6,90,,,percent of total billed charges,90% of total billed charges,5775.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,131.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5775.38,97,,,percent of total billed charges,97% of total billed charges,4465.5,75,,,percent of total billed charges,75% of total billed charges,5715.84,96,,,percent of total billed charges,96% of total billed charges,131.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4465.5,75,,,percent of total billed charges,75% of total billed charges,4465.5,75,,,percent of total billed charges,75% of total billed charges,131.49,5775.38,
PF CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION,78000872P,CDM,975,RC,27500,HCPCS,Outpatient,,,1887,1415.25,,1736.04,92,,,percent of total billed charges,92% of total billed charges,51.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1754.91,93,,,percent of total billed charges,93% of total billed charges,1698.3,90,,,percent of total billed charges,90% of total billed charges,1698.3,90,,,percent of total billed charges,90% of total billed charges,1830.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,51.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1830.39,97,,,percent of total billed charges,97% of total billed charges,1415.25,75,,,percent of total billed charges,75% of total billed charges,1811.52,96,,,percent of total billed charges,96% of total billed charges,51.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1415.25,75,,,percent of total billed charges,75% of total billed charges,1415.25,75,,,percent of total billed charges,75% of total billed charges,51.96,1830.39,
PF CLOSED TX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANIP,78000874P,CDM,975,RC,27501,HCPCS,Outpatient,,,1954,1465.5,,1797.68,92,,,percent of total billed charges,92% of total billed charges,53.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1817.22,93,,,percent of total billed charges,93% of total billed charges,1758.6,90,,,percent of total billed charges,90% of total billed charges,1758.6,90,,,percent of total billed charges,90% of total billed charges,1895.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1895.38,97,,,percent of total billed charges,97% of total billed charges,1465.5,75,,,percent of total billed charges,75% of total billed charges,1875.84,96,,,percent of total billed charges,96% of total billed charges,53.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1465.5,75,,,percent of total billed charges,75% of total billed charges,1465.5,75,,,percent of total billed charges,75% of total billed charges,53.09,1895.38,
PF CLOSED TX FEMORAL SHFT FX W/MANIP,78000876P,CDM,975,RC,27502,HCPCS,Outpatient,,,2983,2237.25,,2744.36,92,,,percent of total billed charges,92% of total billed charges,89.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2774.19,93,,,percent of total billed charges,93% of total billed charges,2684.7,90,,,percent of total billed charges,90% of total billed charges,2684.7,90,,,percent of total billed charges,90% of total billed charges,2893.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,89.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2893.51,97,,,percent of total billed charges,97% of total billed charges,2237.25,75,,,percent of total billed charges,75% of total billed charges,2863.68,96,,,percent of total billed charges,96% of total billed charges,89.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2237.25,75,,,percent of total billed charges,75% of total billed charges,2237.25,75,,,percent of total billed charges,75% of total billed charges,89.78,2893.51,
PF CLOSED TX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANIP,78000878P,CDM,975,RC,27503,HCPCS,Outpatient,,,3146,2359.5,,2894.32,92,,,percent of total billed charges,92% of total billed charges,90.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2925.78,93,,,percent of total billed charges,93% of total billed charges,2831.4,90,,,percent of total billed charges,90% of total billed charges,2831.4,90,,,percent of total billed charges,90% of total billed charges,3051.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,90.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3051.62,97,,,percent of total billed charges,97% of total billed charges,2359.5,75,,,percent of total billed charges,75% of total billed charges,3020.16,96,,,percent of total billed charges,96% of total billed charges,90.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2359.5,75,,,percent of total billed charges,75% of total billed charges,2359.5,75,,,percent of total billed charges,75% of total billed charges,90.06,3051.62,
PF OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCRW,78000880P,CDM,975,RC,27506,HCPCS,Outpatient,,,6201,4650.75,,5704.92,92,,,percent of total billed charges,92% of total billed charges,155.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5766.93,93,,,percent of total billed charges,93% of total billed charges,5580.9,90,,,percent of total billed charges,90% of total billed charges,5580.9,90,,,percent of total billed charges,90% of total billed charges,6014.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,155.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6014.97,97,,,percent of total billed charges,97% of total billed charges,4650.75,75,,,percent of total billed charges,75% of total billed charges,5952.96,96,,,percent of total billed charges,96% of total billed charges,155.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4650.75,75,,,percent of total billed charges,75% of total billed charges,4650.75,75,,,percent of total billed charges,75% of total billed charges,155.49,6014.97,
PF OPEN TX FEMORAL SHAFT FX W/PLATE/SCREWS W/WO CERCLAGE,78000882P,CDM,975,RC,27507,HCPCS,Outpatient,,,5567,4175.25,,5121.64,92,,,percent of total billed charges,92% of total billed charges,113.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5177.31,93,,,percent of total billed charges,93% of total billed charges,5010.3,90,,,percent of total billed charges,90% of total billed charges,5010.3,90,,,percent of total billed charges,90% of total billed charges,5399.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,113.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5399.99,97,,,percent of total billed charges,97% of total billed charges,4175.25,75,,,percent of total billed charges,75% of total billed charges,5344.32,96,,,percent of total billed charges,96% of total billed charges,113.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4175.25,75,,,percent of total billed charges,75% of total billed charges,4175.25,75,,,percent of total billed charges,75% of total billed charges,113.6,5399.99,
PF CLOSED TX FEMORAL FX DISTAL END MEDIAL/LAT CONDYLE W/O MA,78000884P,CDM,975,RC,27508,HCPCS,Outpatient,,,1949,1461.75,,1793.08,92,,,percent of total billed charges,92% of total billed charges,51.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1812.57,93,,,percent of total billed charges,93% of total billed charges,1754.1,90,,,percent of total billed charges,90% of total billed charges,1754.1,90,,,percent of total billed charges,90% of total billed charges,1890.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,51.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1890.53,97,,,percent of total billed charges,97% of total billed charges,1461.75,75,,,percent of total billed charges,75% of total billed charges,1871.04,96,,,percent of total billed charges,96% of total billed charges,51.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1461.75,75,,,percent of total billed charges,75% of total billed charges,1461.75,75,,,percent of total billed charges,75% of total billed charges,51.55,1890.53,
PF CLOSED TX FEMORAL FX DISTAL END MEDIAL/LAT CONDYLE W/MANI,78000886P,CDM,975,RC,27510,HCPCS,Outpatient,,,2672,2004,,2458.24,92,,,percent of total billed charges,92% of total billed charges,78.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2484.96,93,,,percent of total billed charges,93% of total billed charges,2404.8,90,,,percent of total billed charges,90% of total billed charges,2404.8,90,,,percent of total billed charges,90% of total billed charges,2591.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,78.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2591.84,97,,,percent of total billed charges,97% of total billed charges,2004,75,,,percent of total billed charges,75% of total billed charges,2565.12,96,,,percent of total billed charges,96% of total billed charges,78.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2004,75,,,percent of total billed charges,75% of total billed charges,2004,75,,,percent of total billed charges,75% of total billed charges,78.7,2591.84,
PF OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/EXTENSION,78000888P,CDM,975,RC,27513,HCPCS,Outpatient,,,6422,4816.5,,5908.24,92,,,percent of total billed charges,92% of total billed charges,149.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5972.46,93,,,percent of total billed charges,93% of total billed charges,5779.8,90,,,percent of total billed charges,90% of total billed charges,5779.8,90,,,percent of total billed charges,90% of total billed charges,6229.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,149.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6229.34,97,,,percent of total billed charges,97% of total billed charges,4816.5,75,,,percent of total billed charges,75% of total billed charges,6165.12,96,,,percent of total billed charges,96% of total billed charges,149.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4816.5,75,,,percent of total billed charges,75% of total billed charges,4816.5,75,,,percent of total billed charges,75% of total billed charges,149.58,6229.34,
PF OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE,78000890P,CDM,975,RC,27514,HCPCS,Outpatient,,,5916,4437,,5442.72,92,,,percent of total billed charges,92% of total billed charges,114.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5501.88,93,,,percent of total billed charges,93% of total billed charges,5324.4,90,,,percent of total billed charges,90% of total billed charges,5324.4,90,,,percent of total billed charges,90% of total billed charges,5738.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,114.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5738.52,97,,,percent of total billed charges,97% of total billed charges,4437,75,,,percent of total billed charges,75% of total billed charges,5679.36,96,,,percent of total billed charges,96% of total billed charges,114.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4437,75,,,percent of total billed charges,75% of total billed charges,4437,75,,,percent of total billed charges,75% of total billed charges,114.05,5738.52,
PF CLOSED TX PATELLAR FRACTURE W/O MANIPULATION,78000892P,CDM,975,RC,27520,HCPCS,Outpatient,,,1302,976.5,,1197.84,92,,,percent of total billed charges,92% of total billed charges,27.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1210.86,93,,,percent of total billed charges,93% of total billed charges,1171.8,90,,,percent of total billed charges,90% of total billed charges,1171.8,90,,,percent of total billed charges,90% of total billed charges,1262.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1262.94,97,,,percent of total billed charges,97% of total billed charges,976.5,75,,,percent of total billed charges,75% of total billed charges,1249.92,96,,,percent of total billed charges,96% of total billed charges,27.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,976.5,75,,,percent of total billed charges,75% of total billed charges,976.5,75,,,percent of total billed charges,75% of total billed charges,27.12,1262.94,
PF OPEN TX PATELLAR FX W/INTERNAL FIX  SOFT TISSUE REPAIR,78000894P,CDM,975,RC,27524,HCPCS,Outpatient,,,3837,2877.75,,3530.04,92,,,percent of total billed charges,92% of total billed charges,83.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3568.41,93,,,percent of total billed charges,93% of total billed charges,3453.3,90,,,percent of total billed charges,90% of total billed charges,3453.3,90,,,percent of total billed charges,90% of total billed charges,3721.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,83.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3721.89,97,,,percent of total billed charges,97% of total billed charges,2877.75,75,,,percent of total billed charges,75% of total billed charges,3683.52,96,,,percent of total billed charges,96% of total billed charges,83.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2877.75,75,,,percent of total billed charges,75% of total billed charges,2877.75,75,,,percent of total billed charges,75% of total billed charges,83.59,3721.89,
PF ClOSED TX TIBIAL FX PROXIMAL W/O MANIPULATION,78000896P,CDM,975,RC,27530,HCPCS,Outpatient,,,468,351,,430.56,92,,,percent of total billed charges,92% of total billed charges,24.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,435.24,93,,,percent of total billed charges,93% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,453.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,453.96,97,,,percent of total billed charges,97% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,449.28,96,,,percent of total billed charges,96% of total billed charges,24.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,351,75,,,percent of total billed charges,75% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,24.53,453.96,
PF CLOSED TX TIBIAL FX PROXIMAL W/SKELETAL TRACTION,78000898P,CDM,975,RC,27532,HCPCS,Outpatient,,,2865,2148.75,,2635.8,92,,,percent of total billed charges,92% of total billed charges,62.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2664.45,93,,,percent of total billed charges,93% of total billed charges,2578.5,90,,,percent of total billed charges,90% of total billed charges,2578.5,90,,,percent of total billed charges,90% of total billed charges,2779.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,62.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2779.05,97,,,percent of total billed charges,97% of total billed charges,2148.75,75,,,percent of total billed charges,75% of total billed charges,2750.4,96,,,percent of total billed charges,96% of total billed charges,62.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2148.75,75,,,percent of total billed charges,75% of total billed charges,2148.75,75,,,percent of total billed charges,75% of total billed charges,62.51,2779.05,
PF OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR,78000899P,CDM,975,RC,27535,HCPCS,Outpatient,,,4492,3369,,4132.64,92,,,percent of total billed charges,92% of total billed charges,105.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4177.56,93,,,percent of total billed charges,93% of total billed charges,4042.8,90,,,percent of total billed charges,90% of total billed charges,4042.8,90,,,percent of total billed charges,90% of total billed charges,4357.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,105.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4357.24,97,,,percent of total billed charges,97% of total billed charges,3369,75,,,percent of total billed charges,75% of total billed charges,4312.32,96,,,percent of total billed charges,96% of total billed charges,105.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3369,75,,,percent of total billed charges,75% of total billed charges,3369,75,,,percent of total billed charges,75% of total billed charges,105.46,4357.24,
PF OPEN TX TIBIAL FX PROXIMAL BICONDYLAR,78000901P,CDM,975,RC,27536,HCPCS,Outpatient,,,5561,4170.75,,5116.12,92,,,percent of total billed charges,92% of total billed charges,138.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5171.73,93,,,percent of total billed charges,93% of total billed charges,5004.9,90,,,percent of total billed charges,90% of total billed charges,5004.9,90,,,percent of total billed charges,90% of total billed charges,5394.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,138.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5394.17,97,,,percent of total billed charges,97% of total billed charges,4170.75,75,,,percent of total billed charges,75% of total billed charges,5338.56,96,,,percent of total billed charges,96% of total billed charges,138.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4170.75,75,,,percent of total billed charges,75% of total billed charges,4170.75,75,,,percent of total billed charges,75% of total billed charges,138.1,5394.17,
PF CLOSED TX KNEE DISLOCATION W/O ANESTHESIA,78000903P,CDM,975,RC,27550,HCPCS,Outpatient,,,1903,1427.25,,1750.76,92,,,percent of total billed charges,92% of total billed charges,50.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1769.79,93,,,percent of total billed charges,93% of total billed charges,1712.7,90,,,percent of total billed charges,90% of total billed charges,1712.7,90,,,percent of total billed charges,90% of total billed charges,1845.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1845.91,97,,,percent of total billed charges,97% of total billed charges,1427.25,75,,,percent of total billed charges,75% of total billed charges,1826.88,96,,,percent of total billed charges,96% of total billed charges,50.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1427.25,75,,,percent of total billed charges,75% of total billed charges,1427.25,75,,,percent of total billed charges,75% of total billed charges,50.07,1845.91,
PF CLOSED TX KNEE DISLOCATION W/ANESTHESIA,78000905P,CDM,975,RC,27552,HCPCS,Outpatient,,,2472,1854,,2274.24,92,,,percent of total billed charges,92% of total billed charges,67.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2298.96,93,,,percent of total billed charges,93% of total billed charges,2224.8,90,,,percent of total billed charges,90% of total billed charges,2224.8,90,,,percent of total billed charges,90% of total billed charges,2397.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,67.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2397.84,97,,,percent of total billed charges,97% of total billed charges,1854,75,,,percent of total billed charges,75% of total billed charges,2373.12,96,,,percent of total billed charges,96% of total billed charges,67.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1854,75,,,percent of total billed charges,75% of total billed charges,1854,75,,,percent of total billed charges,75% of total billed charges,67.64,2397.84,
PF OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR,78000907P,CDM,975,RC,27557,HCPCS,Outpatient,,,5719,4289.25,,5261.48,92,,,percent of total billed charges,92% of total billed charges,125.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5318.67,93,,,percent of total billed charges,93% of total billed charges,5147.1,90,,,percent of total billed charges,90% of total billed charges,5147.1,90,,,percent of total billed charges,90% of total billed charges,5547.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,125.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5547.43,97,,,percent of total billed charges,97% of total billed charges,4289.25,75,,,percent of total billed charges,75% of total billed charges,5490.24,96,,,percent of total billed charges,96% of total billed charges,125.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4289.25,75,,,percent of total billed charges,75% of total billed charges,4289.25,75,,,percent of total billed charges,75% of total billed charges,125.43,5547.43,
PF CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA,78000909P,CDM,975,RC,27560,HCPCS,Outpatient,,,1347,1010.25,,1239.24,92,,,percent of total billed charges,92% of total billed charges,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1252.71,93,,,percent of total billed charges,93% of total billed charges,1212.3,90,,,percent of total billed charges,90% of total billed charges,1212.3,90,,,percent of total billed charges,90% of total billed charges,1306.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1306.59,97,,,percent of total billed charges,97% of total billed charges,1010.25,75,,,percent of total billed charges,75% of total billed charges,1293.12,96,,,percent of total billed charges,96% of total billed charges,34.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1010.25,75,,,percent of total billed charges,75% of total billed charges,1010.25,75,,,percent of total billed charges,75% of total billed charges,34.49,1306.59,
PF CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA,78000911P,CDM,975,RC,27562,HCPCS,Outpatient,,,1910,1432.5,,1757.2,92,,,percent of total billed charges,92% of total billed charges,50.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1776.3,93,,,percent of total billed charges,93% of total billed charges,1719,90,,,percent of total billed charges,90% of total billed charges,1719,90,,,percent of total billed charges,90% of total billed charges,1852.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1852.7,97,,,percent of total billed charges,97% of total billed charges,1432.5,75,,,percent of total billed charges,75% of total billed charges,1833.6,96,,,percent of total billed charges,96% of total billed charges,50.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1432.5,75,,,percent of total billed charges,75% of total billed charges,1432.5,75,,,percent of total billed charges,75% of total billed charges,50.75,1852.7,
PF MANIPULATION KNEE JOINT UNDER GENERAL ANESTH,78000913P,CDM,975,RC,27570,HCPCS,Outpatient,,,1127,845.25,,1036.84,92,,,percent of total billed charges,92% of total billed charges,15.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1048.11,93,,,percent of total billed charges,93% of total billed charges,1014.3,90,,,percent of total billed charges,90% of total billed charges,1014.3,90,,,percent of total billed charges,90% of total billed charges,1093.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1093.19,97,,,percent of total billed charges,97% of total billed charges,845.25,75,,,percent of total billed charges,75% of total billed charges,1081.92,96,,,percent of total billed charges,96% of total billed charges,15.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,845.25,75,,,percent of total billed charges,75% of total billed charges,845.25,75,,,percent of total billed charges,75% of total billed charges,15.45,1093.19,
PF AMPUTATION THIGH THROUGH FEMUR ANY LEVEL,78000914P,CDM,975,RC,27590,HCPCS,Outpatient,,,4170,3127.5,,3836.4,92,,,percent of total billed charges,92% of total billed charges,115.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3878.1,93,,,percent of total billed charges,93% of total billed charges,3753,90,,,percent of total billed charges,90% of total billed charges,3753,90,,,percent of total billed charges,90% of total billed charges,4044.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,115.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4044.9,97,,,percent of total billed charges,97% of total billed charges,3127.5,75,,,percent of total billed charges,75% of total billed charges,4003.2,96,,,percent of total billed charges,96% of total billed charges,115.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3127.5,75,,,percent of total billed charges,75% of total billed charges,3127.5,75,,,percent of total billed charges,75% of total billed charges,115.7,4044.9,
PF AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION,78000916P,CDM,975,RC,27596,HCPCS,Outpatient,,,3805,2853.75,,3500.6,92,,,percent of total billed charges,92% of total billed charges,96.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3538.65,93,,,percent of total billed charges,93% of total billed charges,3424.5,90,,,percent of total billed charges,90% of total billed charges,3424.5,90,,,percent of total billed charges,90% of total billed charges,3690.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,96.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3690.85,97,,,percent of total billed charges,97% of total billed charges,2853.75,75,,,percent of total billed charges,75% of total billed charges,3652.8,96,,,percent of total billed charges,96% of total billed charges,96.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2853.75,75,,,percent of total billed charges,75% of total billed charges,2853.75,75,,,percent of total billed charges,75% of total billed charges,96.45,3690.85,
PF UNLISTED PROCEDURE FEMUR/KNEE,78000917P,CDM,975,RC,27599,HCPCS,Outpatient,,,3400,2550,,3128,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,3162,93,,,percent of total billed charges,93% of total billed charges,3060,90,,,percent of total billed charges,90% of total billed charges,3060,90,,,percent of total billed charges,90% of total billed charges,3298,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3298,97,,,percent of total billed charges,97% of total billed charges,2550,75,,,percent of total billed charges,75% of total billed charges,3264,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,2550,75,,,percent of total billed charges,75% of total billed charges,2550,75,,,percent of total billed charges,75% of total billed charges,2550,3298,
PF DECOMPRESSIONN FASCIOTOMY LEG POST COMPARTMENT ONLY,78000920P,CDM,975,RC,27601,HCPCS,Outpatient,,,1959,1469.25,,1802.28,92,,,percent of total billed charges,92% of total billed charges,47.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1821.87,93,,,percent of total billed charges,93% of total billed charges,1763.1,90,,,percent of total billed charges,90% of total billed charges,1763.1,90,,,percent of total billed charges,90% of total billed charges,1900.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,47.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1900.23,97,,,percent of total billed charges,97% of total billed charges,1469.25,75,,,percent of total billed charges,75% of total billed charges,1880.64,96,,,percent of total billed charges,96% of total billed charges,47.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1469.25,75,,,percent of total billed charges,75% of total billed charges,1469.25,75,,,percent of total billed charges,75% of total billed charges,47.99,1900.23,
PF INCISION  DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA,78000921P,CDM,975,RC,27603,HCPCS,Outpatient,,,2096,1572,,1928.32,92,,,percent of total billed charges,92% of total billed charges,39.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1949.28,93,,,percent of total billed charges,93% of total billed charges,1886.4,90,,,percent of total billed charges,90% of total billed charges,1886.4,90,,,percent of total billed charges,90% of total billed charges,2033.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,39.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2033.12,97,,,percent of total billed charges,97% of total billed charges,1572,75,,,percent of total billed charges,75% of total billed charges,2012.16,96,,,percent of total billed charges,96% of total billed charges,39.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1572,75,,,percent of total billed charges,75% of total billed charges,1572,75,,,percent of total billed charges,75% of total billed charges,39.38,2033.12,
PF TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES,78000923P,CDM,975,RC,27606,HCPCS,Outpatient,,,1857,1392.75,,1708.44,92,,,percent of total billed charges,92% of total billed charges,26.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1727.01,93,,,percent of total billed charges,93% of total billed charges,1671.3,90,,,percent of total billed charges,90% of total billed charges,1671.3,90,,,percent of total billed charges,90% of total billed charges,1801.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1801.29,97,,,percent of total billed charges,97% of total billed charges,1392.75,75,,,percent of total billed charges,75% of total billed charges,1782.72,96,,,percent of total billed charges,96% of total billed charges,26.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1392.75,75,,,percent of total billed charges,75% of total billed charges,1392.75,75,,,percent of total billed charges,75% of total billed charges,26.46,1801.29,
PF BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL,78000925P,CDM,975,RC,27613,HCPCS,Outpatient,,,833,624.75,,766.36,92,,,percent of total billed charges,92% of total billed charges,14.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,774.69,93,,,percent of total billed charges,93% of total billed charges,749.7,90,,,percent of total billed charges,90% of total billed charges,749.7,90,,,percent of total billed charges,90% of total billed charges,808.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,808.01,97,,,percent of total billed charges,97% of total billed charges,624.75,75,,,percent of total billed charges,75% of total billed charges,799.68,96,,,percent of total billed charges,96% of total billed charges,14.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,624.75,75,,,percent of total billed charges,75% of total billed charges,624.75,75,,,percent of total billed charges,75% of total billed charges,14.31,808.01,
PF EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM,78000927P,CDM,975,RC,27618,HCPCS,Outpatient,,,1878,1408.5,,1727.76,92,,,percent of total billed charges,92% of total billed charges,31.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1746.54,93,,,percent of total billed charges,93% of total billed charges,1690.2,90,,,percent of total billed charges,90% of total billed charges,1690.2,90,,,percent of total billed charges,90% of total billed charges,1821.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,31.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1821.66,97,,,percent of total billed charges,97% of total billed charges,1408.5,75,,,percent of total billed charges,75% of total billed charges,1802.88,96,,,percent of total billed charges,96% of total billed charges,31.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1408.5,75,,,percent of total billed charges,75% of total billed charges,1408.5,75,,,percent of total billed charges,75% of total billed charges,31.34,1821.66,
PF ARTHROTOMY ANKLE W/JOINT EXPLORATION,78000929P,CDM,975,RC,27620,HCPCS,Outpatient,,,2522,1891.5,,2320.24,92,,,percent of total billed charges,92% of total billed charges,41.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2345.46,93,,,percent of total billed charges,93% of total billed charges,2269.8,90,,,percent of total billed charges,90% of total billed charges,2269.8,90,,,percent of total billed charges,90% of total billed charges,2446.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2446.34,97,,,percent of total billed charges,97% of total billed charges,1891.5,75,,,percent of total billed charges,75% of total billed charges,2421.12,96,,,percent of total billed charges,96% of total billed charges,41.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1891.5,75,,,percent of total billed charges,75% of total billed charges,1891.5,75,,,percent of total billed charges,75% of total billed charges,41.2,2446.34,
PF EXCISION LESION TENDON SHEATH/CAPSULE LEG/ANK,78000931P,CDM,975,RC,27630,HCPCS,Outpatient,,,1995,1496.25,,1835.4,92,,,percent of total billed charges,92% of total billed charges,31.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1855.35,93,,,percent of total billed charges,93% of total billed charges,1795.5,90,,,percent of total billed charges,90% of total billed charges,1795.5,90,,,percent of total billed charges,90% of total billed charges,1935.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,31.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1935.15,97,,,percent of total billed charges,97% of total billed charges,1496.25,75,,,percent of total billed charges,75% of total billed charges,1915.2,96,,,percent of total billed charges,96% of total billed charges,31.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1496.25,75,,,percent of total billed charges,75% of total billed charges,1496.25,75,,,percent of total billed charges,75% of total billed charges,31.78,1935.15,
PF EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA,78000933P,CDM,975,RC,27635,HCPCS,Outpatient,,,3507,2630.25,,3226.44,92,,,percent of total billed charges,92% of total billed charges,58.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3261.51,93,,,percent of total billed charges,93% of total billed charges,3156.3,90,,,percent of total billed charges,90% of total billed charges,3156.3,90,,,percent of total billed charges,90% of total billed charges,3401.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,58.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3401.79,97,,,percent of total billed charges,97% of total billed charges,2630.25,75,,,percent of total billed charges,75% of total billed charges,3366.72,96,,,percent of total billed charges,96% of total billed charges,58.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2630.25,75,,,percent of total billed charges,75% of total billed charges,2630.25,75,,,percent of total billed charges,75% of total billed charges,58.79,3401.79,
PF RADICAL RESECTION OF TUMOR TIBIA,78000935P,CDM,975,RC,27645,HCPCS,Outpatient,,,4766,3574.5,,4384.72,92,,,percent of total billed charges,92% of total billed charges,213.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4432.38,93,,,percent of total billed charges,93% of total billed charges,4289.4,90,,,percent of total billed charges,90% of total billed charges,4289.4,90,,,percent of total billed charges,90% of total billed charges,4623.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,213.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4623.02,97,,,percent of total billed charges,97% of total billed charges,3574.5,75,,,percent of total billed charges,75% of total billed charges,4575.36,96,,,percent of total billed charges,96% of total billed charges,213.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3574.5,75,,,percent of total billed charges,75% of total billed charges,3574.5,75,,,percent of total billed charges,75% of total billed charges,213.51,4623.02,
PF INJECTION ANKLE ARTHROGRAPHY,78000936P,CDM,975,RC,27648,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186,93,,,percent of total billed charges,93% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,194,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194,97,,,percent of total billed charges,97% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,192,96,,,percent of total billed charges,96% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150,75,,,percent of total billed charges,75% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,5.56,194,
PF REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDN,78000940P,CDM,975,RC,27650,HCPCS,Outpatient,,,3544,2658,,3260.48,92,,,percent of total billed charges,92% of total billed charges,61.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3295.92,93,,,percent of total billed charges,93% of total billed charges,3189.6,90,,,percent of total billed charges,90% of total billed charges,3189.6,90,,,percent of total billed charges,90% of total billed charges,3437.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3437.68,97,,,percent of total billed charges,97% of total billed charges,2658,75,,,percent of total billed charges,75% of total billed charges,3402.24,96,,,percent of total billed charges,96% of total billed charges,61.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2658,75,,,percent of total billed charges,75% of total billed charges,2658,75,,,percent of total billed charges,75% of total billed charges,61.74,3437.68,
PF REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT,78000942P,CDM,975,RC,27652,HCPCS,Outpatient,,,4124,3093,,3794.08,92,,,percent of total billed charges,92% of total billed charges,61.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3835.32,93,,,percent of total billed charges,93% of total billed charges,3711.6,90,,,percent of total billed charges,90% of total billed charges,3711.6,90,,,percent of total billed charges,90% of total billed charges,4000.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4000.28,97,,,percent of total billed charges,97% of total billed charges,3093,75,,,percent of total billed charges,75% of total billed charges,3959.04,96,,,percent of total billed charges,96% of total billed charges,61.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3093,75,,,percent of total billed charges,75% of total billed charges,3093,75,,,percent of total billed charges,75% of total billed charges,61.09,4000.28,
PF REPAIR FASCIAL DEFECT LEG,78000943P,CDM,975,RC,27656,HCPCS,Outpatient,,,1895,1421.25,,1743.4,92,,,percent of total billed charges,92% of total billed charges,29.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1762.35,93,,,percent of total billed charges,93% of total billed charges,1705.5,90,,,percent of total billed charges,90% of total billed charges,1705.5,90,,,percent of total billed charges,90% of total billed charges,1838.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1838.15,97,,,percent of total billed charges,97% of total billed charges,1421.25,75,,,percent of total billed charges,75% of total billed charges,1819.2,96,,,percent of total billed charges,96% of total billed charges,29.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1421.25,75,,,percent of total billed charges,75% of total billed charges,1421.25,75,,,percent of total billed charges,75% of total billed charges,29.03,1838.15,
PF REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH,78000945P,CDM,975,RC,27658,HCPCS,Outpatient,,,2147,1610.25,,1975.24,92,,,percent of total billed charges,92% of total billed charges,32.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1996.71,93,,,percent of total billed charges,93% of total billed charges,1932.3,90,,,percent of total billed charges,90% of total billed charges,1932.3,90,,,percent of total billed charges,90% of total billed charges,2082.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2082.59,97,,,percent of total billed charges,97% of total billed charges,1610.25,75,,,percent of total billed charges,75% of total billed charges,2061.12,96,,,percent of total billed charges,96% of total billed charges,32.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1610.25,75,,,percent of total billed charges,75% of total billed charges,1610.25,75,,,percent of total billed charges,75% of total billed charges,32.74,2082.59,
PF REPAIR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH,78000947P,CDM,975,RC,27664,HCPCS,Outpatient,,,1995,1496.25,,1835.4,92,,,percent of total billed charges,92% of total billed charges,32.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1855.35,93,,,percent of total billed charges,93% of total billed charges,1795.5,90,,,percent of total billed charges,90% of total billed charges,1795.5,90,,,percent of total billed charges,90% of total billed charges,1935.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1935.15,97,,,percent of total billed charges,97% of total billed charges,1496.25,75,,,percent of total billed charges,75% of total billed charges,1915.2,96,,,percent of total billed charges,96% of total billed charges,32.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1496.25,75,,,percent of total billed charges,75% of total billed charges,1496.25,75,,,percent of total billed charges,75% of total billed charges,32.78,1935.15,
PF REPAIR DISLOC PERONEAL TENDN W/O FIBULAR OSTEOTOMY,78000948P,CDM,975,RC,27675,HCPCS,Outpatient,,,2481,1860.75,,2282.52,92,,,percent of total billed charges,92% of total billed charges,45.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2307.33,93,,,percent of total billed charges,93% of total billed charges,2232.9,90,,,percent of total billed charges,90% of total billed charges,2232.9,90,,,percent of total billed charges,90% of total billed charges,2406.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2406.57,97,,,percent of total billed charges,97% of total billed charges,1860.75,75,,,percent of total billed charges,75% of total billed charges,2381.76,96,,,percent of total billed charges,96% of total billed charges,45.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1860.75,75,,,percent of total billed charges,75% of total billed charges,1860.75,75,,,percent of total billed charges,75% of total billed charges,45.53,2406.57,
PF REPAIR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL,78000950P,CDM,975,RC,27695,HCPCS,Outpatient,,,2906,2179.5,,2673.52,92,,,percent of total billed charges,92% of total billed charges,45.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2702.58,93,,,percent of total billed charges,93% of total billed charges,2615.4,90,,,percent of total billed charges,90% of total billed charges,2615.4,90,,,percent of total billed charges,90% of total billed charges,2818.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2818.82,97,,,percent of total billed charges,97% of total billed charges,2179.5,75,,,percent of total billed charges,75% of total billed charges,2789.76,96,,,percent of total billed charges,96% of total billed charges,45.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2179.5,75,,,percent of total billed charges,75% of total billed charges,2179.5,75,,,percent of total billed charges,75% of total billed charges,45.78,2818.82,
PF REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE CLTRL,78000951P,CDM,975,RC,27698,HCPCS,Outpatient,,,4448,3336,,4092.16,92,,,percent of total billed charges,92% of total billed charges,62.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4136.64,93,,,percent of total billed charges,93% of total billed charges,4003.2,90,,,percent of total billed charges,90% of total billed charges,4003.2,90,,,percent of total billed charges,90% of total billed charges,4314.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,62.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4314.56,97,,,percent of total billed charges,97% of total billed charges,3336,75,,,percent of total billed charges,75% of total billed charges,4270.08,96,,,percent of total billed charges,96% of total billed charges,62.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3336,75,,,percent of total billed charges,75% of total billed charges,3336,75,,,percent of total billed charges,75% of total billed charges,62.64,4314.56,
PF REMOVAL ANKLE IMPLANT,78000953P,CDM,975,RC,27704,HCPCS,Outpatient,,,2629,1971.75,,2418.68,92,,,percent of total billed charges,92% of total billed charges,56.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2444.97,93,,,percent of total billed charges,93% of total billed charges,2366.1,90,,,percent of total billed charges,90% of total billed charges,2366.1,90,,,percent of total billed charges,90% of total billed charges,2550.13,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,56.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2550.13,97,,,percent of total billed charges,97% of total billed charges,1971.75,75,,,percent of total billed charges,75% of total billed charges,2523.84,96,,,percent of total billed charges,96% of total billed charges,56.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1971.75,75,,,percent of total billed charges,75% of total billed charges,1971.75,75,,,percent of total billed charges,75% of total billed charges,56.71,2550.13,
PF OSTEOTOMY TIBIA,78000955P,CDM,975,RC,27705,HCPCS,Outpatient,,,3933,2949.75,,3618.36,92,,,percent of total billed charges,92% of total billed charges,79.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3657.69,93,,,percent of total billed charges,93% of total billed charges,3539.7,90,,,percent of total billed charges,90% of total billed charges,3539.7,90,,,percent of total billed charges,90% of total billed charges,3815.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,79.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3815.01,97,,,percent of total billed charges,97% of total billed charges,2949.75,75,,,percent of total billed charges,75% of total billed charges,3775.68,96,,,percent of total billed charges,96% of total billed charges,79.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2949.75,75,,,percent of total billed charges,75% of total billed charges,2949.75,75,,,percent of total billed charges,75% of total billed charges,79.84,3815.01,
PF OSTEOPLASTY TIBIA AND FIBULA SHORT OR LENTHEN,78002220P,CDM,975,RC,27715,HCPCS,Outpatient,,,1595,1196.25,,1467.4,92,,,percent of total billed charges,92% of total billed charges,124.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1483.35,93,,,percent of total billed charges,93% of total billed charges,1435.5,90,,,percent of total billed charges,90% of total billed charges,1435.5,90,,,percent of total billed charges,90% of total billed charges,1547.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,124.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1547.15,97,,,percent of total billed charges,97% of total billed charges,1196.25,75,,,percent of total billed charges,75% of total billed charges,1531.2,96,,,percent of total billed charges,96% of total billed charges,124.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1196.25,75,,,percent of total billed charges,75% of total billed charges,1196.25,75,,,percent of total billed charges,75% of total billed charges,124.38,1547.15,
PF REPAIR NONUNION/MALUNION TIBIA W/O GRAFT,78000957P,CDM,975,RC,27720,HCPCS,Outpatient,,,5140,3855,,4728.8,92,,,percent of total billed charges,92% of total billed charges,95.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4780.2,93,,,percent of total billed charges,93% of total billed charges,4626,90,,,percent of total billed charges,90% of total billed charges,4626,90,,,percent of total billed charges,90% of total billed charges,4985.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,95.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4985.8,97,,,percent of total billed charges,97% of total billed charges,3855,75,,,percent of total billed charges,75% of total billed charges,4934.4,96,,,percent of total billed charges,96% of total billed charges,95.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3855,75,,,percent of total billed charges,75% of total billed charges,3855,75,,,percent of total billed charges,75% of total billed charges,95.52,4985.8,
PF RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT,78000959P,CDM,975,RC,27724,HCPCS,Outpatient,,,6637,4977.75,,6106.04,92,,,percent of total billed charges,92% of total billed charges,150.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6172.41,93,,,percent of total billed charges,93% of total billed charges,5973.3,90,,,percent of total billed charges,90% of total billed charges,5973.3,90,,,percent of total billed charges,90% of total billed charges,6437.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,150.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6437.89,97,,,percent of total billed charges,97% of total billed charges,4977.75,75,,,percent of total billed charges,75% of total billed charges,6371.52,96,,,percent of total billed charges,96% of total billed charges,150.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4977.75,75,,,percent of total billed charges,75% of total billed charges,4977.75,75,,,percent of total billed charges,75% of total billed charges,150.33,6437.89,
PF REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION,78000961P,CDM,975,RC,27726,HCPCS,Outpatient,,,5312,3984,,4887.04,92,,,percent of total billed charges,92% of total billed charges,107.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4940.16,93,,,percent of total billed charges,93% of total billed charges,4780.8,90,,,percent of total billed charges,90% of total billed charges,4780.8,90,,,percent of total billed charges,90% of total billed charges,5152.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,107.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5152.64,97,,,percent of total billed charges,97% of total billed charges,3984,75,,,percent of total billed charges,75% of total billed charges,5099.52,96,,,percent of total billed charges,96% of total billed charges,107.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3984,75,,,percent of total billed charges,75% of total billed charges,3984,75,,,percent of total billed charges,75% of total billed charges,107.54,5152.64,
PF CLOSED TX TIBIAL SHAFT FX W/O MANIPULATION,78000963P,CDM,975,RC,27750,HCPCS,Outpatient,,,526,394.5,,483.92,92,,,percent of total billed charges,92% of total billed charges,29.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,489.18,93,,,percent of total billed charges,93% of total billed charges,473.4,90,,,percent of total billed charges,90% of total billed charges,473.4,90,,,percent of total billed charges,90% of total billed charges,510.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,510.22,97,,,percent of total billed charges,97% of total billed charges,394.5,75,,,percent of total billed charges,75% of total billed charges,504.96,96,,,percent of total billed charges,96% of total billed charges,29.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,394.5,75,,,percent of total billed charges,75% of total billed charges,394.5,75,,,percent of total billed charges,75% of total billed charges,29.8,510.22,
PF CLOSED TX TIBIAL SHAFT FX W/MANIP W/WO SKEL TRACTION,78000965P,CDM,975,RC,27752,HCPCS,Outpatient,,,2666,1999.5,,2452.72,92,,,percent of total billed charges,92% of total billed charges,52.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2479.38,93,,,percent of total billed charges,93% of total billed charges,2399.4,90,,,percent of total billed charges,90% of total billed charges,2399.4,90,,,percent of total billed charges,90% of total billed charges,2586.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,52.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2586.02,97,,,percent of total billed charges,97% of total billed charges,1999.5,75,,,percent of total billed charges,75% of total billed charges,2559.36,96,,,percent of total billed charges,96% of total billed charges,52.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1999.5,75,,,percent of total billed charges,75% of total billed charges,1999.5,75,,,percent of total billed charges,75% of total billed charges,52.37,2586.02,
PF PERCUT SKELETAL FIXATION TIBIAL SHAFT FRACTURE,78000967P,CDM,975,RC,27756,HCPCS,Outpatient,,,3201,2400.75,,2944.92,92,,,percent of total billed charges,92% of total billed charges,59.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2976.93,93,,,percent of total billed charges,93% of total billed charges,2880.9,90,,,percent of total billed charges,90% of total billed charges,2880.9,90,,,percent of total billed charges,90% of total billed charges,3104.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,59.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3104.97,97,,,percent of total billed charges,97% of total billed charges,2400.75,75,,,percent of total billed charges,75% of total billed charges,3072.96,96,,,percent of total billed charges,96% of total billed charges,59.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2400.75,75,,,percent of total billed charges,75% of total billed charges,2400.75,75,,,percent of total billed charges,75% of total billed charges,59.38,3104.97,
PF OPEN TX TIBIAL SHAFT FX W/PLATE/SCREWS W/WO CERCLGE,78000969P,CDM,975,RC,27758,HCPCS,Outpatient,,,4679,3509.25,,4304.68,92,,,percent of total billed charges,92% of total billed charges,100.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4351.47,93,,,percent of total billed charges,93% of total billed charges,4211.1,90,,,percent of total billed charges,90% of total billed charges,4211.1,90,,,percent of total billed charges,90% of total billed charges,4538.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,100.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4538.63,97,,,percent of total billed charges,97% of total billed charges,3509.25,75,,,percent of total billed charges,75% of total billed charges,4491.84,96,,,percent of total billed charges,96% of total billed charges,100.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3509.25,75,,,percent of total billed charges,75% of total billed charges,3509.25,75,,,percent of total billed charges,75% of total billed charges,100.72,4538.63,
PF TX TIBIAL SHIFT FX INTRAMEDULLARY IMPLANT,78000971P,CDM,975,RC,27759,HCPCS,Outpatient,,,2647,1985.25,,2435.24,92,,,percent of total billed charges,92% of total billed charges,114.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2461.71,93,,,percent of total billed charges,93% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,2382.3,90,,,percent of total billed charges,90% of total billed charges,2567.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,114.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2567.59,97,,,percent of total billed charges,97% of total billed charges,1985.25,75,,,percent of total billed charges,75% of total billed charges,2541.12,96,,,percent of total billed charges,96% of total billed charges,114.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1985.25,75,,,percent of total billed charges,75% of total billed charges,1985.25,75,,,percent of total billed charges,75% of total billed charges,114.44,2567.59,
PF CLOSED TX MEDIAL MALLEOLUS FX W/O MANIPULATION,78000974P,CDM,975,RC,27760,HCPCS,Outpatient,,,1204,903,,1107.68,92,,,percent of total billed charges,92% of total billed charges,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1119.72,93,,,percent of total billed charges,93% of total billed charges,1083.6,90,,,percent of total billed charges,90% of total billed charges,1083.6,90,,,percent of total billed charges,90% of total billed charges,1167.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1167.88,97,,,percent of total billed charges,97% of total billed charges,903,75,,,percent of total billed charges,75% of total billed charges,1155.84,96,,,percent of total billed charges,96% of total billed charges,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,903,75,,,percent of total billed charges,75% of total billed charges,903,75,,,percent of total billed charges,75% of total billed charges,26.53,1167.88,
PF CLOSED TX MEDIAL MALLEOLUS FX W/MANIP,78000976P,CDM,975,RC,27762,HCPCS,Outpatient,,,2058,1543.5,,1893.36,92,,,percent of total billed charges,92% of total billed charges,46.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1913.94,93,,,percent of total billed charges,93% of total billed charges,1852.2,90,,,percent of total billed charges,90% of total billed charges,1852.2,90,,,percent of total billed charges,90% of total billed charges,1996.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1996.26,97,,,percent of total billed charges,97% of total billed charges,1543.5,75,,,percent of total billed charges,75% of total billed charges,1975.68,96,,,percent of total billed charges,96% of total billed charges,46.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1543.5,75,,,percent of total billed charges,75% of total billed charges,1543.5,75,,,percent of total billed charges,75% of total billed charges,46.38,1996.26,
PF OPEN TX MEDIAL MALLEOLUS FRACTURE,78000978P,CDM,975,RC,27766,HCPCS,Outpatient,,,3173,2379.75,,2919.16,92,,,percent of total billed charges,92% of total billed charges,61.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2950.89,93,,,percent of total billed charges,93% of total billed charges,2855.7,90,,,percent of total billed charges,90% of total billed charges,2855.7,90,,,percent of total billed charges,90% of total billed charges,3077.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3077.81,97,,,percent of total billed charges,97% of total billed charges,2379.75,75,,,percent of total billed charges,75% of total billed charges,3046.08,96,,,percent of total billed charges,96% of total billed charges,61.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2379.75,75,,,percent of total billed charges,75% of total billed charges,2379.75,75,,,percent of total billed charges,75% of total billed charges,61.62,3077.81,
PF CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP,78000979P,CDM,975,RC,27767,HCPCS,Outpatient,,,1121,840.75,,1031.32,92,,,percent of total billed charges,92% of total billed charges,23.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1042.53,93,,,percent of total billed charges,93% of total billed charges,1008.9,90,,,percent of total billed charges,90% of total billed charges,1008.9,90,,,percent of total billed charges,90% of total billed charges,1087.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1087.37,97,,,percent of total billed charges,97% of total billed charges,840.75,75,,,percent of total billed charges,75% of total billed charges,1076.16,96,,,percent of total billed charges,96% of total billed charges,23.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.75,75,,,percent of total billed charges,75% of total billed charges,840.75,75,,,percent of total billed charges,75% of total billed charges,23.45,1087.37,
PF CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,78000981P,CDM,975,RC,27768,HCPCS,Outpatient,,,1741,1305.75,,1601.72,92,,,percent of total billed charges,92% of total billed charges,45.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1619.13,93,,,percent of total billed charges,93% of total billed charges,1566.9,90,,,percent of total billed charges,90% of total billed charges,1566.9,90,,,percent of total billed charges,90% of total billed charges,1688.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1688.77,97,,,percent of total billed charges,97% of total billed charges,1305.75,75,,,percent of total billed charges,75% of total billed charges,1671.36,96,,,percent of total billed charges,96% of total billed charges,45.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1305.75,75,,,percent of total billed charges,75% of total billed charges,1305.75,75,,,percent of total billed charges,75% of total billed charges,45.27,1688.77,
PF OPEN TX POSTERIOR MALLEOLUS FRACTURE,78000983P,CDM,975,RC,27769,HCPCS,Outpatient,,,3335,2501.25,,3068.2,92,,,percent of total billed charges,92% of total billed charges,79.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3101.55,93,,,percent of total billed charges,93% of total billed charges,3001.5,90,,,percent of total billed charges,90% of total billed charges,3001.5,90,,,percent of total billed charges,90% of total billed charges,3234.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,79.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3234.95,97,,,percent of total billed charges,97% of total billed charges,2501.25,75,,,percent of total billed charges,75% of total billed charges,3201.6,96,,,percent of total billed charges,96% of total billed charges,79.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2501.25,75,,,percent of total billed charges,75% of total billed charges,2501.25,75,,,percent of total billed charges,75% of total billed charges,79.09,3234.95,
PF CLOSED TX PROX FIBULA/SHAFT FX W/O MANIP,78000984P,CDM,975,RC,27780,HCPCS,Outpatient,,,1104,828,,1015.68,92,,,percent of total billed charges,92% of total billed charges,24.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1026.72,93,,,percent of total billed charges,93% of total billed charges,993.6,90,,,percent of total billed charges,90% of total billed charges,993.6,90,,,percent of total billed charges,90% of total billed charges,1070.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1070.88,97,,,percent of total billed charges,97% of total billed charges,828,75,,,percent of total billed charges,75% of total billed charges,1059.84,96,,,percent of total billed charges,96% of total billed charges,24.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,828,75,,,percent of total billed charges,75% of total billed charges,828,75,,,percent of total billed charges,75% of total billed charges,24.91,1070.88,
PF CLOSED TX PROX FIBULA/SHAFT FX W/MANIP,78000986P,CDM,975,RC,27781,HCPCS,Outpatient,,,1565,1173.75,,1439.8,92,,,percent of total billed charges,92% of total billed charges,39.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1455.45,93,,,percent of total billed charges,93% of total billed charges,1408.5,90,,,percent of total billed charges,90% of total billed charges,1408.5,90,,,percent of total billed charges,90% of total billed charges,1518.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,39.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1518.05,97,,,percent of total billed charges,97% of total billed charges,1173.75,75,,,percent of total billed charges,75% of total billed charges,1502.4,96,,,percent of total billed charges,96% of total billed charges,39.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1173.75,75,,,percent of total billed charges,75% of total billed charges,1173.75,75,,,percent of total billed charges,75% of total billed charges,39.39,1518.05,
PF OPEN TX PROXIMAL FIBULA/SHAFT FRACTURE,78000988P,CDM,975,RC,27784,HCPCS,Outpatient,,,2869,2151.75,,2639.48,92,,,percent of total billed charges,92% of total billed charges,76.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2668.17,93,,,percent of total billed charges,93% of total billed charges,2582.1,90,,,percent of total billed charges,90% of total billed charges,2582.1,90,,,percent of total billed charges,90% of total billed charges,2782.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2782.93,97,,,percent of total billed charges,97% of total billed charges,2151.75,75,,,percent of total billed charges,75% of total billed charges,2754.24,96,,,percent of total billed charges,96% of total billed charges,76.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2151.75,75,,,percent of total billed charges,75% of total billed charges,2151.75,75,,,percent of total billed charges,75% of total billed charges,76.32,2782.93,
PF CLOSED TX DISTAL FIBULAR FX LATERAL MALLS W/O MANIP,78000989P,CDM,975,RC,27786,HCPCS,Outpatient,,,1128,846,,1037.76,92,,,percent of total billed charges,92% of total billed charges,24.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1049.04,93,,,percent of total billed charges,93% of total billed charges,1015.2,90,,,percent of total billed charges,90% of total billed charges,1015.2,90,,,percent of total billed charges,90% of total billed charges,1094.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1094.16,97,,,percent of total billed charges,97% of total billed charges,846,75,,,percent of total billed charges,75% of total billed charges,1082.88,96,,,percent of total billed charges,96% of total billed charges,24.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,846,75,,,percent of total billed charges,75% of total billed charges,846,75,,,percent of total billed charges,75% of total billed charges,24.97,1094.16,
PF CLOSED TX DISTAL FIBULAR FX LAT MALLS W/MANIP,78000991P,CDM,975,RC,27788,HCPCS,Outpatient,,,1514,1135.5,,1392.88,92,,,percent of total billed charges,92% of total billed charges,38.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1408.02,93,,,percent of total billed charges,93% of total billed charges,1362.6,90,,,percent of total billed charges,90% of total billed charges,1362.6,90,,,percent of total billed charges,90% of total billed charges,1468.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,38.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1468.58,97,,,percent of total billed charges,97% of total billed charges,1135.5,75,,,percent of total billed charges,75% of total billed charges,1453.44,96,,,percent of total billed charges,96% of total billed charges,38.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1135.5,75,,,percent of total billed charges,75% of total billed charges,1135.5,75,,,percent of total billed charges,75% of total billed charges,38.44,1468.58,
PF OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS,78000993P,CDM,975,RC,27792,HCPCS,Outpatient,,,3088,2316,,2840.96,92,,,percent of total billed charges,92% of total billed charges,66.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2871.84,93,,,percent of total billed charges,93% of total billed charges,2779.2,90,,,percent of total billed charges,90% of total billed charges,2779.2,90,,,percent of total billed charges,90% of total billed charges,2995.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,66.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2995.36,97,,,percent of total billed charges,97% of total billed charges,2316,75,,,percent of total billed charges,75% of total billed charges,2964.48,96,,,percent of total billed charges,96% of total billed charges,66.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2316,75,,,percent of total billed charges,75% of total billed charges,2316,75,,,percent of total billed charges,75% of total billed charges,66.53,2995.36,
PF CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP,78000994P,CDM,975,RC,27808,HCPCS,Outpatient,,,1190,892.5,,1094.8,92,,,percent of total billed charges,92% of total billed charges,26.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1106.7,93,,,percent of total billed charges,93% of total billed charges,1071,90,,,percent of total billed charges,90% of total billed charges,1071,90,,,percent of total billed charges,90% of total billed charges,1154.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1154.3,97,,,percent of total billed charges,97% of total billed charges,892.5,75,,,percent of total billed charges,75% of total billed charges,1142.4,96,,,percent of total billed charges,96% of total billed charges,26.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,892.5,75,,,percent of total billed charges,75% of total billed charges,892.5,75,,,percent of total billed charges,75% of total billed charges,26.47,1154.3,
PF CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANIP,78000996P,CDM,975,RC,27810,HCPCS,Outpatient,,,1663,1247.25,,1529.96,92,,,percent of total billed charges,92% of total billed charges,45.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1546.59,93,,,percent of total billed charges,93% of total billed charges,1496.7,90,,,percent of total billed charges,90% of total billed charges,1496.7,90,,,percent of total billed charges,90% of total billed charges,1613.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1613.11,97,,,percent of total billed charges,97% of total billed charges,1247.25,75,,,percent of total billed charges,75% of total billed charges,1596.48,96,,,percent of total billed charges,96% of total billed charges,45.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1247.25,75,,,percent of total billed charges,75% of total billed charges,1247.25,75,,,percent of total billed charges,75% of total billed charges,45.11,1613.11,
PF OPEN TX BIMALLEOLAR ANKLE FRACTURE,78000998P,CDM,975,RC,27814,HCPCS,Outpatient,,,3996,2997,,3676.32,92,,,percent of total billed charges,92% of total billed charges,82.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3716.28,93,,,percent of total billed charges,93% of total billed charges,3596.4,90,,,percent of total billed charges,90% of total billed charges,3596.4,90,,,percent of total billed charges,90% of total billed charges,3876.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,82.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3876.12,97,,,percent of total billed charges,97% of total billed charges,2997,75,,,percent of total billed charges,75% of total billed charges,3836.16,96,,,percent of total billed charges,96% of total billed charges,82.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2997,75,,,percent of total billed charges,75% of total billed charges,2997,75,,,percent of total billed charges,75% of total billed charges,82.03,3876.12,
PF CLOSED TX TRIMALLEOLAR ANKLE FX W/O MANIP,78001000P,CDM,975,RC,27816,HCPCS,Outpatient,,,1271,953.25,,1169.32,92,,,percent of total billed charges,92% of total billed charges,26.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1182.03,93,,,percent of total billed charges,93% of total billed charges,1143.9,90,,,percent of total billed charges,90% of total billed charges,1143.9,90,,,percent of total billed charges,90% of total billed charges,1232.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1232.87,97,,,percent of total billed charges,97% of total billed charges,953.25,75,,,percent of total billed charges,75% of total billed charges,1220.16,96,,,percent of total billed charges,96% of total billed charges,26.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,953.25,75,,,percent of total billed charges,75% of total billed charges,953.25,75,,,percent of total billed charges,75% of total billed charges,26.6,1232.87,
PF CLOSED TX TRIMALLEOLAR ANKLE FX W/MANIPULATION,78001002P,CDM,975,RC,27818,HCPCS,Outpatient,,,1709,1281.75,,1572.28,92,,,percent of total billed charges,92% of total billed charges,47.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1589.37,93,,,percent of total billed charges,93% of total billed charges,1538.1,90,,,percent of total billed charges,90% of total billed charges,1538.1,90,,,percent of total billed charges,90% of total billed charges,1657.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,47.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1657.73,97,,,percent of total billed charges,97% of total billed charges,1281.75,75,,,percent of total billed charges,75% of total billed charges,1640.64,96,,,percent of total billed charges,96% of total billed charges,47.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1281.75,75,,,percent of total billed charges,75% of total billed charges,1281.75,75,,,percent of total billed charges,75% of total billed charges,47.43,1657.73,
PF OPEN TX TRIMALLEOLAR ANKLE FX W/O FIX POSTER LIP,78001004P,CDM,975,RC,27822,HCPCS,Outpatient,,,4623,3467.25,,4253.16,92,,,percent of total billed charges,92% of total billed charges,88.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4299.39,93,,,percent of total billed charges,93% of total billed charges,4160.7,90,,,percent of total billed charges,90% of total billed charges,4160.7,90,,,percent of total billed charges,90% of total billed charges,4484.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,88.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4484.31,97,,,percent of total billed charges,97% of total billed charges,3467.25,75,,,percent of total billed charges,75% of total billed charges,4438.08,96,,,percent of total billed charges,96% of total billed charges,88.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3467.25,75,,,percent of total billed charges,75% of total billed charges,3467.25,75,,,percent of total billed charges,75% of total billed charges,88.53,4484.31,
PF OPEN TX TRIMALLEOLAR ANKLE FX W/FIX POSTERIOR LIP,78001006P,CDM,975,RC,27823,HCPCS,Outpatient,,,5252,3939,,4831.84,92,,,percent of total billed charges,92% of total billed charges,103.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4884.36,93,,,percent of total billed charges,93% of total billed charges,4726.8,90,,,percent of total billed charges,90% of total billed charges,4726.8,90,,,percent of total billed charges,90% of total billed charges,5094.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,103.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5094.44,97,,,percent of total billed charges,97% of total billed charges,3939,75,,,percent of total billed charges,75% of total billed charges,5041.92,96,,,percent of total billed charges,96% of total billed charges,103.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3939,75,,,percent of total billed charges,75% of total billed charges,3939,75,,,percent of total billed charges,75% of total billed charges,103.22,5094.44,
PF CLOSED TX FX WEIGHT BEARING ARTICULAR DISTAL TIBIA W/O MA,78001008P,CDM,975,RC,27824,HCPCS,Outpatient,,,1196,897,,1100.32,92,,,percent of total billed charges,92% of total billed charges,27.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1112.28,93,,,percent of total billed charges,93% of total billed charges,1076.4,90,,,percent of total billed charges,90% of total billed charges,1076.4,90,,,percent of total billed charges,90% of total billed charges,1160.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1160.12,97,,,percent of total billed charges,97% of total billed charges,897,75,,,percent of total billed charges,75% of total billed charges,1148.16,96,,,percent of total billed charges,96% of total billed charges,27.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,897,75,,,percent of total billed charges,75% of total billed charges,897,75,,,percent of total billed charges,75% of total billed charges,27.49,1160.12,
PF CLOSED TX FX WEIGHT BEARING ARTCLR DISTAL TIBOA W/SKEL,78001010P,CDM,975,RC,27825,HCPCS,Outpatient,,,1941,1455.75,,1785.72,92,,,percent of total billed charges,92% of total billed charges,53.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1805.13,93,,,percent of total billed charges,93% of total billed charges,1746.9,90,,,percent of total billed charges,90% of total billed charges,1746.9,90,,,percent of total billed charges,90% of total billed charges,1882.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1882.77,97,,,percent of total billed charges,97% of total billed charges,1455.75,75,,,percent of total billed charges,75% of total billed charges,1863.36,96,,,percent of total billed charges,96% of total billed charges,53.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1455.75,75,,,percent of total billed charges,75% of total billed charges,1455.75,75,,,percent of total billed charges,75% of total billed charges,53.22,1882.77,
PF OPEN TX FRACTURE DISTAL TIBIA ONLY,78001012P,CDM,975,RC,27827,HCPCS,Outpatient,,,5822,4366.5,,5356.24,92,,,percent of total billed charges,92% of total billed charges,117.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5414.46,93,,,percent of total billed charges,93% of total billed charges,5239.8,90,,,percent of total billed charges,90% of total billed charges,5239.8,90,,,percent of total billed charges,90% of total billed charges,5647.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,117.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5647.34,97,,,percent of total billed charges,97% of total billed charges,4366.5,75,,,percent of total billed charges,75% of total billed charges,5589.12,96,,,percent of total billed charges,96% of total billed charges,117.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4366.5,75,,,percent of total billed charges,75% of total billed charges,4366.5,75,,,percent of total billed charges,75% of total billed charges,117.68,5647.34,
PF OPEN TX FRACTURE DISTAL TIBIA  FIBULA,78001014P,CDM,975,RC,27828,HCPCS,Outpatient,,,6631,4973.25,,6100.52,92,,,percent of total billed charges,92% of total billed charges,144.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6166.83,93,,,percent of total billed charges,93% of total billed charges,5967.9,90,,,percent of total billed charges,90% of total billed charges,5967.9,90,,,percent of total billed charges,90% of total billed charges,6432.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,144.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6432.07,97,,,percent of total billed charges,97% of total billed charges,4973.25,75,,,percent of total billed charges,75% of total billed charges,6365.76,96,,,percent of total billed charges,96% of total billed charges,144.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4973.25,75,,,percent of total billed charges,75% of total billed charges,4973.25,75,,,percent of total billed charges,75% of total billed charges,144.3,6432.07,
PF OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION,78001016P,CDM,975,RC,27829,HCPCS,Outpatient,,,3020,2265,,2778.4,92,,,percent of total billed charges,92% of total billed charges,69.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2808.6,93,,,percent of total billed charges,93% of total billed charges,2718,90,,,percent of total billed charges,90% of total billed charges,2718,90,,,percent of total billed charges,90% of total billed charges,2929.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,69.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2929.4,97,,,percent of total billed charges,97% of total billed charges,2265,75,,,percent of total billed charges,75% of total billed charges,2899.2,96,,,percent of total billed charges,96% of total billed charges,69.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2265,75,,,percent of total billed charges,75% of total billed charges,2265,75,,,percent of total billed charges,75% of total billed charges,69.21,2929.4,
PF CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA,78001018P,CDM,975,RC,27840,HCPCS,Outpatient,,,1477,1107.75,,1358.84,92,,,percent of total billed charges,92% of total billed charges,40.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1373.61,93,,,percent of total billed charges,93% of total billed charges,1329.3,90,,,percent of total billed charges,90% of total billed charges,1329.3,90,,,percent of total billed charges,90% of total billed charges,1432.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1432.69,97,,,percent of total billed charges,97% of total billed charges,1107.75,75,,,percent of total billed charges,75% of total billed charges,1417.92,96,,,percent of total billed charges,96% of total billed charges,40.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1107.75,75,,,percent of total billed charges,75% of total billed charges,1107.75,75,,,percent of total billed charges,75% of total billed charges,40.13,1432.69,
PF CLOSED TX ANKLE DISLOCATION REQUIRING ANESTH,78001020P,CDM,975,RC,27842,HCPCS,Outpatient,,,2149,1611.75,,1977.08,92,,,percent of total billed charges,92% of total billed charges,51.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1998.57,93,,,percent of total billed charges,93% of total billed charges,1934.1,90,,,percent of total billed charges,90% of total billed charges,1934.1,90,,,percent of total billed charges,90% of total billed charges,2084.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,51.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2084.53,97,,,percent of total billed charges,97% of total billed charges,1611.75,75,,,percent of total billed charges,75% of total billed charges,2063.04,96,,,percent of total billed charges,96% of total billed charges,51.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1611.75,75,,,percent of total billed charges,75% of total billed charges,1611.75,75,,,percent of total billed charges,75% of total billed charges,51.03,2084.53,
PF MANIPULATION ANKLE UNDER GENERAL ANESTHESIA,78001022P,CDM,975,RC,27860,HCPCS,Outpatient,,,925,693.75,,851,92,,,percent of total billed charges,92% of total billed charges,14.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,860.25,93,,,percent of total billed charges,93% of total billed charges,832.5,90,,,percent of total billed charges,90% of total billed charges,832.5,90,,,percent of total billed charges,90% of total billed charges,897.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,897.25,97,,,percent of total billed charges,97% of total billed charges,693.75,75,,,percent of total billed charges,75% of total billed charges,888,96,,,percent of total billed charges,96% of total billed charges,14.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.75,75,,,percent of total billed charges,75% of total billed charges,693.75,75,,,percent of total billed charges,75% of total billed charges,14.65,897.25,
PF ARTHRODESIS ANKLE OPEN,78001023P,CDM,975,RC,27870,HCPCS,Outpatient,,,5395,4046.25,,4963.4,92,,,percent of total billed charges,92% of total billed charges,107.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5017.35,93,,,percent of total billed charges,93% of total billed charges,4855.5,90,,,percent of total billed charges,90% of total billed charges,4855.5,90,,,percent of total billed charges,90% of total billed charges,5233.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,107.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5233.15,97,,,percent of total billed charges,97% of total billed charges,4046.25,75,,,percent of total billed charges,75% of total billed charges,5179.2,96,,,percent of total billed charges,96% of total billed charges,107.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4046.25,75,,,percent of total billed charges,75% of total billed charges,4046.25,75,,,percent of total billed charges,75% of total billed charges,107.73,5233.15,
PF AMPUTATION LEG THROUGH TIBIAFIBULA,78001025P,CDM,975,RC,27880,HCPCS,Outpatient,,,4115,3086.25,,3785.8,92,,,percent of total billed charges,92% of total billed charges,130.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3826.95,93,,,percent of total billed charges,93% of total billed charges,3703.5,90,,,percent of total billed charges,90% of total billed charges,3703.5,90,,,percent of total billed charges,90% of total billed charges,3991.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,130.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3991.55,97,,,percent of total billed charges,97% of total billed charges,3086.25,75,,,percent of total billed charges,75% of total billed charges,3950.4,96,,,percent of total billed charges,96% of total billed charges,130.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3086.25,75,,,percent of total billed charges,75% of total billed charges,3086.25,75,,,percent of total billed charges,75% of total billed charges,130.2,3991.55,
PF AMP LEG THRU TIBIAFIBULA SEC CLOSURE/SCAR REV,78001027P,CDM,975,RC,27884,HCPCS,Outpatient,,,2747,2060.25,,2527.24,92,,,percent of total billed charges,92% of total billed charges,75.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2554.71,93,,,percent of total billed charges,93% of total billed charges,2472.3,90,,,percent of total billed charges,90% of total billed charges,2472.3,90,,,percent of total billed charges,90% of total billed charges,2664.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,75.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2664.59,97,,,percent of total billed charges,97% of total billed charges,2060.25,75,,,percent of total billed charges,75% of total billed charges,2637.12,96,,,percent of total billed charges,96% of total billed charges,75.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2060.25,75,,,percent of total billed charges,75% of total billed charges,2060.25,75,,,percent of total billed charges,75% of total billed charges,75.36,2664.59,
PF AMP LEG THRU TIBIAFIBULA RE-AMPUTATION,78001028P,CDM,975,RC,27886,HCPCS,Outpatient,,,3774,2830.5,,3472.08,92,,,percent of total billed charges,92% of total billed charges,85.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3509.82,93,,,percent of total billed charges,93% of total billed charges,3396.6,90,,,percent of total billed charges,90% of total billed charges,3396.6,90,,,percent of total billed charges,90% of total billed charges,3660.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,85.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3660.78,97,,,percent of total billed charges,97% of total billed charges,2830.5,75,,,percent of total billed charges,75% of total billed charges,3623.04,96,,,percent of total billed charges,96% of total billed charges,85.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2830.5,75,,,percent of total billed charges,75% of total billed charges,2830.5,75,,,percent of total billed charges,75% of total billed charges,85.63,3660.78,
PF INCISION and DRAINAGE BURSA FOOT,78001029P,CDM,975,RC,28001,HCPCS,Outpatient,,,689,516.75,,633.88,92,,,percent of total billed charges,92% of total billed charges,7.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,640.77,93,,,percent of total billed charges,93% of total billed charges,620.1,90,,,percent of total billed charges,90% of total billed charges,620.1,90,,,percent of total billed charges,90% of total billed charges,668.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,668.33,97,,,percent of total billed charges,97% of total billed charges,516.75,75,,,percent of total billed charges,75% of total billed charges,661.44,96,,,percent of total billed charges,96% of total billed charges,7.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,516.75,75,,,percent of total billed charges,75% of total billed charges,516.75,75,,,percent of total billed charges,75% of total billed charges,7.9,668.33,
PF I and D BELOW FASCIA FOOT 1 BURSAL SPACE,78001031P,CDM,975,RC,28002,HCPCS,Outpatient,,,1330,997.5,,1223.6,92,,,percent of total billed charges,92% of total billed charges,11.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1236.9,93,,,percent of total billed charges,93% of total billed charges,1197,90,,,percent of total billed charges,90% of total billed charges,1197,90,,,percent of total billed charges,90% of total billed charges,1290.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1290.1,97,,,percent of total billed charges,97% of total billed charges,997.5,75,,,percent of total billed charges,75% of total billed charges,1276.8,96,,,percent of total billed charges,96% of total billed charges,11.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,997.5,75,,,percent of total billed charges,75% of total billed charges,997.5,75,,,percent of total billed charges,75% of total billed charges,11.6,1290.1,
PF INCISION BONE CORTEX FOOT,78001033P,CDM,975,RC,28005,HCPCS,Outpatient,,,2240,1680,,2060.8,92,,,percent of total billed charges,92% of total billed charges,44.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2083.2,93,,,percent of total billed charges,93% of total billed charges,2016,90,,,percent of total billed charges,90% of total billed charges,2016,90,,,percent of total billed charges,90% of total billed charges,2172.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,44.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2172.8,97,,,percent of total billed charges,97% of total billed charges,1680,75,,,percent of total billed charges,75% of total billed charges,2150.4,96,,,percent of total billed charges,96% of total billed charges,44.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1680,75,,,percent of total billed charges,75% of total billed charges,1680,75,,,percent of total billed charges,75% of total billed charges,44.51,2172.8,
PF ARTHROTOMY W/EXPLORE DRAIN OR REMOVE FB INTERTARSAL JT,78001034P,CDM,975,RC,28020,HCPCS,Outpatient,,,1773,1329.75,,1631.16,92,,,percent of total billed charges,92% of total billed charges,30.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1648.89,93,,,percent of total billed charges,93% of total billed charges,1595.7,90,,,percent of total billed charges,90% of total billed charges,1595.7,90,,,percent of total billed charges,90% of total billed charges,1719.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1719.81,97,,,percent of total billed charges,97% of total billed charges,1329.75,75,,,percent of total billed charges,75% of total billed charges,1702.08,96,,,percent of total billed charges,96% of total billed charges,30.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1329.75,75,,,percent of total billed charges,75% of total billed charges,1329.75,75,,,percent of total billed charges,75% of total billed charges,30.93,1719.81,
PF ARTHROTOMY W/EXPLORE DRAIN OR REMOVE FB METATARS JT,78001035P,CDM,975,RC,28022,HCPCS,Outpatient,,,1624,1218,,1494.08,92,,,percent of total billed charges,92% of total billed charges,26.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1510.32,93,,,percent of total billed charges,93% of total billed charges,1461.6,90,,,percent of total billed charges,90% of total billed charges,1461.6,90,,,percent of total billed charges,90% of total billed charges,1575.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1575.28,97,,,percent of total billed charges,97% of total billed charges,1218,75,,,percent of total billed charges,75% of total billed charges,1559.04,96,,,percent of total billed charges,96% of total billed charges,26.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1218,75,,,percent of total billed charges,75% of total billed charges,1218,75,,,percent of total billed charges,75% of total billed charges,26.07,1575.28,
PF ARTHROTOMY W/EXPLORE DRAIN OR REMOVE FB INTERPHALANGEAL J,78001036P,CDM,975,RC,28024,HCPCS,Outpatient,,,805,603.75,,740.6,92,,,percent of total billed charges,92% of total billed charges,23.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,748.65,93,,,percent of total billed charges,93% of total billed charges,724.5,90,,,percent of total billed charges,90% of total billed charges,724.5,90,,,percent of total billed charges,90% of total billed charges,780.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,780.85,97,,,percent of total billed charges,97% of total billed charges,603.75,75,,,percent of total billed charges,75% of total billed charges,772.8,96,,,percent of total billed charges,96% of total billed charges,23.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,603.75,75,,,percent of total billed charges,75% of total billed charges,603.75,75,,,percent of total billed charges,75% of total billed charges,23.24,780.85,
PF RELEASE TARSAL TUNNEL,78001037P,CDM,975,RC,28035,HCPCS,Outpatient,,,2544,1908,,2340.48,92,,,percent of total billed charges,92% of total billed charges,29.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2365.92,93,,,percent of total billed charges,93% of total billed charges,2289.6,90,,,percent of total billed charges,90% of total billed charges,2289.6,90,,,percent of total billed charges,90% of total billed charges,2467.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2467.68,97,,,percent of total billed charges,97% of total billed charges,1908,75,,,percent of total billed charges,75% of total billed charges,2442.24,96,,,percent of total billed charges,96% of total billed charges,29.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1908,75,,,percent of total billed charges,75% of total billed charges,1908,75,,,percent of total billed charges,75% of total billed charges,29.87,2467.68,
PF EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>,78001038P,CDM,975,RC,28039,HCPCS,Outpatient,,,1998,1498.5,,1838.16,92,,,percent of total billed charges,92% of total billed charges,28.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1858.14,93,,,percent of total billed charges,93% of total billed charges,1798.2,90,,,percent of total billed charges,90% of total billed charges,1798.2,90,,,percent of total billed charges,90% of total billed charges,1938.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1938.06,97,,,percent of total billed charges,97% of total billed charges,1498.5,75,,,percent of total billed charges,75% of total billed charges,1918.08,96,,,percent of total billed charges,96% of total billed charges,28.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1498.5,75,,,percent of total billed charges,75% of total billed charges,1498.5,75,,,percent of total billed charges,75% of total billed charges,28.32,1938.06,
PF EXCISION TUMOR SOFT TISSUE FOOT/TOE SBQ <1.5CM,78001040P,CDM,975,RC,28043,HCPCS,Outpatient,,,1524,1143,,1402.08,92,,,percent of total billed charges,92% of total billed charges,19.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1417.32,93,,,percent of total billed charges,93% of total billed charges,1371.6,90,,,percent of total billed charges,90% of total billed charges,1371.6,90,,,percent of total billed charges,90% of total billed charges,1478.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1478.28,97,,,percent of total billed charges,97% of total billed charges,1143,75,,,percent of total billed charges,75% of total billed charges,1463.04,96,,,percent of total billed charges,96% of total billed charges,19.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1143,75,,,percent of total billed charges,75% of total billed charges,1143,75,,,percent of total billed charges,75% of total billed charges,19.68,1478.28,
PF EXCISE TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM,78001042P,CDM,975,RC,28045,HCPCS,Outpatient,,,1882,1411.5,,1731.44,92,,,percent of total billed charges,92% of total billed charges,26.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1750.26,93,,,percent of total billed charges,93% of total billed charges,1693.8,90,,,percent of total billed charges,90% of total billed charges,1693.8,90,,,percent of total billed charges,90% of total billed charges,1825.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1825.54,97,,,percent of total billed charges,97% of total billed charges,1411.5,75,,,percent of total billed charges,75% of total billed charges,1806.72,96,,,percent of total billed charges,96% of total billed charges,26.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1411.5,75,,,percent of total billed charges,75% of total billed charges,1411.5,75,,,percent of total billed charges,75% of total billed charges,26.19,1825.54,
PF FASCIECTOMY PLANTAR FASCIA PARTIAL,78001044P,CDM,975,RC,28060,HCPCS,Outpatient,,,1782,1336.5,,1639.44,92,,,percent of total billed charges,92% of total billed charges,28.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1657.26,93,,,percent of total billed charges,93% of total billed charges,1603.8,90,,,percent of total billed charges,90% of total billed charges,1603.8,90,,,percent of total billed charges,90% of total billed charges,1728.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1728.54,97,,,percent of total billed charges,97% of total billed charges,1336.5,75,,,percent of total billed charges,75% of total billed charges,1710.72,96,,,percent of total billed charges,96% of total billed charges,28.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1336.5,75,,,percent of total billed charges,75% of total billed charges,1336.5,75,,,percent of total billed charges,75% of total billed charges,28.3,1728.54,
PF EXCISION INTERDIGITAL NEUROMA SINGLE EACH,78001046P,CDM,975,RC,28080,HCPCS,Outpatient,,,1741,1305.75,,1601.72,92,,,percent of total billed charges,92% of total billed charges,27.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1619.13,93,,,percent of total billed charges,93% of total billed charges,1566.9,90,,,percent of total billed charges,90% of total billed charges,1566.9,90,,,percent of total billed charges,90% of total billed charges,1688.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1688.77,97,,,percent of total billed charges,97% of total billed charges,1305.75,75,,,percent of total billed charges,75% of total billed charges,1671.36,96,,,percent of total billed charges,96% of total billed charges,27.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1305.75,75,,,percent of total billed charges,75% of total billed charges,1305.75,75,,,percent of total billed charges,75% of total billed charges,27.05,1688.77,
PF EXCISION LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT,78001047P,CDM,975,RC,28090,HCPCS,Outpatient,,,1609,1206.75,,1480.28,92,,,percent of total billed charges,92% of total billed charges,23.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1496.37,93,,,percent of total billed charges,93% of total billed charges,1448.1,90,,,percent of total billed charges,90% of total billed charges,1448.1,90,,,percent of total billed charges,90% of total billed charges,1560.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1560.73,97,,,percent of total billed charges,97% of total billed charges,1206.75,75,,,percent of total billed charges,75% of total billed charges,1544.64,96,,,percent of total billed charges,96% of total billed charges,23.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1206.75,75,,,percent of total billed charges,75% of total billed charges,1206.75,75,,,percent of total billed charges,75% of total billed charges,23.52,1560.73,
PF EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS,78001048P,CDM,975,RC,28100,HCPCS,Outpatient,,,2213,1659.75,,2035.96,92,,,percent of total billed charges,92% of total billed charges,36.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2058.09,93,,,percent of total billed charges,93% of total billed charges,1991.7,90,,,percent of total billed charges,90% of total billed charges,1991.7,90,,,percent of total billed charges,90% of total billed charges,2146.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,36.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2146.61,97,,,percent of total billed charges,97% of total billed charges,1659.75,75,,,percent of total billed charges,75% of total billed charges,2124.48,96,,,percent of total billed charges,96% of total billed charges,36.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1659.75,75,,,percent of total billed charges,75% of total billed charges,1659.75,75,,,percent of total billed charges,75% of total billed charges,36.82,2146.61,
PF EXCISE BONE CYST OR BENIGN TUMOR TARSAL/METATARSAL,78001050P,CDM,975,RC,28104,HCPCS,Outpatient,,,2019,1514.25,,1857.48,92,,,percent of total billed charges,92% of total billed charges,29.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1877.67,93,,,percent of total billed charges,93% of total billed charges,1817.1,90,,,percent of total billed charges,90% of total billed charges,1817.1,90,,,percent of total billed charges,90% of total billed charges,1958.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1958.43,97,,,percent of total billed charges,97% of total billed charges,1514.25,75,,,percent of total billed charges,75% of total billed charges,1938.24,96,,,percent of total billed charges,96% of total billed charges,29.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1514.25,75,,,percent of total billed charges,75% of total billed charges,1514.25,75,,,percent of total billed charges,75% of total billed charges,29.19,1958.43,
PF EXCISE BONE CYST OR BEIGN TUMOR PHALANGES FOOT,78001052P,CDM,975,RC,28108,HCPCS,Outpatient,,,762,571.5,,701.04,92,,,percent of total billed charges,92% of total billed charges,20.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,708.66,93,,,percent of total billed charges,93% of total billed charges,685.8,90,,,percent of total billed charges,90% of total billed charges,685.8,90,,,percent of total billed charges,90% of total billed charges,739.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,739.14,97,,,percent of total billed charges,97% of total billed charges,571.5,75,,,percent of total billed charges,75% of total billed charges,731.52,96,,,percent of total billed charges,96% of total billed charges,20.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,571.5,75,,,percent of total billed charges,75% of total billed charges,571.5,75,,,percent of total billed charges,75% of total billed charges,20.92,739.14,
PF OSTECTOMY PARTIAL EXCISION 5TH METATARSAL HEAD,78001053P,CDM,975,RC,28110,HCPCS,Outpatient,,,1672,1254,,1538.24,92,,,percent of total billed charges,92% of total billed charges,22.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1554.96,93,,,percent of total billed charges,93% of total billed charges,1504.8,90,,,percent of total billed charges,90% of total billed charges,1504.8,90,,,percent of total billed charges,90% of total billed charges,1621.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1621.84,97,,,percent of total billed charges,97% of total billed charges,1254,75,,,percent of total billed charges,75% of total billed charges,1605.12,96,,,percent of total billed charges,96% of total billed charges,22.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1254,75,,,percent of total billed charges,75% of total billed charges,1254,75,,,percent of total billed charges,75% of total billed charges,22.19,1621.84,
PF OSTECTOMY COMPLETE 1ST METATARSAL HEAD,78001055P,CDM,975,RC,28111,HCPCS,Outpatient,,,1989,1491.75,,1829.88,92,,,percent of total billed charges,92% of total billed charges,25.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1849.77,93,,,percent of total billed charges,93% of total billed charges,1790.1,90,,,percent of total billed charges,90% of total billed charges,1790.1,90,,,percent of total billed charges,90% of total billed charges,1929.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1929.33,97,,,percent of total billed charges,97% of total billed charges,1491.75,75,,,percent of total billed charges,75% of total billed charges,1909.44,96,,,percent of total billed charges,96% of total billed charges,25.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1491.75,75,,,percent of total billed charges,75% of total billed charges,1491.75,75,,,percent of total billed charges,75% of total billed charges,25.2,1929.33,
PF OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4,78001056P,CDM,975,RC,28112,HCPCS,Outpatient,,,1934,1450.5,,1779.28,92,,,percent of total billed charges,92% of total billed charges,24.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1798.62,93,,,percent of total billed charges,93% of total billed charges,1740.6,90,,,percent of total billed charges,90% of total billed charges,1740.6,90,,,percent of total billed charges,90% of total billed charges,1875.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1875.98,97,,,percent of total billed charges,97% of total billed charges,1450.5,75,,,percent of total billed charges,75% of total billed charges,1856.64,96,,,percent of total billed charges,96% of total billed charges,24.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1450.5,75,,,percent of total billed charges,75% of total billed charges,1450.5,75,,,percent of total billed charges,75% of total billed charges,24.48,1875.98,
PF OSTECTOMY CALCANEUS,78001057P,CDM,975,RC,28118,HCPCS,Outpatient,,,2231,1673.25,,2052.52,92,,,percent of total billed charges,92% of total billed charges,37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2074.83,93,,,percent of total billed charges,93% of total billed charges,2007.9,90,,,percent of total billed charges,90% of total billed charges,2007.9,90,,,percent of total billed charges,90% of total billed charges,2164.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2164.07,97,,,percent of total billed charges,97% of total billed charges,1673.25,75,,,percent of total billed charges,75% of total billed charges,2141.76,96,,,percent of total billed charges,96% of total billed charges,37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1673.25,75,,,percent of total billed charges,75% of total billed charges,1673.25,75,,,percent of total billed charges,75% of total billed charges,37,2164.07,
PF OSTECTOMY CALCANS SPUR W/WO PLNTAR FASCIAL RLS,78001059P,CDM,975,RC,28119,HCPCS,Outpatient,,,2394,1795.5,,2202.48,92,,,percent of total billed charges,92% of total billed charges,28.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2226.42,93,,,percent of total billed charges,93% of total billed charges,2154.6,90,,,percent of total billed charges,90% of total billed charges,2154.6,90,,,percent of total billed charges,90% of total billed charges,2322.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2322.18,97,,,percent of total billed charges,97% of total billed charges,1795.5,75,,,percent of total billed charges,75% of total billed charges,2298.24,96,,,percent of total billed charges,96% of total billed charges,28.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1795.5,75,,,percent of total billed charges,75% of total billed charges,1795.5,75,,,percent of total billed charges,75% of total billed charges,28.18,2322.18,
PF PARTIAL EXCISION BONE TALUS OR CALCANEUS,78002454P,CDM,975,RC,28120,HCPCS,Outpatient,,,1713,1284.75,,1575.96,92,,,percent of total billed charges,92% of total billed charges,43.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1593.09,93,,,percent of total billed charges,93% of total billed charges,1541.7,90,,,percent of total billed charges,90% of total billed charges,1541.7,90,,,percent of total billed charges,90% of total billed charges,1661.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1661.61,97,,,percent of total billed charges,97% of total billed charges,1284.75,75,,,percent of total billed charges,75% of total billed charges,1644.48,96,,,percent of total billed charges,96% of total billed charges,43.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1284.75,75,,,percent of total billed charges,75% of total billed charges,1284.75,75,,,percent of total billed charges,75% of total billed charges,43.32,1661.61,
PF PARTIAL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS,78001060P,CDM,975,RC,28122,HCPCS,Outpatient,,,2453,1839.75,,2256.76,92,,,percent of total billed charges,92% of total billed charges,35.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2281.29,93,,,percent of total billed charges,93% of total billed charges,2207.7,90,,,percent of total billed charges,90% of total billed charges,2207.7,90,,,percent of total billed charges,90% of total billed charges,2379.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,35.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2379.41,97,,,percent of total billed charges,97% of total billed charges,1839.75,75,,,percent of total billed charges,75% of total billed charges,2354.88,96,,,percent of total billed charges,96% of total billed charges,35.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1839.75,75,,,percent of total billed charges,75% of total billed charges,1839.75,75,,,percent of total billed charges,75% of total billed charges,35.11,2379.41,
PF PARTICAL EXCISION BONE PHALANX TOE,78001062P,CDM,975,RC,28124,HCPCS,Outpatient,,,1662,1246.5,,1529.04,92,,,percent of total billed charges,92% of total billed charges,23.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1545.66,93,,,percent of total billed charges,93% of total billed charges,1495.8,90,,,percent of total billed charges,90% of total billed charges,1495.8,90,,,percent of total billed charges,90% of total billed charges,1612.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1612.14,97,,,percent of total billed charges,97% of total billed charges,1246.5,75,,,percent of total billed charges,75% of total billed charges,1595.52,96,,,percent of total billed charges,96% of total billed charges,23.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1246.5,75,,,percent of total billed charges,75% of total billed charges,1246.5,75,,,percent of total billed charges,75% of total billed charges,23.87,1612.14,
PF RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH,78001063P,CDM,975,RC,28126,HCPCS,Outpatient,,,1373,1029.75,,1263.16,92,,,percent of total billed charges,92% of total billed charges,19.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1276.89,93,,,percent of total billed charges,93% of total billed charges,1235.7,90,,,percent of total billed charges,90% of total billed charges,1235.7,90,,,percent of total billed charges,90% of total billed charges,1331.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1331.81,97,,,percent of total billed charges,97% of total billed charges,1029.75,75,,,percent of total billed charges,75% of total billed charges,1318.08,96,,,percent of total billed charges,96% of total billed charges,19.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1029.75,75,,,percent of total billed charges,75% of total billed charges,1029.75,75,,,percent of total billed charges,75% of total billed charges,19.88,1331.81,
PF METATARSECTOMY,78001064P,CDM,975,RC,28140,HCPCS,Outpatient,,,2344,1758,,2156.48,92,,,percent of total billed charges,92% of total billed charges,40.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2179.92,93,,,percent of total billed charges,93% of total billed charges,2109.6,90,,,percent of total billed charges,90% of total billed charges,2109.6,90,,,percent of total billed charges,90% of total billed charges,2273.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2273.68,97,,,percent of total billed charges,97% of total billed charges,1758,75,,,percent of total billed charges,75% of total billed charges,2250.24,96,,,percent of total billed charges,96% of total billed charges,40.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1758,75,,,percent of total billed charges,75% of total billed charges,1758,75,,,percent of total billed charges,75% of total billed charges,40.01,2273.68,
PF PHALANGECTOMY TOE EACH TOE,78001065P,CDM,975,RC,28150,HCPCS,Outpatient,,,1579,1184.25,,1452.68,92,,,percent of total billed charges,92% of total billed charges,21.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1468.47,93,,,percent of total billed charges,93% of total billed charges,1421.1,90,,,percent of total billed charges,90% of total billed charges,1421.1,90,,,percent of total billed charges,90% of total billed charges,1531.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1531.63,97,,,percent of total billed charges,97% of total billed charges,1184.25,75,,,percent of total billed charges,75% of total billed charges,1515.84,96,,,percent of total billed charges,96% of total billed charges,21.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1184.25,75,,,percent of total billed charges,75% of total billed charges,1184.25,75,,,percent of total billed charges,75% of total billed charges,21.14,1531.63,
PF HEMIPHALANGECTOMY INTERPHALANGEAL JOINT EXC TOE,78001066P,CDM,975,RC,28160,HCPCS,Outpatient,,,1476,1107,,1357.92,92,,,percent of total billed charges,92% of total billed charges,19.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1372.68,93,,,percent of total billed charges,93% of total billed charges,1328.4,90,,,percent of total billed charges,90% of total billed charges,1328.4,90,,,percent of total billed charges,90% of total billed charges,1431.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1431.72,97,,,percent of total billed charges,97% of total billed charges,1107,75,,,percent of total billed charges,75% of total billed charges,1416.96,96,,,percent of total billed charges,96% of total billed charges,19.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1107,75,,,percent of total billed charges,75% of total billed charges,1107,75,,,percent of total billed charges,75% of total billed charges,19.36,1431.72,
PF REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,78001067P,CDM,975,RC,28190,HCPCS,Outpatient,,,748,561,,688.16,92,,,percent of total billed charges,92% of total billed charges,10.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,695.64,93,,,percent of total billed charges,93% of total billed charges,673.2,90,,,percent of total billed charges,90% of total billed charges,673.2,90,,,percent of total billed charges,90% of total billed charges,725.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,725.56,97,,,percent of total billed charges,97% of total billed charges,561,75,,,percent of total billed charges,75% of total billed charges,718.08,96,,,percent of total billed charges,96% of total billed charges,10.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,561,75,,,percent of total billed charges,75% of total billed charges,561,75,,,percent of total billed charges,75% of total billed charges,10.03,725.56,
PF REMOVAL FOREIGN BODY FOOT DEEP,78001069P,CDM,975,RC,28192,HCPCS,Outpatient,,,1455,1091.25,,1338.6,92,,,percent of total billed charges,92% of total billed charges,23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1353.15,93,,,percent of total billed charges,93% of total billed charges,1309.5,90,,,percent of total billed charges,90% of total billed charges,1309.5,90,,,percent of total billed charges,90% of total billed charges,1411.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1411.35,97,,,percent of total billed charges,97% of total billed charges,1091.25,75,,,percent of total billed charges,75% of total billed charges,1396.8,96,,,percent of total billed charges,96% of total billed charges,23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1091.25,75,,,percent of total billed charges,75% of total billed charges,1091.25,75,,,percent of total billed charges,75% of total billed charges,23,1411.35,
PF REMOVAL FOREIGN BODY FOOT COMPLICATED,78001072P,CDM,975,RC,28193,HCPCS,Outpatient,,,1416,1062,,1302.72,92,,,percent of total billed charges,92% of total billed charges,26.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1316.88,93,,,percent of total billed charges,93% of total billed charges,1274.4,90,,,percent of total billed charges,90% of total billed charges,1274.4,90,,,percent of total billed charges,90% of total billed charges,1373.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1373.52,97,,,percent of total billed charges,97% of total billed charges,1062,75,,,percent of total billed charges,75% of total billed charges,1359.36,96,,,percent of total billed charges,96% of total billed charges,26.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1062,75,,,percent of total billed charges,75% of total billed charges,1062,75,,,percent of total billed charges,75% of total billed charges,26.81,1373.52,
PF REPAIR TENDON FLEXOR FOOT 1/2 W/O FREE GRFT EA TENDON,78001073P,CDM,975,RC,28200,HCPCS,Outpatient,,,1835,1376.25,,1688.2,92,,,percent of total billed charges,92% of total billed charges,26.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1706.55,93,,,percent of total billed charges,93% of total billed charges,1651.5,90,,,percent of total billed charges,90% of total billed charges,1651.5,90,,,percent of total billed charges,90% of total billed charges,1779.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1779.95,97,,,percent of total billed charges,97% of total billed charges,1376.25,75,,,percent of total billed charges,75% of total billed charges,1761.6,96,,,percent of total billed charges,96% of total billed charges,26.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1376.25,75,,,percent of total billed charges,75% of total billed charges,1376.25,75,,,percent of total billed charges,75% of total billed charges,26.05,1779.95,
PF REPAIR TENDON FLEXOR FOOT SEC W/FREE GRAFT EA TENDON,78001074P,CDM,975,RC,28202,HCPCS,Outpatient,,,2470,1852.5,,2272.4,92,,,percent of total billed charges,92% of total billed charges,33.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2297.1,93,,,percent of total billed charges,93% of total billed charges,2223,90,,,percent of total billed charges,90% of total billed charges,2223,90,,,percent of total billed charges,90% of total billed charges,2395.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2395.9,97,,,percent of total billed charges,97% of total billed charges,1852.5,75,,,percent of total billed charges,75% of total billed charges,2371.2,96,,,percent of total billed charges,96% of total billed charges,33.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1852.5,75,,,percent of total billed charges,75% of total billed charges,1852.5,75,,,percent of total billed charges,75% of total billed charges,33.61,2395.9,
PF REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,78001076P,CDM,975,RC,28208,HCPCS,Outpatient,,,1419,1064.25,,1305.48,92,,,percent of total billed charges,92% of total billed charges,25.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1319.67,93,,,percent of total billed charges,93% of total billed charges,1277.1,90,,,percent of total billed charges,90% of total billed charges,1277.1,90,,,percent of total billed charges,90% of total billed charges,1376.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1376.43,97,,,percent of total billed charges,97% of total billed charges,1064.25,75,,,percent of total billed charges,75% of total billed charges,1362.24,96,,,percent of total billed charges,96% of total billed charges,25.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1064.25,75,,,percent of total billed charges,75% of total billed charges,1064.25,75,,,percent of total billed charges,75% of total billed charges,25.87,1376.43,
PF CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT,78001077P,CDM,975,RC,28270,HCPCS,Outpatient,,,1565,1173.75,,1439.8,92,,,percent of total billed charges,92% of total billed charges,24.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1455.45,93,,,percent of total billed charges,93% of total billed charges,1408.5,90,,,percent of total billed charges,90% of total billed charges,1408.5,90,,,percent of total billed charges,90% of total billed charges,1518.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1518.05,97,,,percent of total billed charges,97% of total billed charges,1173.75,75,,,percent of total billed charges,75% of total billed charges,1502.4,96,,,percent of total billed charges,96% of total billed charges,24.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1173.75,75,,,percent of total billed charges,75% of total billed charges,1173.75,75,,,percent of total billed charges,75% of total billed charges,24.95,1518.05,
PF CORRECTION HAMMERTOE,78001078P,CDM,975,RC,28285,HCPCS,Outpatient,,,1693,1269.75,,1557.56,92,,,percent of total billed charges,92% of total billed charges,29.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1574.49,93,,,percent of total billed charges,93% of total billed charges,1523.7,90,,,percent of total billed charges,90% of total billed charges,1523.7,90,,,percent of total billed charges,90% of total billed charges,1642.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1642.21,97,,,percent of total billed charges,97% of total billed charges,1269.75,75,,,percent of total billed charges,75% of total billed charges,1625.28,96,,,percent of total billed charges,96% of total billed charges,29.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1269.75,75,,,percent of total billed charges,75% of total billed charges,1269.75,75,,,percent of total billed charges,75% of total billed charges,29.5,1642.21,
PF CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE,78001079P,CDM,975,RC,28286,HCPCS,Outpatient,,,1663,1247.25,,1529.96,92,,,percent of total billed charges,92% of total billed charges,21.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1546.59,93,,,percent of total billed charges,93% of total billed charges,1496.7,90,,,percent of total billed charges,90% of total billed charges,1496.7,90,,,percent of total billed charges,90% of total billed charges,1613.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1613.11,97,,,percent of total billed charges,97% of total billed charges,1247.25,75,,,percent of total billed charges,75% of total billed charges,1596.48,96,,,percent of total billed charges,96% of total billed charges,21.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1247.25,75,,,percent of total billed charges,75% of total billed charges,1247.25,75,,,percent of total billed charges,75% of total billed charges,21.23,1613.11,
PF OSTECTOMY PARTIAL EXOST/CONDYLECTOMY METAR HEAD,78001080P,CDM,975,RC,28288,HCPCS,Outpatient,,,2172,1629,,1998.24,92,,,percent of total billed charges,92% of total billed charges,33.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2019.96,93,,,percent of total billed charges,93% of total billed charges,1954.8,90,,,percent of total billed charges,90% of total billed charges,1954.8,90,,,percent of total billed charges,90% of total billed charges,2106.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2106.84,97,,,percent of total billed charges,97% of total billed charges,1629,75,,,percent of total billed charges,75% of total billed charges,2085.12,96,,,percent of total billed charges,96% of total billed charges,33.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1629,75,,,percent of total billed charges,75% of total billed charges,1629,75,,,percent of total billed charges,75% of total billed charges,33.1,2106.84,
PF HALLUX RIGIDUS CORRECT W/CHEILECTOMY 1ST MP JT,78001081P,CDM,975,RC,28289,HCPCS,Outpatient,,,2693,2019.75,,2477.56,92,,,percent of total billed charges,92% of total billed charges,37.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2504.49,93,,,percent of total billed charges,93% of total billed charges,2423.7,90,,,percent of total billed charges,90% of total billed charges,2423.7,90,,,percent of total billed charges,90% of total billed charges,2612.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2612.21,97,,,percent of total billed charges,97% of total billed charges,2019.75,75,,,percent of total billed charges,75% of total billed charges,2585.28,96,,,percent of total billed charges,96% of total billed charges,37.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2019.75,75,,,percent of total billed charges,75% of total billed charges,2019.75,75,,,percent of total billed charges,75% of total billed charges,37.79,2612.21,
PF KELLER/MCBRIDE/MAYO PROCEDURE,78001083P,CDM,975,RC,28292,HCPCS,Outpatient,,,3438,2578.5,,3162.96,92,,,percent of total billed charges,92% of total billed charges,37.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3197.34,93,,,percent of total billed charges,93% of total billed charges,3094.2,90,,,percent of total billed charges,90% of total billed charges,3094.2,90,,,percent of total billed charges,90% of total billed charges,3334.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3334.86,97,,,percent of total billed charges,97% of total billed charges,2578.5,75,,,percent of total billed charges,75% of total billed charges,3300.48,96,,,percent of total billed charges,96% of total billed charges,37.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2578.5,75,,,percent of total billed charges,75% of total billed charges,2578.5,75,,,percent of total billed charges,75% of total billed charges,37.01,3334.86,
PF CORRJ HALLUX VALGUS W/WO SESMDC W/METAR OSTEOT,78001085P,CDM,975,RC,28296,HCPCS,Outpatient,,,3803,2852.25,,3498.76,92,,,percent of total billed charges,92% of total billed charges,38.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3536.79,93,,,percent of total billed charges,93% of total billed charges,3422.7,90,,,percent of total billed charges,90% of total billed charges,3422.7,90,,,percent of total billed charges,90% of total billed charges,3688.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,38.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3688.91,97,,,percent of total billed charges,97% of total billed charges,2852.25,75,,,percent of total billed charges,75% of total billed charges,3650.88,96,,,percent of total billed charges,96% of total billed charges,38.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2852.25,75,,,percent of total billed charges,75% of total billed charges,2852.25,75,,,percent of total billed charges,75% of total billed charges,38.76,3688.91,
PF CORRJ HALLUX VALGUS W/WO SESMDC PHALANX OSTEOT,78001087P,CDM,975,RC,28298,HCPCS,Outpatient,,,3067,2300.25,,2821.64,92,,,percent of total billed charges,92% of total billed charges,43.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2852.31,93,,,percent of total billed charges,93% of total billed charges,2760.3,90,,,percent of total billed charges,90% of total billed charges,2760.3,90,,,percent of total billed charges,90% of total billed charges,2974.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2974.99,97,,,percent of total billed charges,97% of total billed charges,2300.25,75,,,percent of total billed charges,75% of total billed charges,2944.32,96,,,percent of total billed charges,96% of total billed charges,43.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2300.25,75,,,percent of total billed charges,75% of total billed charges,2300.25,75,,,percent of total billed charges,75% of total billed charges,43.2,2974.99,
PF CORRJ HALLUX VALGUS W/WO SESMDC 2 OSTEOT,78001089P,CDM,975,RC,28299,HCPCS,Outpatient,,,4290,3217.5,,3946.8,92,,,percent of total billed charges,92% of total billed charges,50.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3989.7,93,,,percent of total billed charges,93% of total billed charges,3861,90,,,percent of total billed charges,90% of total billed charges,3861,90,,,percent of total billed charges,90% of total billed charges,4161.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4161.3,97,,,percent of total billed charges,97% of total billed charges,3217.5,75,,,percent of total billed charges,75% of total billed charges,4118.4,96,,,percent of total billed charges,96% of total billed charges,50.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3217.5,75,,,percent of total billed charges,75% of total billed charges,3217.5,75,,,percent of total billed charges,75% of total billed charges,50.02,4161.3,
PF OSTEOTOMY,78002455P,CDM,975,RC,28302,HCPCS,Outpatient,,,1817,1362.75,,1671.64,92,,,percent of total billed charges,92% of total billed charges,79.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1689.81,93,,,percent of total billed charges,93% of total billed charges,1635.3,90,,,percent of total billed charges,90% of total billed charges,1635.3,90,,,percent of total billed charges,90% of total billed charges,1762.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,79.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1762.49,97,,,percent of total billed charges,97% of total billed charges,1362.75,75,,,percent of total billed charges,75% of total billed charges,1744.32,96,,,percent of total billed charges,96% of total billed charges,79.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1362.75,75,,,percent of total billed charges,75% of total billed charges,1362.75,75,,,percent of total billed charges,75% of total billed charges,79.6,1762.49,
PF OSTEOTOMY SHORTENING CORRECT PROX PHALANX 1ST TOE,78001091P,CDM,975,RC,28310,HCPCS,Outpatient,,,3256,2442,,2995.52,92,,,percent of total billed charges,92% of total billed charges,29.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3028.08,93,,,percent of total billed charges,93% of total billed charges,2930.4,90,,,percent of total billed charges,90% of total billed charges,2930.4,90,,,percent of total billed charges,90% of total billed charges,3158.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3158.32,97,,,percent of total billed charges,97% of total billed charges,2442,75,,,percent of total billed charges,75% of total billed charges,3125.76,96,,,percent of total billed charges,96% of total billed charges,29.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2442,75,,,percent of total billed charges,75% of total billed charges,2442,75,,,percent of total billed charges,75% of total billed charges,29.78,3158.32,
PF OSTEOTOMY SHORTEN SHORTEN ANGULAR OR ROTATION CORRECT,78001092P,CDM,975,RC,28312,HCPCS,Outpatient,,,1597,1197.75,,1469.24,92,,,percent of total billed charges,92% of total billed charges,28.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1485.21,93,,,percent of total billed charges,93% of total billed charges,1437.3,90,,,percent of total billed charges,90% of total billed charges,1437.3,90,,,percent of total billed charges,90% of total billed charges,1549.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1549.09,97,,,percent of total billed charges,97% of total billed charges,1197.75,75,,,percent of total billed charges,75% of total billed charges,1533.12,96,,,percent of total billed charges,96% of total billed charges,28.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1197.75,75,,,percent of total billed charges,75% of total billed charges,1197.75,75,,,percent of total billed charges,75% of total billed charges,28.88,1549.09,
PF REPAIR NON/MALUNION METARSAL W/WO BONE GRAFT,78001093P,CDM,975,RC,28322,HCPCS,Outpatient,,,2961,2220.75,,2724.12,92,,,percent of total billed charges,92% of total billed charges,55.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2753.73,93,,,percent of total billed charges,93% of total billed charges,2664.9,90,,,percent of total billed charges,90% of total billed charges,2664.9,90,,,percent of total billed charges,90% of total billed charges,2872.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,55.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2872.17,97,,,percent of total billed charges,97% of total billed charges,2220.75,75,,,percent of total billed charges,75% of total billed charges,2842.56,96,,,percent of total billed charges,96% of total billed charges,55.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2220.75,75,,,percent of total billed charges,75% of total billed charges,2220.75,75,,,percent of total billed charges,75% of total billed charges,55.71,2872.17,
PF CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION,78001095P,CDM,975,RC,28400,HCPCS,Outpatient,,,1080,810,,993.6,92,,,percent of total billed charges,92% of total billed charges,17.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1004.4,93,,,percent of total billed charges,93% of total billed charges,972,90,,,percent of total billed charges,90% of total billed charges,972,90,,,percent of total billed charges,90% of total billed charges,1047.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1047.6,97,,,percent of total billed charges,97% of total billed charges,810,75,,,percent of total billed charges,75% of total billed charges,1036.8,96,,,percent of total billed charges,96% of total billed charges,17.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,810,75,,,percent of total billed charges,75% of total billed charges,810,75,,,percent of total billed charges,75% of total billed charges,17.99,1047.6,
PF PERCUT SKELETAL FIXATION OF CALCANEAL FX W/MANIP,78002883P,CDM,975,RC,28406,HCPCS,Outpatient,,,1139,854.25,,1047.88,92,,,percent of total billed charges,92% of total billed charges,57.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1059.27,93,,,percent of total billed charges,93% of total billed charges,1025.1,90,,,percent of total billed charges,90% of total billed charges,1025.1,90,,,percent of total billed charges,90% of total billed charges,1104.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,57.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1104.83,97,,,percent of total billed charges,97% of total billed charges,854.25,75,,,percent of total billed charges,75% of total billed charges,1093.44,96,,,percent of total billed charges,96% of total billed charges,57.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,854.25,75,,,percent of total billed charges,75% of total billed charges,854.25,75,,,percent of total billed charges,75% of total billed charges,57.42,1104.83,
PF OPEN TX CALCANEAL FRACTURE,78001097P,CDM,975,RC,28415,HCPCS,Outpatient,,,5083,3812.25,,4676.36,92,,,percent of total billed charges,92% of total billed charges,111.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4727.19,93,,,percent of total billed charges,93% of total billed charges,4574.7,90,,,percent of total billed charges,90% of total billed charges,4574.7,90,,,percent of total billed charges,90% of total billed charges,4930.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,111.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4930.51,97,,,percent of total billed charges,97% of total billed charges,3812.25,75,,,percent of total billed charges,75% of total billed charges,4879.68,96,,,percent of total billed charges,96% of total billed charges,111.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3812.25,75,,,percent of total billed charges,75% of total billed charges,3812.25,75,,,percent of total billed charges,75% of total billed charges,111.68,4930.51,
PF CLOSED TX TALUS FRACTURE W/O MANIPULATION,78001099P,CDM,975,RC,28430,HCPCS,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges,17.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,337.59,93,,,percent of total billed charges,93% of total billed charges,326.7,90,,,percent of total billed charges,90% of total billed charges,326.7,90,,,percent of total billed charges,90% of total billed charges,352.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.11,97,,,percent of total billed charges,97% of total billed charges,272.25,75,,,percent of total billed charges,75% of total billed charges,348.48,96,,,percent of total billed charges,96% of total billed charges,17.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,272.25,75,,,percent of total billed charges,75% of total billed charges,272.25,75,,,percent of total billed charges,75% of total billed charges,17.3,352.11,
PF CLOSED TX TALUS FRACTURE W/MANIPULATION,78001101P,CDM,975,RC,28435,HCPCS,Outpatient,,,1419,1064.25,,1305.48,92,,,percent of total billed charges,92% of total billed charges,31.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1319.67,93,,,percent of total billed charges,93% of total billed charges,1277.1,90,,,percent of total billed charges,90% of total billed charges,1277.1,90,,,percent of total billed charges,90% of total billed charges,1376.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,31.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1376.43,97,,,percent of total billed charges,97% of total billed charges,1064.25,75,,,percent of total billed charges,75% of total billed charges,1362.24,96,,,percent of total billed charges,96% of total billed charges,31.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1064.25,75,,,percent of total billed charges,75% of total billed charges,1064.25,75,,,percent of total billed charges,75% of total billed charges,31.54,1376.43,
PF OPEN TX TALUS FRACTURE,78001103P,CDM,975,RC,28445,HCPCS,Outpatient,,,4642,3481.5,,4270.64,92,,,percent of total billed charges,92% of total billed charges,110,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4317.06,93,,,percent of total billed charges,93% of total billed charges,4177.8,90,,,percent of total billed charges,90% of total billed charges,4177.8,90,,,percent of total billed charges,90% of total billed charges,4502.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,110,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4502.74,97,,,percent of total billed charges,97% of total billed charges,3481.5,75,,,percent of total billed charges,75% of total billed charges,4456.32,96,,,percent of total billed charges,96% of total billed charges,110,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3481.5,75,,,percent of total billed charges,75% of total billed charges,3481.5,75,,,percent of total billed charges,75% of total billed charges,110,4502.74,
PF TX TARSAL BONE FX EXCEPT  TALUS  and  CALCN W/O MANIP,78001105P,CDM,975,RC,28450,HCPCS,Outpatient,,,936,702,,861.12,92,,,percent of total billed charges,92% of total billed charges,14.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,870.48,93,,,percent of total billed charges,93% of total billed charges,842.4,90,,,percent of total billed charges,90% of total billed charges,842.4,90,,,percent of total billed charges,90% of total billed charges,907.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,907.92,97,,,percent of total billed charges,97% of total billed charges,702,75,,,percent of total billed charges,75% of total billed charges,898.56,96,,,percent of total billed charges,96% of total billed charges,14.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,702,75,,,percent of total billed charges,75% of total billed charges,702,75,,,percent of total billed charges,75% of total billed charges,14.16,907.92,
PF CLOSED TX METATARSAL FRACTURE W/O MANIPULATION,78001106P,CDM,975,RC,28470,HCPCS,Outpatient,,,801,600.75,,736.92,92,,,percent of total billed charges,92% of total billed charges,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,744.93,93,,,percent of total billed charges,93% of total billed charges,720.9,90,,,percent of total billed charges,90% of total billed charges,720.9,90,,,percent of total billed charges,90% of total billed charges,776.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,776.97,97,,,percent of total billed charges,97% of total billed charges,600.75,75,,,percent of total billed charges,75% of total billed charges,768.96,96,,,percent of total billed charges,96% of total billed charges,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,600.75,75,,,percent of total billed charges,75% of total billed charges,600.75,75,,,percent of total billed charges,75% of total billed charges,15.21,776.97,
PF CLOSED TX METATARSAL FX W/MANIP,78001108P,CDM,975,RC,28475,HCPCS,Outpatient,,,893,669.75,,821.56,92,,,percent of total billed charges,92% of total billed charges,18.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,830.49,93,,,percent of total billed charges,93% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,866.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,866.21,97,,,percent of total billed charges,97% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,857.28,96,,,percent of total billed charges,96% of total billed charges,18.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,669.75,75,,,percent of total billed charges,75% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,18.18,866.21,
PF PRQ SKEL FIXJ METAR FX W/MANJ,78001110P,CDM,975,RC,28476,HCPCS,Outpatient,,,1626,1219.5,,1495.92,92,,,percent of total billed charges,92% of total billed charges,28.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1512.18,93,,,percent of total billed charges,93% of total billed charges,1463.4,90,,,percent of total billed charges,90% of total billed charges,1463.4,90,,,percent of total billed charges,90% of total billed charges,1577.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1577.22,97,,,percent of total billed charges,97% of total billed charges,1219.5,75,,,percent of total billed charges,75% of total billed charges,1560.96,96,,,percent of total billed charges,96% of total billed charges,28.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1219.5,75,,,percent of total billed charges,75% of total billed charges,1219.5,75,,,percent of total billed charges,75% of total billed charges,28.55,1577.22,
PF OPEN TX METATARSAL FRACTURE EACH,78001111P,CDM,975,RC,28485,HCPCS,Outpatient,,,2549,1911.75,,2345.08,92,,,percent of total billed charges,92% of total billed charges,46.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2370.57,93,,,percent of total billed charges,93% of total billed charges,2294.1,90,,,percent of total billed charges,90% of total billed charges,2294.1,90,,,percent of total billed charges,90% of total billed charges,2472.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2472.53,97,,,percent of total billed charges,97% of total billed charges,1911.75,75,,,percent of total billed charges,75% of total billed charges,2447.04,96,,,percent of total billed charges,96% of total billed charges,46.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1911.75,75,,,percent of total billed charges,75% of total billed charges,1911.75,75,,,percent of total billed charges,75% of total billed charges,46.31,2472.53,
PF CLOSED TX FX GREAT TOE PHLX/PHLG W/O MANIP,78001112P,CDM,975,RC,28490,HCPCS,Outpatient,,,553,414.75,,508.76,92,,,percent of total billed charges,92% of total billed charges,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,514.29,93,,,percent of total billed charges,93% of total billed charges,497.7,90,,,percent of total billed charges,90% of total billed charges,497.7,90,,,percent of total billed charges,90% of total billed charges,536.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.41,97,,,percent of total billed charges,97% of total billed charges,414.75,75,,,percent of total billed charges,75% of total billed charges,530.88,96,,,percent of total billed charges,96% of total billed charges,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,414.75,75,,,percent of total billed charges,75% of total billed charges,414.75,75,,,percent of total billed charges,75% of total billed charges,8.79,536.41,
PF CLOSED TX FX GREAT TOE PHLX/PHLG W/MANIP,78001114P,CDM,975,RC,28495,HCPCS,Outpatient,,,582,436.5,,535.44,92,,,percent of total billed charges,92% of total billed charges,10.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,541.26,93,,,percent of total billed charges,93% of total billed charges,523.8,90,,,percent of total billed charges,90% of total billed charges,523.8,90,,,percent of total billed charges,90% of total billed charges,564.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564.54,97,,,percent of total billed charges,97% of total billed charges,436.5,75,,,percent of total billed charges,75% of total billed charges,558.72,96,,,percent of total billed charges,96% of total billed charges,10.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,436.5,75,,,percent of total billed charges,75% of total billed charges,436.5,75,,,percent of total billed charges,75% of total billed charges,10.47,564.54,
PF PERQ SKELETAL FIX FX GREATER TOE PHLX/PHLG W/MANIP,78001116P,CDM,975,RC,28496,HCPCS,Outpatient,,,1670,1252.5,,1536.4,92,,,percent of total billed charges,92% of total billed charges,23.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1553.1,93,,,percent of total billed charges,93% of total billed charges,1503,90,,,percent of total billed charges,90% of total billed charges,1503,90,,,percent of total billed charges,90% of total billed charges,1619.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1619.9,97,,,percent of total billed charges,97% of total billed charges,1252.5,75,,,percent of total billed charges,75% of total billed charges,1603.2,96,,,percent of total billed charges,96% of total billed charges,23.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1252.5,75,,,percent of total billed charges,75% of total billed charges,1252.5,75,,,percent of total billed charges,75% of total billed charges,23.26,1619.9,
PF OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES,78001117P,CDM,975,RC,28505,HCPCS,Outpatient,,,2044,1533,,1880.48,92,,,percent of total billed charges,92% of total billed charges,42.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1900.92,93,,,percent of total billed charges,93% of total billed charges,1839.6,90,,,percent of total billed charges,90% of total billed charges,1839.6,90,,,percent of total billed charges,90% of total billed charges,1982.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,42.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1982.68,97,,,percent of total billed charges,97% of total billed charges,1533,75,,,percent of total billed charges,75% of total billed charges,1962.24,96,,,percent of total billed charges,96% of total billed charges,42.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1533,75,,,percent of total billed charges,75% of total billed charges,1533,75,,,percent of total billed charges,75% of total billed charges,42.28,1982.68,
PF CLOSED TX FX PHALANX OR PHALANGES NOT GREAT TOE W/O MANIP,78001118P,CDM,975,RC,28510,HCPCS,Outpatient,,,467,350.25,,429.64,92,,,percent of total billed charges,92% of total billed charges,8.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,434.31,93,,,percent of total billed charges,93% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,452.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,452.99,97,,,percent of total billed charges,97% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,448.32,96,,,percent of total billed charges,96% of total billed charges,8.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,350.25,75,,,percent of total billed charges,75% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,8.11,452.99,
PF CLOSED TX FX PHALANX/PHALANGES NOT GREAT TOE W/MANIP,78001120P,CDM,975,RC,28515,HCPCS,Outpatient,,,559,419.25,,514.28,92,,,percent of total billed charges,92% of total billed charges,9.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,519.87,93,,,percent of total billed charges,93% of total billed charges,503.1,90,,,percent of total billed charges,90% of total billed charges,503.1,90,,,percent of total billed charges,90% of total billed charges,542.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,542.23,97,,,percent of total billed charges,97% of total billed charges,419.25,75,,,percent of total billed charges,75% of total billed charges,536.64,96,,,percent of total billed charges,96% of total billed charges,9.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,419.25,75,,,percent of total billed charges,75% of total billed charges,419.25,75,,,percent of total billed charges,75% of total billed charges,9.73,542.23,
PF OPEN TX FRACTRE PHALANX/PHALANGES NOT GREAT TOE,78001122P,CDM,975,RC,28525,HCPCS,Outpatient,,,1076,807,,989.92,92,,,percent of total billed charges,92% of total billed charges,32.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1000.68,93,,,percent of total billed charges,93% of total billed charges,968.4,90,,,percent of total billed charges,90% of total billed charges,968.4,90,,,percent of total billed charges,90% of total billed charges,1043.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1043.72,97,,,percent of total billed charges,97% of total billed charges,807,75,,,percent of total billed charges,75% of total billed charges,1032.96,96,,,percent of total billed charges,96% of total billed charges,32.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,807,75,,,percent of total billed charges,75% of total billed charges,807,75,,,percent of total billed charges,75% of total billed charges,32.97,1043.72,
PF CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES,78001123P,CDM,975,RC,28540,HCPCS,Outpatient,,,702,526.5,,645.84,92,,,percent of total billed charges,92% of total billed charges,10.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,652.86,93,,,percent of total billed charges,93% of total billed charges,631.8,90,,,percent of total billed charges,90% of total billed charges,631.8,90,,,percent of total billed charges,90% of total billed charges,680.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,680.94,97,,,percent of total billed charges,97% of total billed charges,526.5,75,,,percent of total billed charges,75% of total billed charges,673.92,96,,,percent of total billed charges,96% of total billed charges,10.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,526.5,75,,,percent of total billed charges,75% of total billed charges,526.5,75,,,percent of total billed charges,75% of total billed charges,10.86,680.94,
PF CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES,78001125P,CDM,975,RC,28575,HCPCS,Outpatient,,,1221,915.75,,1123.32,92,,,percent of total billed charges,92% of total billed charges,31.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1135.53,93,,,percent of total billed charges,93% of total billed charges,1098.9,90,,,percent of total billed charges,90% of total billed charges,1098.9,90,,,percent of total billed charges,90% of total billed charges,1184.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,31.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1184.37,97,,,percent of total billed charges,97% of total billed charges,915.75,75,,,percent of total billed charges,75% of total billed charges,1172.16,96,,,percent of total billed charges,96% of total billed charges,31.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,915.75,75,,,percent of total billed charges,75% of total billed charges,915.75,75,,,percent of total billed charges,75% of total billed charges,31.66,1184.37,
PF CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES,78001127P,CDM,975,RC,28600,HCPCS,Outpatient,,,786,589.5,,723.12,92,,,percent of total billed charges,92% of total billed charges,10.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,730.98,93,,,percent of total billed charges,93% of total billed charges,707.4,90,,,percent of total billed charges,90% of total billed charges,707.4,90,,,percent of total billed charges,90% of total billed charges,762.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,762.42,97,,,percent of total billed charges,97% of total billed charges,589.5,75,,,percent of total billed charges,75% of total billed charges,754.56,96,,,percent of total billed charges,96% of total billed charges,10.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,589.5,75,,,percent of total billed charges,75% of total billed charges,589.5,75,,,percent of total billed charges,75% of total billed charges,10.03,762.42,
PF PERCUTANEOUS SKELTAL FX TARSOMETATARSAL JOINT W/MANIP,78001129P,CDM,975,RC,28606,HCPCS,Outpatient,,,5922,4441.5,,5448.24,92,,,percent of total billed charges,92% of total billed charges,37.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5507.46,93,,,percent of total billed charges,93% of total billed charges,5329.8,90,,,percent of total billed charges,90% of total billed charges,5329.8,90,,,percent of total billed charges,90% of total billed charges,5744.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5744.34,97,,,percent of total billed charges,97% of total billed charges,4441.5,75,,,percent of total billed charges,75% of total billed charges,5685.12,96,,,percent of total billed charges,96% of total billed charges,37.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4441.5,75,,,percent of total billed charges,75% of total billed charges,4441.5,75,,,percent of total billed charges,75% of total billed charges,37.95,5744.34,
PF OPEN TX TARSOMETATARSAL JOINT DISLOCATION,78001130P,CDM,975,RC,28615,HCPCS,Outpatient,,,3000,2250,,2760,92,,,percent of total billed charges,92% of total billed charges,76.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2790,93,,,percent of total billed charges,93% of total billed charges,2700,90,,,percent of total billed charges,90% of total billed charges,2700,90,,,percent of total billed charges,90% of total billed charges,2910,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2910,97,,,percent of total billed charges,97% of total billed charges,2250,75,,,percent of total billed charges,75% of total billed charges,2880,96,,,percent of total billed charges,96% of total billed charges,76.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2250,75,,,percent of total billed charges,75% of total billed charges,2250,75,,,percent of total billed charges,75% of total billed charges,76.95,2910,
PF CLTX METATARSOPHLNGL JT DISLC W/O ANES,78001132P,CDM,975,RC,28630,HCPCS,Outpatient,,,351,263.25,,322.92,92,,,percent of total billed charges,92% of total billed charges,11.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,326.43,93,,,percent of total billed charges,93% of total billed charges,315.9,90,,,percent of total billed charges,90% of total billed charges,315.9,90,,,percent of total billed charges,90% of total billed charges,340.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,340.47,97,,,percent of total billed charges,97% of total billed charges,263.25,75,,,percent of total billed charges,75% of total billed charges,336.96,96,,,percent of total billed charges,96% of total billed charges,11.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,263.25,75,,,percent of total billed charges,75% of total billed charges,263.25,75,,,percent of total billed charges,75% of total billed charges,11.2,340.47,
PF CLOSED TX METATARSOPHLNGL JT DISLC REQ ANESTH,78001134P,CDM,975,RC,28635,HCPCS,Outpatient,,,521,390.75,,479.32,92,,,percent of total billed charges,92% of total billed charges,10.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,484.53,93,,,percent of total billed charges,93% of total billed charges,468.9,90,,,percent of total billed charges,90% of total billed charges,468.9,90,,,percent of total billed charges,90% of total billed charges,505.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,505.37,97,,,percent of total billed charges,97% of total billed charges,390.75,75,,,percent of total billed charges,75% of total billed charges,500.16,96,,,percent of total billed charges,96% of total billed charges,10.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,390.75,75,,,percent of total billed charges,75% of total billed charges,390.75,75,,,percent of total billed charges,75% of total billed charges,10.26,505.37,
PF CLOSED TX INTERPHALANGEAL JOINT DISLOCATION REQ ANES,78001136P,CDM,975,RC,28665,HCPCS,Outpatient,,,509,381.75,,468.28,92,,,percent of total billed charges,92% of total billed charges,9.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,473.37,93,,,percent of total billed charges,93% of total billed charges,458.1,90,,,percent of total billed charges,90% of total billed charges,458.1,90,,,percent of total billed charges,90% of total billed charges,493.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,493.73,97,,,percent of total billed charges,97% of total billed charges,381.75,75,,,percent of total billed charges,75% of total billed charges,488.64,96,,,percent of total billed charges,96% of total billed charges,9.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,381.75,75,,,percent of total billed charges,75% of total billed charges,381.75,75,,,percent of total billed charges,75% of total billed charges,9.57,493.73,
PF ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT,78001138P,CDM,975,RC,28740,HCPCS,Outpatient,,,2167,1625.25,,1993.64,92,,,percent of total billed charges,92% of total billed charges,55.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2015.31,93,,,percent of total billed charges,93% of total billed charges,1950.3,90,,,percent of total billed charges,90% of total billed charges,1950.3,90,,,percent of total billed charges,90% of total billed charges,2101.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,55.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2101.99,97,,,percent of total billed charges,97% of total billed charges,1625.25,75,,,percent of total billed charges,75% of total billed charges,2080.32,96,,,percent of total billed charges,96% of total billed charges,55.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1625.25,75,,,percent of total billed charges,75% of total billed charges,1625.25,75,,,percent of total billed charges,75% of total billed charges,55.91,2101.99,
PF ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT,78001140P,CDM,975,RC,28755,HCPCS,Outpatient,,,5009,3756.75,,4608.28,92,,,percent of total billed charges,92% of total billed charges,27.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4658.37,93,,,percent of total billed charges,93% of total billed charges,4508.1,90,,,percent of total billed charges,90% of total billed charges,4508.1,90,,,percent of total billed charges,90% of total billed charges,4858.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4858.73,97,,,percent of total billed charges,97% of total billed charges,3756.75,75,,,percent of total billed charges,75% of total billed charges,4808.64,96,,,percent of total billed charges,96% of total billed charges,27.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3756.75,75,,,percent of total billed charges,75% of total billed charges,3756.75,75,,,percent of total billed charges,75% of total billed charges,27.14,4858.73,
PF AMPUTATION FOOT MIDTARSAL,78001141P,CDM,975,RC,28800,HCPCS,Outpatient,,,2960,2220,,2723.2,92,,,percent of total billed charges,92% of total billed charges,45.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2752.8,93,,,percent of total billed charges,93% of total billed charges,2664,90,,,percent of total billed charges,90% of total billed charges,2664,90,,,percent of total billed charges,90% of total billed charges,2871.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2871.2,97,,,percent of total billed charges,97% of total billed charges,2220,75,,,percent of total billed charges,75% of total billed charges,2841.6,96,,,percent of total billed charges,96% of total billed charges,45.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2220,75,,,percent of total billed charges,75% of total billed charges,2220,75,,,percent of total billed charges,75% of total billed charges,45.13,2871.2,
PF AMPUTATION METATARSAL W/TOE SINGLE,78001143P,CDM,975,RC,28810,HCPCS,Outpatient,,,2149,1611.75,,1977.08,92,,,percent of total billed charges,92% of total billed charges,41.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1998.57,93,,,percent of total billed charges,93% of total billed charges,1934.1,90,,,percent of total billed charges,90% of total billed charges,1934.1,90,,,percent of total billed charges,90% of total billed charges,2084.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2084.53,97,,,percent of total billed charges,97% of total billed charges,1611.75,75,,,percent of total billed charges,75% of total billed charges,2063.04,96,,,percent of total billed charges,96% of total billed charges,41.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1611.75,75,,,percent of total billed charges,75% of total billed charges,1611.75,75,,,percent of total billed charges,75% of total billed charges,41.52,2084.53,
PF AMPUTATION TOE METATARSOPHALANGEAL JOINT,78001144P,CDM,975,RC,28820,HCPCS,Outpatient,,,5009,3756.75,,4608.28,92,,,percent of total billed charges,92% of total billed charges,17.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4658.37,93,,,percent of total billed charges,93% of total billed charges,4508.1,90,,,percent of total billed charges,90% of total billed charges,4508.1,90,,,percent of total billed charges,90% of total billed charges,4858.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4858.73,97,,,percent of total billed charges,97% of total billed charges,3756.75,75,,,percent of total billed charges,75% of total billed charges,4808.64,96,,,percent of total billed charges,96% of total billed charges,17.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3756.75,75,,,percent of total billed charges,75% of total billed charges,3756.75,75,,,percent of total billed charges,75% of total billed charges,17.22,4858.73,
PF AMPUTATION TOE INTERPHALANGEAL JOINT,78001145P,CDM,975,RC,28825,HCPCS,Outpatient,,,5009,3756.75,,4608.28,92,,,percent of total billed charges,92% of total billed charges,16.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4658.37,93,,,percent of total billed charges,93% of total billed charges,4508.1,90,,,percent of total billed charges,90% of total billed charges,4508.1,90,,,percent of total billed charges,90% of total billed charges,4858.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4858.73,97,,,percent of total billed charges,97% of total billed charges,3756.75,75,,,percent of total billed charges,75% of total billed charges,4808.64,96,,,percent of total billed charges,96% of total billed charges,16.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3756.75,75,,,percent of total billed charges,75% of total billed charges,3756.75,75,,,percent of total billed charges,75% of total billed charges,16.8,4858.73,
PF UNLISTED PROCEDURE FOOT/TOES,78001146P,CDM,975,RC,28899,HCPCS,Outpatient,,,2789,2091.75,,2565.88,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,2593.77,93,,,percent of total billed charges,93% of total billed charges,2510.1,90,,,percent of total billed charges,90% of total billed charges,2510.1,90,,,percent of total billed charges,90% of total billed charges,2705.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2705.33,97,,,percent of total billed charges,97% of total billed charges,2091.75,75,,,percent of total billed charges,75% of total billed charges,2677.44,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,2091.75,75,,,percent of total billed charges,75% of total billed charges,2091.75,75,,,percent of total billed charges,75% of total billed charges,2091.75,2705.33,
PF APPLICATION CAST SHOULDER HAND LONG ARM,78001148P,CDM,975,RC,29065,HCPCS,Outpatient,,,266,199.5,,244.72,92,,,percent of total billed charges,92% of total billed charges,6.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,247.38,93,,,percent of total billed charges,93% of total billed charges,239.4,90,,,percent of total billed charges,90% of total billed charges,239.4,90,,,percent of total billed charges,90% of total billed charges,258.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,258.02,97,,,percent of total billed charges,97% of total billed charges,199.5,75,,,percent of total billed charges,75% of total billed charges,255.36,96,,,percent of total billed charges,96% of total billed charges,6.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,199.5,75,,,percent of total billed charges,75% of total billed charges,199.5,75,,,percent of total billed charges,75% of total billed charges,6.98,258.02,
PF APPLICATION OF CAST ELBOW TO FINGER (SHORT ARM),78001150P,CDM,975,RC,29075,HCPCS,Outpatient,,,240,180,,220.8,92,,,percent of total billed charges,92% of total billed charges,6.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.2,93,,,percent of total billed charges,93% of total billed charges,216,90,,,percent of total billed charges,90% of total billed charges,216,90,,,percent of total billed charges,90% of total billed charges,232.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,232.8,97,,,percent of total billed charges,97% of total billed charges,180,75,,,percent of total billed charges,75% of total billed charges,230.4,96,,,percent of total billed charges,96% of total billed charges,6.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180,75,,,percent of total billed charges,75% of total billed charges,180,75,,,percent of total billed charges,75% of total billed charges,6.24,232.8,
PF APPLICATION CAST HAND  LOWER FOREARM GAUNTLET,78001152P,CDM,975,RC,29085,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,6.69,255.11,
PF APPLICATION CAST FINGER,78001154P,CDM,975,RC,29086,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,3.61,255.11,
PF APPLICATION LONG ARM SPLINT SHOULDER HAND,78001156P,CDM,975,RC,29105,HCPCS,Outpatient,,,255,191.25,,234.6,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237.15,93,,,percent of total billed charges,93% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,247.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,247.35,97,,,percent of total billed charges,97% of total billed charges,191.25,75,,,percent of total billed charges,75% of total billed charges,244.8,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.25,75,,,percent of total billed charges,75% of total billed charges,191.25,75,,,percent of total billed charges,75% of total billed charges,5.78,247.35,
PF APPLY SHORT ARM SPLINT FOREARM-HAND STATIC,78001158P,CDM,975,RC,29125,HCPCS,Outpatient,,,255,191.25,,234.6,92,,,percent of total billed charges,92% of total billed charges,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237.15,93,,,percent of total billed charges,93% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,247.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,247.35,97,,,percent of total billed charges,97% of total billed charges,191.25,75,,,percent of total billed charges,75% of total billed charges,244.8,96,,,percent of total billed charges,96% of total billed charges,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.25,75,,,percent of total billed charges,75% of total billed charges,191.25,75,,,percent of total billed charges,75% of total billed charges,3.85,247.35,
PF APPLICATION FINGER SPLINT STATIC,78001160P,CDM,975,RC,29130,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.88,93,,,percent of total billed charges,93% of total billed charges,104.4,90,,,percent of total billed charges,90% of total billed charges,104.4,90,,,percent of total billed charges,90% of total billed charges,112.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,112.52,97,,,percent of total billed charges,97% of total billed charges,87,75,,,percent of total billed charges,75% of total billed charges,111.36,96,,,percent of total billed charges,96% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,87,75,,,percent of total billed charges,75% of total billed charges,87,75,,,percent of total billed charges,75% of total billed charges,3.44,112.52,
PF STRAPPING THORAX,78001162P,CDM,975,RC,29200,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges,1.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,93,,,percent of total billed charges,93% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,72.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72.75,97,,,percent of total billed charges,97% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,72,96,,,percent of total billed charges,96% of total billed charges,1.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.25,75,,,percent of total billed charges,75% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,1.16,72.75,
PF STRAPPING SHOULDER,78001164P,CDM,975,RC,29240,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.35,93,,,percent of total billed charges,93% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,189.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.15,97,,,percent of total billed charges,97% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,187.2,96,,,percent of total billed charges,96% of total billed charges,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.25,75,,,percent of total billed charges,75% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,1.15,189.15,
PF STRAPPING ELBOW/WRIST,78001166P,CDM,975,RC,29260,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,1.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,1.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,1.46,255.11,
PF STRAPPING HAND/FINGER,78001168P,CDM,975,RC,29280,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges,2.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.26,93,,,percent of total billed charges,93% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,79.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.54,97,,,percent of total billed charges,97% of total billed charges,61.5,75,,,percent of total billed charges,75% of total billed charges,78.72,96,,,percent of total billed charges,96% of total billed charges,2.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.5,75,,,percent of total billed charges,75% of total billed charges,61.5,75,,,percent of total billed charges,75% of total billed charges,2.05,79.54,
PF APPLICATION HIP SPICA CAST 1 LEG,78001170P,CDM,975,RC,29305,HCPCS,Outpatient,,,843,632.25,,775.56,92,,,percent of total billed charges,92% of total billed charges,16.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,783.99,93,,,percent of total billed charges,93% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,817.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,817.71,97,,,percent of total billed charges,97% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,809.28,96,,,percent of total billed charges,96% of total billed charges,16.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,632.25,75,,,percent of total billed charges,75% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,16.62,817.71,
PF APPL HIP SPICA CAST ONE and ONE-HALF SPICA/BOTH LGS,78001172P,CDM,975,RC,29325,HCPCS,Outpatient,,,953,714.75,,876.76,92,,,percent of total billed charges,92% of total billed charges,18.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,886.29,93,,,percent of total billed charges,93% of total billed charges,857.7,90,,,percent of total billed charges,90% of total billed charges,857.7,90,,,percent of total billed charges,90% of total billed charges,924.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,924.41,97,,,percent of total billed charges,97% of total billed charges,714.75,75,,,percent of total billed charges,75% of total billed charges,914.88,96,,,percent of total billed charges,96% of total billed charges,18.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,714.75,75,,,percent of total billed charges,75% of total billed charges,714.75,75,,,percent of total billed charges,75% of total billed charges,18.91,924.41,
PF APPLICATION LONG LEG CAST THIGH-TOE,78001174P,CDM,975,RC,29345,HCPCS,Outpatient,,,261,195.75,,240.12,92,,,percent of total billed charges,92% of total billed charges,10.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,242.73,93,,,percent of total billed charges,93% of total billed charges,234.9,90,,,percent of total billed charges,90% of total billed charges,234.9,90,,,percent of total billed charges,90% of total billed charges,253.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,253.17,97,,,percent of total billed charges,97% of total billed charges,195.75,75,,,percent of total billed charges,75% of total billed charges,250.56,96,,,percent of total billed charges,96% of total billed charges,10.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.75,75,,,percent of total billed charges,75% of total billed charges,195.75,75,,,percent of total billed charges,75% of total billed charges,10.48,253.17,
PF APPLICATION SHORT LEG CAST BELOW KNEE-TOE,78001176P,CDM,975,RC,29405,HCPCS,Outpatient,,,230,172.5,,211.6,92,,,percent of total billed charges,92% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.9,93,,,percent of total billed charges,93% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,223.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.1,97,,,percent of total billed charges,97% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,220.8,96,,,percent of total billed charges,96% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.5,75,,,percent of total billed charges,75% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,5.56,223.1,
PF APPLICATION SHORT LEG CAST WALKING/AMBULATORY,78001178P,CDM,975,RC,29425,HCPCS,Outpatient,,,392,294,,360.64,92,,,percent of total billed charges,92% of total billed charges,4.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,364.56,93,,,percent of total billed charges,93% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,380.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,380.24,97,,,percent of total billed charges,97% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,376.32,96,,,percent of total billed charges,96% of total billed charges,4.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,294,75,,,percent of total billed charges,75% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,4.59,380.24,
PF ADDING WALKER PREVIOUSLY APPLIED CAST,78001180P,CDM,975,RC,29440,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,2.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,2.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,2.32,255.11,
PF APPLICATION RIGID TOTAL CONTACT LEG CAST,78001182P,CDM,975,RC,29445,HCPCS,Outpatient,,,190,142.5,,174.8,92,,,percent of total billed charges,92% of total billed charges,8.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.7,93,,,percent of total billed charges,93% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,184.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.3,97,,,percent of total billed charges,97% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,182.4,96,,,percent of total billed charges,96% of total billed charges,8.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.5,75,,,percent of total billed charges,75% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,8.82,184.3,
PF APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG,78001184P,CDM,975,RC,29450,HCPCS,Outpatient,,,586,439.5,,539.12,92,,,percent of total billed charges,92% of total billed charges,10.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,544.98,93,,,percent of total billed charges,93% of total billed charges,527.4,90,,,percent of total billed charges,90% of total billed charges,527.4,90,,,percent of total billed charges,90% of total billed charges,568.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,568.42,97,,,percent of total billed charges,97% of total billed charges,439.5,75,,,percent of total billed charges,75% of total billed charges,562.56,96,,,percent of total billed charges,96% of total billed charges,10.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,439.5,75,,,percent of total billed charges,75% of total billed charges,439.5,75,,,percent of total billed charges,75% of total billed charges,10.12,568.42,
PF APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES,78001186P,CDM,975,RC,29505,HCPCS,Outpatient,,,197,147.75,,181.24,92,,,percent of total billed charges,92% of total billed charges,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,183.21,93,,,percent of total billed charges,93% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,191.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.09,97,,,percent of total billed charges,97% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,189.12,96,,,percent of total billed charges,96% of total billed charges,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.75,75,,,percent of total billed charges,75% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,5.07,191.09,
PF APPLICATION SHORT LEG SPLINT CALF FOOT,78001188P,CDM,975,RC,29515,HCPCS,Outpatient,,,193,144.75,,177.56,92,,,percent of total billed charges,92% of total billed charges,4.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.49,93,,,percent of total billed charges,93% of total billed charges,173.7,90,,,percent of total billed charges,90% of total billed charges,173.7,90,,,percent of total billed charges,90% of total billed charges,187.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,187.21,97,,,percent of total billed charges,97% of total billed charges,144.75,75,,,percent of total billed charges,75% of total billed charges,185.28,96,,,percent of total billed charges,96% of total billed charges,4.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.75,75,,,percent of total billed charges,75% of total billed charges,144.75,75,,,percent of total billed charges,75% of total billed charges,4.71,187.21,
PF STRAPPING KNEE,78001190P,CDM,975,RC,29530,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,93,,,percent of total billed charges,93% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,72.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72.75,97,,,percent of total billed charges,97% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,72,96,,,percent of total billed charges,96% of total billed charges,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.25,75,,,percent of total billed charges,75% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,1.15,72.75,
PF STRAPPING ANKLE  and /FOOT,78001192P,CDM,975,RC,29540,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges,1.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.1,93,,,percent of total billed charges,93% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,67.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,67.9,97,,,percent of total billed charges,97% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,67.2,96,,,percent of total billed charges,96% of total billed charges,1.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,52.5,75,,,percent of total billed charges,75% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,1.4,67.9,
PF STRAPPING TOES,78001194P,CDM,975,RC,29550,HCPCS,Outpatient,,,45,33.75,,41.4,92,,,percent of total billed charges,92% of total billed charges,0.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,41.85,93,,,percent of total billed charges,93% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,40.5,90,,,percent of total billed charges,90% of total billed charges,43.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.65,97,,,percent of total billed charges,97% of total billed charges,33.75,75,,,percent of total billed charges,75% of total billed charges,43.2,96,,,percent of total billed charges,96% of total billed charges,0.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,33.75,75,,,percent of total billed charges,75% of total billed charges,33.75,75,,,percent of total billed charges,75% of total billed charges,0.92,43.65,
PF STRAPPING UNNA BOOT,78001196P,CDM,975,RC,29580,HCPCS,Outpatient,,,107,80.25,,98.44,92,,,percent of total billed charges,92% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,99.51,93,,,percent of total billed charges,93% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,103.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.79,97,,,percent of total billed charges,97% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges,102.72,96,,,percent of total billed charges,96% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.25,75,,,percent of total billed charges,75% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges,2.8,103.79,
PF APPL MLTLAYR COMPRES LEG BELW KNEE W/ANKLE FOOT,78001198P,CDM,975,RC,29581,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.96,93,,,percent of total billed charges,93% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,69.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.84,97,,,percent of total billed charges,97% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,69.12,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54,75,,,percent of total billed charges,75% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,1.18,69.84,
PF REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST,78001200P,CDM,975,RC,29700,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,3.85,255.11,
PF WINDOWING CAST,78001202P,CDM,975,RC,29730,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,5.07,255.11,
PF WEDGING CAST EXCEPT CLUBFOOT CASTS,78001204P,CDM,975,RC,29740,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,8.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,8.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,8.61,255.11,
PF ARTHROSCOPY SHOULDR DX W/WO SYNOVIAL BIOPSY SPX,78001206P,CDM,975,RC,29805,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,48.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,48.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,48.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,48.42,6546.53,
PF ARTHROSCOPY SHOULDER CAPSULORRHAPHY,78002835P,CDM,975,RC,29806,HCPCS,Outpatient,,,2636,1977,,2425.12,92,,,percent of total billed charges,92% of total billed charges,118.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2451.48,93,,,percent of total billed charges,93% of total billed charges,2372.4,90,,,percent of total billed charges,90% of total billed charges,2372.4,90,,,percent of total billed charges,90% of total billed charges,2556.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,118.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2556.92,97,,,percent of total billed charges,97% of total billed charges,1977,75,,,percent of total billed charges,75% of total billed charges,2530.56,96,,,percent of total billed charges,96% of total billed charges,118.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1977,75,,,percent of total billed charges,75% of total billed charges,1977,75,,,percent of total billed charges,75% of total billed charges,118.78,2556.92,
PF ARTHROSCOPY SHOULDER REPAIR OF SLAP LESION,78002221P,CDM,975,RC,29807,HCPCS,Outpatient,,,1537,1152.75,,1414.04,92,,,percent of total billed charges,92% of total billed charges,115.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1429.41,93,,,percent of total billed charges,93% of total billed charges,1383.3,90,,,percent of total billed charges,90% of total billed charges,1383.3,90,,,percent of total billed charges,90% of total billed charges,1490.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,115.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1490.89,97,,,percent of total billed charges,97% of total billed charges,1152.75,75,,,percent of total billed charges,75% of total billed charges,1475.52,96,,,percent of total billed charges,96% of total billed charges,115.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1152.75,75,,,percent of total billed charges,75% of total billed charges,1152.75,75,,,percent of total billed charges,75% of total billed charges,115.48,1490.89,
PF ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FB,78001208P,CDM,975,RC,29819,HCPCS,Outpatient,,,4043,3032.25,,3719.56,92,,,percent of total billed charges,92% of total billed charges,62.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3759.99,93,,,percent of total billed charges,93% of total billed charges,3638.7,90,,,percent of total billed charges,90% of total billed charges,3638.7,90,,,percent of total billed charges,90% of total billed charges,3921.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,62.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3921.71,97,,,percent of total billed charges,97% of total billed charges,3032.25,75,,,percent of total billed charges,75% of total billed charges,3881.28,96,,,percent of total billed charges,96% of total billed charges,62.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3032.25,75,,,percent of total billed charges,75% of total billed charges,3032.25,75,,,percent of total billed charges,75% of total billed charges,62.35,3921.71,
PF ARTHROSCOPY SHOULDER SURG SYNOVECTOMY PARTIAL,78001210P,CDM,975,RC,29820,HCPCS,Outpatient,,,3795,2846.25,,3491.4,92,,,percent of total billed charges,92% of total billed charges,56.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3529.35,93,,,percent of total billed charges,93% of total billed charges,3415.5,90,,,percent of total billed charges,90% of total billed charges,3415.5,90,,,percent of total billed charges,90% of total billed charges,3681.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,56.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3681.15,97,,,percent of total billed charges,97% of total billed charges,2846.25,75,,,percent of total billed charges,75% of total billed charges,3643.2,96,,,percent of total billed charges,96% of total billed charges,56.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2846.25,75,,,percent of total billed charges,75% of total billed charges,2846.25,75,,,percent of total billed charges,75% of total billed charges,56.39,3681.15,
PF ARTHROSCOPY SHOULDER SURG SYNOVECTOMY COMPLETE,78001212P,CDM,975,RC,29821,HCPCS,Outpatient,,,4410,3307.5,,4057.2,92,,,percent of total billed charges,92% of total billed charges,63.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4101.3,93,,,percent of total billed charges,93% of total billed charges,3969,90,,,percent of total billed charges,90% of total billed charges,3969,90,,,percent of total billed charges,90% of total billed charges,4277.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,63.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4277.7,97,,,percent of total billed charges,97% of total billed charges,3307.5,75,,,percent of total billed charges,75% of total billed charges,4233.6,96,,,percent of total billed charges,96% of total billed charges,63.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3307.5,75,,,percent of total billed charges,75% of total billed charges,3307.5,75,,,percent of total billed charges,75% of total billed charges,63.07,4277.7,
PF ARTHROSCOPY SHOULDER SURG DEBRIDEMENT LIMITED,78001214P,CDM,975,RC,29822,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,56.97,6546.53,
PF ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EXTENSIVE,78001216P,CDM,975,RC,29823,HCPCS,Outpatient,,,4808,3606,,4423.36,92,,,percent of total billed charges,92% of total billed charges,63.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4471.44,93,,,percent of total billed charges,93% of total billed charges,4327.2,90,,,percent of total billed charges,90% of total billed charges,4327.2,90,,,percent of total billed charges,90% of total billed charges,4663.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,63.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4663.76,97,,,percent of total billed charges,97% of total billed charges,3606,75,,,percent of total billed charges,75% of total billed charges,4615.68,96,,,percent of total billed charges,96% of total billed charges,63.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3606,75,,,percent of total billed charges,75% of total billed charges,3606,75,,,percent of total billed charges,75% of total billed charges,63.35,4663.76,
PF ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY,78001218P,CDM,975,RC,29824,HCPCS,Outpatient,,,6750,5062.5,,6210,92,,,percent of total billed charges,92% of total billed charges,71.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6277.5,93,,,percent of total billed charges,93% of total billed charges,6075,90,,,percent of total billed charges,90% of total billed charges,6075,90,,,percent of total billed charges,90% of total billed charges,6547.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,71.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6547.5,97,,,percent of total billed charges,97% of total billed charges,5062.5,75,,,percent of total billed charges,75% of total billed charges,6480,96,,,percent of total billed charges,96% of total billed charges,71.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5062.5,75,,,percent of total billed charges,75% of total billed charges,5062.5,75,,,percent of total billed charges,75% of total billed charges,71.72,6547.5,
PF ARTHROSCOPY SHOULDER AHESIOLYSIS W/WO MANIPJ,78001220P,CDM,975,RC,29825,HCPCS,Outpatient,,,4219,3164.25,,3881.48,92,,,percent of total billed charges,92% of total billed charges,61.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3923.67,93,,,percent of total billed charges,93% of total billed charges,3797.1,90,,,percent of total billed charges,90% of total billed charges,3797.1,90,,,percent of total billed charges,90% of total billed charges,4092.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4092.43,97,,,percent of total billed charges,97% of total billed charges,3164.25,75,,,percent of total billed charges,75% of total billed charges,4050.24,96,,,percent of total billed charges,96% of total billed charges,61.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3164.25,75,,,percent of total billed charges,75% of total billed charges,3164.25,75,,,percent of total billed charges,75% of total billed charges,61.76,4092.43,
PF ARTHROSCOPY SHOULDR W/CORACOACRM LIGMNT RELEASE,78001222P,CDM,975,RC,29826,HCPCS,Outpatient,,,6750,5062.5,,6210,92,,,percent of total billed charges,92% of total billed charges,21.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6277.5,93,,,percent of total billed charges,93% of total billed charges,6075,90,,,percent of total billed charges,90% of total billed charges,6075,90,,,percent of total billed charges,90% of total billed charges,6547.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6547.5,97,,,percent of total billed charges,97% of total billed charges,5062.5,75,,,percent of total billed charges,75% of total billed charges,6480,96,,,percent of total billed charges,96% of total billed charges,21.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5062.5,75,,,percent of total billed charges,75% of total billed charges,5062.5,75,,,percent of total billed charges,75% of total billed charges,21.61,6547.5,
PF ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR,78001224P,CDM,975,RC,29827,HCPCS,Outpatient,,,6750,5062.5,,6210,92,,,percent of total billed charges,92% of total billed charges,120.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6277.5,93,,,percent of total billed charges,93% of total billed charges,6075,90,,,percent of total billed charges,90% of total billed charges,6075,90,,,percent of total billed charges,90% of total billed charges,6547.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,120.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6547.5,97,,,percent of total billed charges,97% of total billed charges,5062.5,75,,,percent of total billed charges,75% of total billed charges,6480,96,,,percent of total billed charges,96% of total billed charges,120.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5062.5,75,,,percent of total billed charges,75% of total billed charges,5062.5,75,,,percent of total billed charges,75% of total billed charges,120.42,6547.5,
PF ARTHROSCOPY SHOULDER BICEPS TENODESIS,78001226P,CDM,975,RC,29828,HCPCS,Outpatient,,,6750,5062.5,,6210,92,,,percent of total billed charges,92% of total billed charges,102.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6277.5,93,,,percent of total billed charges,93% of total billed charges,6075,90,,,percent of total billed charges,90% of total billed charges,6075,90,,,percent of total billed charges,90% of total billed charges,6547.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,102.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6547.5,97,,,percent of total billed charges,97% of total billed charges,5062.5,75,,,percent of total billed charges,75% of total billed charges,6480,96,,,percent of total billed charges,96% of total billed charges,102.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5062.5,75,,,percent of total billed charges,75% of total billed charges,5062.5,75,,,percent of total billed charges,75% of total billed charges,102.16,6547.5,
PF ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR,78001228P,CDM,975,RC,29855,HCPCS,Outpatient,,,4038,3028.5,,3714.96,92,,,percent of total billed charges,92% of total billed charges,85.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3755.34,93,,,percent of total billed charges,93% of total billed charges,3634.2,90,,,percent of total billed charges,90% of total billed charges,3634.2,90,,,percent of total billed charges,90% of total billed charges,3916.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,85.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3916.86,97,,,percent of total billed charges,97% of total billed charges,3028.5,75,,,percent of total billed charges,75% of total billed charges,3876.48,96,,,percent of total billed charges,96% of total billed charges,85.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3028.5,75,,,percent of total billed charges,75% of total billed charges,3028.5,75,,,percent of total billed charges,75% of total billed charges,85.56,3916.86,
PF ARTHROSCOPY KNEE DX W/WO SYNOVIAL BX SPX,78001230P,CDM,975,RC,29870,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,42.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,42.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,42.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,42.37,6546.53,
PF ARTHROSCOPY KNEE INFECTION LAVAGE  DRAINAGE,78001231P,CDM,975,RC,29871,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,54.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,54.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,54.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,54.72,6546.53,
PF ARTHROSCOPY KNEE LATERAL RELEASE,78001232P,CDM,975,RC,29873,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,53.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,53.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,53.1,6546.53,
PF ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY,78001233P,CDM,975,RC,29874,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,58.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,58.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,58.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,58.21,6546.53,
PF ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX,78001234P,CDM,975,RC,29875,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,52.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,52.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,52.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,52.7,6546.53,
PF ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS,78001235P,CDM,975,RC,29876,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,70.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,70.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,70.86,6546.53,
PF ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG,78001236P,CDM,975,RC,29877,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,66.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,66.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,66.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,66.77,6546.53,
PF ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX,78001237P,CDM,975,RC,29879,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,72.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,72.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,72.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,72.26,6546.53,
PF ARTHRS KNEE W/MENISCECTOMY MEDLAT W/SHAVING,78001238P,CDM,975,RC,29880,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,59.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,59.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,59.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,59.85,6546.53,
PF ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG,78001239P,CDM,975,RC,29881,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,56.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,56.97,6546.53,
PF ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL,78001240P,CDM,975,RC,29882,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,74.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,74.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,74.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,74.51,6546.53,
PF ARTHROSCOPY KNEE W/MENISCUS RPR MEDIALLATERAL,78001241P,CDM,975,RC,29883,HCPCS,Outpatient,,,6749,5061.75,,6209.08,92,,,percent of total billed charges,92% of total billed charges,94.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6276.57,93,,,percent of total billed charges,93% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6074.1,90,,,percent of total billed charges,90% of total billed charges,6546.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,94.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6546.53,97,,,percent of total billed charges,97% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,6479.04,96,,,percent of total billed charges,96% of total billed charges,94.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5061.75,75,,,percent of total billed charges,75% of total billed charges,5061.75,75,,,percent of total billed charges,75% of total billed charges,94.8,6546.53,
PF ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ,78001242P,CDM,975,RC,29884,HCPCS,Outpatient,,,4354,3265.5,,4005.68,92,,,percent of total billed charges,92% of total billed charges,66.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4049.22,93,,,percent of total billed charges,93% of total billed charges,3918.6,90,,,percent of total billed charges,90% of total billed charges,3918.6,90,,,percent of total billed charges,90% of total billed charges,4223.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,66.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4223.38,97,,,percent of total billed charges,97% of total billed charges,3265.5,75,,,percent of total billed charges,75% of total billed charges,4179.84,96,,,percent of total billed charges,96% of total billed charges,66.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3265.5,75,,,percent of total billed charges,75% of total billed charges,3265.5,75,,,percent of total billed charges,75% of total billed charges,66.74,4223.38,
PF ARTHROSCOPIC AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNST,78001245P,CDM,975,RC,29888,HCPCS,Outpatient,,,7998,5998.5,,7358.16,92,,,percent of total billed charges,92% of total billed charges,109.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7438.14,93,,,percent of total billed charges,93% of total billed charges,7198.2,90,,,percent of total billed charges,90% of total billed charges,7198.2,90,,,percent of total billed charges,90% of total billed charges,7758.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7758.06,97,,,percent of total billed charges,97% of total billed charges,5998.5,75,,,percent of total billed charges,75% of total billed charges,7678.08,96,,,percent of total billed charges,96% of total billed charges,109.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5998.5,75,,,percent of total billed charges,75% of total billed charges,5998.5,75,,,percent of total billed charges,75% of total billed charges,109.01,7758.06,
PF ARTHROSCOPY ANKLE SURGICAL,78002750P,CDM,975,RC,29891,HCPCS,Outpatient,,,1698,1273.5,,1562.16,92,,,percent of total billed charges,92% of total billed charges,66.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1579.14,93,,,percent of total billed charges,93% of total billed charges,1528.2,90,,,percent of total billed charges,90% of total billed charges,1528.2,90,,,percent of total billed charges,90% of total billed charges,1647.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,66.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1647.06,97,,,percent of total billed charges,97% of total billed charges,1273.5,75,,,percent of total billed charges,75% of total billed charges,1630.08,96,,,percent of total billed charges,96% of total billed charges,66.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1273.5,75,,,percent of total billed charges,75% of total billed charges,1273.5,75,,,percent of total billed charges,75% of total billed charges,66.39,1647.06,
PF ARTHROSCOPY ANKLE W/REMOVAL OF FOREIGN BODY,78002884P,CDM,975,RC,29894,HCPCS,Outpatient,,,994,745.5,,914.48,92,,,percent of total billed charges,92% of total billed charges,50.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,924.42,93,,,percent of total billed charges,93% of total billed charges,894.6,90,,,percent of total billed charges,90% of total billed charges,894.6,90,,,percent of total billed charges,90% of total billed charges,964.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,964.18,97,,,percent of total billed charges,97% of total billed charges,745.5,75,,,percent of total billed charges,75% of total billed charges,954.24,96,,,percent of total billed charges,96% of total billed charges,50.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,745.5,75,,,percent of total billed charges,75% of total billed charges,745.5,75,,,percent of total billed charges,75% of total billed charges,50.16,964.18,
PF ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL,78002832P,CDM,975,RC,29895,HCPCS,Outpatient,,,1133,849.75,,1042.36,92,,,percent of total billed charges,92% of total billed charges,43.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1053.69,93,,,percent of total billed charges,93% of total billed charges,1019.7,90,,,percent of total billed charges,90% of total billed charges,1019.7,90,,,percent of total billed charges,90% of total billed charges,1099.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,43.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1099.01,97,,,percent of total billed charges,97% of total billed charges,849.75,75,,,percent of total billed charges,75% of total billed charges,1087.68,96,,,percent of total billed charges,96% of total billed charges,43.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,849.75,75,,,percent of total billed charges,75% of total billed charges,849.75,75,,,percent of total billed charges,75% of total billed charges,43.82,1099.01,
PF ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED,78002831P,CDM,975,RC,29897,HCPCS,Outpatient,,,1245,933.75,,1145.4,92,,,percent of total billed charges,92% of total billed charges,49.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1157.85,93,,,percent of total billed charges,93% of total billed charges,1120.5,90,,,percent of total billed charges,90% of total billed charges,1120.5,90,,,percent of total billed charges,90% of total billed charges,1207.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,49.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1207.65,97,,,percent of total billed charges,97% of total billed charges,933.75,75,,,percent of total billed charges,75% of total billed charges,1195.2,96,,,percent of total billed charges,96% of total billed charges,49.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,933.75,75,,,percent of total billed charges,75% of total billed charges,933.75,75,,,percent of total billed charges,75% of total billed charges,49.03,1207.65,
PF ARTHROSCOPY  ANKLE SURGICAL DEBRIDEMENT EXTENSIVE,78002453P,CDM,975,RC,29898,HCPCS,Outpatient,,,1421,1065.75,,1307.32,92,,,percent of total billed charges,92% of total billed charges,53.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1321.53,93,,,percent of total billed charges,93% of total billed charges,1278.9,90,,,percent of total billed charges,90% of total billed charges,1278.9,90,,,percent of total billed charges,90% of total billed charges,1378.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1378.37,97,,,percent of total billed charges,97% of total billed charges,1065.75,75,,,percent of total billed charges,75% of total billed charges,1364.16,96,,,percent of total billed charges,96% of total billed charges,53.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1065.75,75,,,percent of total billed charges,75% of total billed charges,1065.75,75,,,percent of total billed charges,75% of total billed charges,53.16,1378.37,
PF ARTHROSCOPY HIP W/FEMOROPLASTY,78001247P,CDM,975,RC,29914,HCPCS,Outpatient,,,3884,2913,,3573.28,92,,,percent of total billed charges,92% of total billed charges,111.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3612.12,93,,,percent of total billed charges,93% of total billed charges,3495.6,90,,,percent of total billed charges,90% of total billed charges,3495.6,90,,,percent of total billed charges,90% of total billed charges,3767.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,111.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3767.48,97,,,percent of total billed charges,97% of total billed charges,2913,75,,,percent of total billed charges,75% of total billed charges,3728.64,96,,,percent of total billed charges,96% of total billed charges,111.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2913,75,,,percent of total billed charges,75% of total billed charges,2913,75,,,percent of total billed charges,75% of total billed charges,111.01,3767.48,
PF ARTHROSCOPY HIP W/LABRAL REPAIR,78001248P,CDM,975,RC,29916,HCPCS,Outpatient,,,4025,3018.75,,3703,92,,,percent of total billed charges,92% of total billed charges,113.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3743.25,93,,,percent of total billed charges,93% of total billed charges,3622.5,90,,,percent of total billed charges,90% of total billed charges,3622.5,90,,,percent of total billed charges,90% of total billed charges,3904.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,113.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3904.25,97,,,percent of total billed charges,97% of total billed charges,3018.75,75,,,percent of total billed charges,75% of total billed charges,3864,96,,,percent of total billed charges,96% of total billed charges,113.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3018.75,75,,,percent of total billed charges,75% of total billed charges,3018.75,75,,,percent of total billed charges,75% of total billed charges,113.89,3904.25,
PF ARTHROSCOPY OF JOINT UNLISTED,78002829P,CDM,975,RC,29999,HCPCS,Outpatient,,,1615,1211.25,,1485.8,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,1501.95,93,,,percent of total billed charges,93% of total billed charges,1453.5,90,,,percent of total billed charges,90% of total billed charges,1453.5,90,,,percent of total billed charges,90% of total billed charges,1566.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1566.55,97,,,percent of total billed charges,97% of total billed charges,1211.25,75,,,percent of total billed charges,75% of total billed charges,1550.4,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,1211.25,75,,,percent of total billed charges,75% of total billed charges,1211.25,75,,,percent of total billed charges,75% of total billed charges,1211.25,1566.55,
PF REMOVAL FOREIGN BODY INTRANASAL,78001249P,CDM,975,RC,30300,HCPCS,Outpatient,,,443,332.25,,407.56,92,,,percent of total billed charges,92% of total billed charges,8.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.99,93,,,percent of total billed charges,93% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,429.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,429.71,97,,,percent of total billed charges,97% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,425.28,96,,,percent of total billed charges,96% of total billed charges,8.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,332.25,75,,,percent of total billed charges,75% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,8.62,429.71,
PF CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE UNILATERAL,78001251P,CDM,975,RC,30901,HCPCS,Outpatient,,,241,180.75,,221.72,92,,,percent of total billed charges,92% of total billed charges,7.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,224.13,93,,,percent of total billed charges,93% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,233.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.77,97,,,percent of total billed charges,97% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,231.36,96,,,percent of total billed charges,96% of total billed charges,7.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.75,75,,,percent of total billed charges,75% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,7.1,233.77,
PF CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX UNI,78001255P,CDM,975,RC,30903,HCPCS,Outpatient,,,309,231.75,,284.28,92,,,percent of total billed charges,92% of total billed charges,9.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,287.37,93,,,percent of total billed charges,93% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,299.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,299.73,97,,,percent of total billed charges,97% of total billed charges,231.75,75,,,percent of total billed charges,75% of total billed charges,296.64,96,,,percent of total billed charges,96% of total billed charges,9.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.75,75,,,percent of total billed charges,75% of total billed charges,231.75,75,,,percent of total billed charges,75% of total billed charges,9.7,299.73,
PF CTRL NSL HEMRRG PST NASAL PACKS and /CAUTERY 1ST,78001259P,CDM,975,RC,30905,HCPCS,Outpatient,,,417,312.75,,383.64,92,,,percent of total billed charges,92% of total billed charges,13.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,387.81,93,,,percent of total billed charges,93% of total billed charges,375.3,90,,,percent of total billed charges,90% of total billed charges,375.3,90,,,percent of total billed charges,90% of total billed charges,404.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,404.49,97,,,percent of total billed charges,97% of total billed charges,312.75,75,,,percent of total billed charges,75% of total billed charges,400.32,96,,,percent of total billed charges,96% of total billed charges,13.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312.75,75,,,percent of total billed charges,75% of total billed charges,312.75,75,,,percent of total billed charges,75% of total billed charges,13.13,404.49,
PF CTRL NSL HEMRRG PST NASAL PACKS and /CAUTERY SUBSQ,78001261P,CDM,975,RC,30906,HCPCS,Outpatient,,,443,332.25,,407.56,92,,,percent of total billed charges,92% of total billed charges,15.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.99,93,,,percent of total billed charges,93% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,429.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,429.71,97,,,percent of total billed charges,97% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,425.28,96,,,percent of total billed charges,96% of total billed charges,15.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,332.25,75,,,percent of total billed charges,75% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,15.41,429.71,
PF INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,78001263P,CDM,975,RC,31500,HCPCS,Outpatient,,,563,422.25,,517.96,92,,,percent of total billed charges,92% of total billed charges,16.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,523.59,93,,,percent of total billed charges,93% of total billed charges,506.7,90,,,percent of total billed charges,90% of total billed charges,506.7,90,,,percent of total billed charges,90% of total billed charges,546.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546.11,97,,,percent of total billed charges,97% of total billed charges,422.25,75,,,percent of total billed charges,75% of total billed charges,540.48,96,,,percent of total billed charges,96% of total billed charges,16.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,422.25,75,,,percent of total billed charges,75% of total billed charges,422.25,75,,,percent of total billed charges,75% of total billed charges,16.47,546.11,
PF LARYNGOSCOPY W/FOREIGN BODY REMOVAL,78001265P,CDM,975,RC,31530,HCPCS,Outpatient,,,4970,3727.5,,4572.4,92,,,percent of total billed charges,92% of total billed charges,20.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4622.1,93,,,percent of total billed charges,93% of total billed charges,4473,90,,,percent of total billed charges,90% of total billed charges,4473,90,,,percent of total billed charges,90% of total billed charges,4820.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4820.9,97,,,percent of total billed charges,97% of total billed charges,3727.5,75,,,percent of total billed charges,75% of total billed charges,4771.2,96,,,percent of total billed charges,96% of total billed charges,20.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3727.5,75,,,percent of total billed charges,75% of total billed charges,3727.5,75,,,percent of total billed charges,75% of total billed charges,20.66,4820.9,
PF TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL,78001266P,CDM,975,RC,31603,HCPCS,Outpatient,,,1744,1308,,1604.48,92,,,percent of total billed charges,92% of total billed charges,41.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1621.92,93,,,percent of total billed charges,93% of total billed charges,1569.6,90,,,percent of total billed charges,90% of total billed charges,1569.6,90,,,percent of total billed charges,90% of total billed charges,1691.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1691.68,97,,,percent of total billed charges,97% of total billed charges,1308,75,,,percent of total billed charges,75% of total billed charges,1674.24,96,,,percent of total billed charges,96% of total billed charges,41.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1308,75,,,percent of total billed charges,75% of total billed charges,1308,75,,,percent of total billed charges,75% of total billed charges,41.33,1691.68,
PF TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE,78001268P,CDM,975,RC,31605,HCPCS,Outpatient,,,1314,985.5,,1208.88,92,,,percent of total billed charges,92% of total billed charges,45.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1222.02,93,,,percent of total billed charges,93% of total billed charges,1182.6,90,,,percent of total billed charges,90% of total billed charges,1182.6,90,,,percent of total billed charges,90% of total billed charges,1274.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1274.58,97,,,percent of total billed charges,97% of total billed charges,985.5,75,,,percent of total billed charges,75% of total billed charges,1261.44,96,,,percent of total billed charges,96% of total billed charges,45.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,985.5,75,,,percent of total billed charges,75% of total billed charges,985.5,75,,,percent of total billed charges,75% of total billed charges,45.45,1274.58,
PF BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX,78001270P,CDM,975,RC,31622,HCPCS,Outpatient,,,2445,1833.75,,2249.4,92,,,percent of total billed charges,92% of total billed charges,12.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2273.85,93,,,percent of total billed charges,93% of total billed charges,2200.5,90,,,percent of total billed charges,90% of total billed charges,2200.5,90,,,percent of total billed charges,90% of total billed charges,2371.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2371.65,97,,,percent of total billed charges,97% of total billed charges,1833.75,75,,,percent of total billed charges,75% of total billed charges,2347.2,96,,,percent of total billed charges,96% of total billed charges,12.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1833.75,75,,,percent of total billed charges,75% of total billed charges,1833.75,75,,,percent of total billed charges,75% of total billed charges,12.9,2371.65,
PF BRONCHOSCOPE DIAGNOSTIC LAVAGE,78002414P,CDM,975,RC,31624,HCPCS,Outpatient,,,334,250.5,,307.28,92,,,percent of total billed charges,92% of total billed charges,11.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,310.62,93,,,percent of total billed charges,93% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,323.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,323.98,97,,,percent of total billed charges,97% of total billed charges,250.5,75,,,percent of total billed charges,75% of total billed charges,320.64,96,,,percent of total billed charges,96% of total billed charges,11.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,250.5,75,,,percent of total billed charges,75% of total billed charges,250.5,75,,,percent of total billed charges,75% of total billed charges,11.02,323.98,
PF THORACOTOMY WITH EXPLORATION,78001271P,CDM,975,RC,32100,HCPCS,Outpatient,,,3167,2375.25,,2913.64,92,,,percent of total billed charges,92% of total billed charges,116.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2945.31,93,,,percent of total billed charges,93% of total billed charges,2850.3,90,,,percent of total billed charges,90% of total billed charges,2850.3,90,,,percent of total billed charges,90% of total billed charges,3071.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,116.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3071.99,97,,,percent of total billed charges,97% of total billed charges,2375.25,75,,,percent of total billed charges,75% of total billed charges,3040.32,96,,,percent of total billed charges,96% of total billed charges,116.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2375.25,75,,,percent of total billed charges,75% of total billed charges,2375.25,75,,,percent of total billed charges,75% of total billed charges,116.43,3071.99,
PF THORCOM CTRL TRAUMTC HEMRRG and /RPR LNG TEAR,78001272P,CDM,975,RC,32110,HCPCS,Outpatient,,,5739,4304.25,,5279.88,92,,,percent of total billed charges,92% of total billed charges,214.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5337.27,93,,,percent of total billed charges,93% of total billed charges,5165.1,90,,,percent of total billed charges,90% of total billed charges,5165.1,90,,,percent of total billed charges,90% of total billed charges,5566.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,214.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5566.83,97,,,percent of total billed charges,97% of total billed charges,4304.25,75,,,percent of total billed charges,75% of total billed charges,5509.44,96,,,percent of total billed charges,96% of total billed charges,214.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4304.25,75,,,percent of total billed charges,75% of total billed charges,4304.25,75,,,percent of total billed charges,75% of total billed charges,214.3,5566.83,
PF THORACOTOMY W/CARDIAC MASSAGE,78001273P,CDM,975,RC,32160,HCPCS,Outpatient,,,3112,2334,,2863.04,92,,,percent of total billed charges,92% of total billed charges,109.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2894.16,93,,,percent of total billed charges,93% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,2800.8,90,,,percent of total billed charges,90% of total billed charges,3018.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3018.64,97,,,percent of total billed charges,97% of total billed charges,2334,75,,,percent of total billed charges,75% of total billed charges,2987.52,96,,,percent of total billed charges,96% of total billed charges,109.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2334,75,,,percent of total billed charges,75% of total billed charges,2334,75,,,percent of total billed charges,75% of total billed charges,109.79,3018.64,
PF TUBE THORACOSTOMY INCLUDES WATER SEAL,78001276P,CDM,975,RC,32551,HCPCS,Outpatient,,,1218,913.5,,1120.56,92,,,percent of total billed charges,92% of total billed charges,19.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1132.74,93,,,percent of total billed charges,93% of total billed charges,1096.2,90,,,percent of total billed charges,90% of total billed charges,1096.2,90,,,percent of total billed charges,90% of total billed charges,1181.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1181.46,97,,,percent of total billed charges,97% of total billed charges,913.5,75,,,percent of total billed charges,75% of total billed charges,1169.28,96,,,percent of total billed charges,96% of total billed charges,19.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,913.5,75,,,percent of total billed charges,75% of total billed charges,913.5,75,,,percent of total billed charges,75% of total billed charges,19.66,1181.46,
PF THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING,78001278P,CDM,975,RC,32554,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,8.7,343.38,
PF THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING,78001280P,CDM,975,RC,32555,HCPCS,Outpatient,,,440,330,,404.8,92,,,percent of total billed charges,92% of total billed charges,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,409.2,93,,,percent of total billed charges,93% of total billed charges,396,90,,,percent of total billed charges,90% of total billed charges,396,90,,,percent of total billed charges,90% of total billed charges,426.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,426.8,97,,,percent of total billed charges,97% of total billed charges,330,75,,,percent of total billed charges,75% of total billed charges,422.4,96,,,percent of total billed charges,96% of total billed charges,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,330,75,,,percent of total billed charges,75% of total billed charges,330,75,,,percent of total billed charges,75% of total billed charges,9.65,426.8,
PF PERCUTANEOUS DRAINAGE PLEURA INSERT CATH W/O IMAGING,78001282P,CDM,975,RC,32556,HCPCS,Outpatient,,,1286,964.5,,1183.12,92,,,percent of total billed charges,92% of total billed charges,14.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1195.98,93,,,percent of total billed charges,93% of total billed charges,1157.4,90,,,percent of total billed charges,90% of total billed charges,1157.4,90,,,percent of total billed charges,90% of total billed charges,1247.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1247.42,97,,,percent of total billed charges,97% of total billed charges,964.5,75,,,percent of total billed charges,75% of total billed charges,1234.56,96,,,percent of total billed charges,96% of total billed charges,14.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,964.5,75,,,percent of total billed charges,75% of total billed charges,964.5,75,,,percent of total billed charges,75% of total billed charges,14.25,1247.42,
PF PLEURAL DRAINAGE PERCUTANEOUS W/INSERTION OF INDWELLING C,78002833P,CDM,975,RC,32557,HCPCS,Outpatient,,,360,270,,331.2,92,,,percent of total billed charges,92% of total billed charges,13.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,334.8,93,,,percent of total billed charges,93% of total billed charges,324,90,,,percent of total billed charges,90% of total billed charges,324,90,,,percent of total billed charges,90% of total billed charges,349.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,349.2,97,,,percent of total billed charges,97% of total billed charges,270,75,,,percent of total billed charges,75% of total billed charges,345.6,96,,,percent of total billed charges,96% of total billed charges,13.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,270,75,,,percent of total billed charges,75% of total billed charges,270,75,,,percent of total billed charges,75% of total billed charges,13.44,349.2,
PF PERICARDIOTOMY REMOVE CLOT/FOREIGN BODY PRIMARY,78001284P,CDM,975,RC,33020,HCPCS,Outpatient,,,3232,2424,,2973.44,92,,,percent of total billed charges,92% of total billed charges,119.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3005.76,93,,,percent of total billed charges,93% of total billed charges,2908.8,90,,,percent of total billed charges,90% of total billed charges,2908.8,90,,,percent of total billed charges,90% of total billed charges,3135.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,119.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3135.04,97,,,percent of total billed charges,97% of total billed charges,2424,75,,,percent of total billed charges,75% of total billed charges,3102.72,96,,,percent of total billed charges,96% of total billed charges,119.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2424,75,,,percent of total billed charges,75% of total billed charges,2424,75,,,percent of total billed charges,75% of total billed charges,119.21,3135.04,
PF INSERT/REPLACE TEMP LEAD SINGLE CHAMBER PACEMKER,78002229P,CDM,975,RC,33210,HCPCS,Outpatient,,,423,317.25,,389.16,92,,,percent of total billed charges,92% of total billed charges,22.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,393.39,93,,,percent of total billed charges,93% of total billed charges,380.7,90,,,percent of total billed charges,90% of total billed charges,380.7,90,,,percent of total billed charges,90% of total billed charges,410.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,410.31,97,,,percent of total billed charges,97% of total billed charges,317.25,75,,,percent of total billed charges,75% of total billed charges,406.08,96,,,percent of total billed charges,96% of total billed charges,22.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,317.25,75,,,percent of total billed charges,75% of total billed charges,317.25,75,,,percent of total billed charges,75% of total billed charges,22.53,410.31,
PF REPAIR CARDIAC WOUND W/O BYPASS,78001285P,CDM,975,RC,33300,HCPCS,Outpatient,,,9603,7202.25,,8834.76,92,,,percent of total billed charges,92% of total billed charges,377.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,8930.79,93,,,percent of total billed charges,93% of total billed charges,8642.7,90,,,percent of total billed charges,90% of total billed charges,8642.7,90,,,percent of total billed charges,90% of total billed charges,9314.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,377.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,9314.91,97,,,percent of total billed charges,97% of total billed charges,7202.25,75,,,percent of total billed charges,75% of total billed charges,9218.88,96,,,percent of total billed charges,96% of total billed charges,377.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7202.25,75,,,percent of total billed charges,75% of total billed charges,7202.25,75,,,percent of total billed charges,75% of total billed charges,377.58,9314.91,
PF REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY,78001286P,CDM,975,RC,35206,HCPCS,Outpatient,,,7275,5456.25,,6693,92,,,percent of total billed charges,92% of total billed charges,114.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6765.75,93,,,percent of total billed charges,93% of total billed charges,6547.5,90,,,percent of total billed charges,90% of total billed charges,6547.5,90,,,percent of total billed charges,90% of total billed charges,7056.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,114.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7056.75,97,,,percent of total billed charges,97% of total billed charges,5456.25,75,,,percent of total billed charges,75% of total billed charges,6984,96,,,percent of total billed charges,96% of total billed charges,114.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5456.25,75,,,percent of total billed charges,75% of total billed charges,5456.25,75,,,percent of total billed charges,75% of total billed charges,114.28,7056.75,
PF RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL,78001287P,CDM,975,RC,35221,HCPCS,Outpatient,,,6552,4914,,6027.84,92,,,percent of total billed charges,92% of total billed charges,226.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6093.36,93,,,percent of total billed charges,93% of total billed charges,5896.8,90,,,percent of total billed charges,90% of total billed charges,5896.8,90,,,percent of total billed charges,90% of total billed charges,6355.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,226.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6355.44,97,,,percent of total billed charges,97% of total billed charges,4914,75,,,percent of total billed charges,75% of total billed charges,6289.92,96,,,percent of total billed charges,96% of total billed charges,226.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4914,75,,,percent of total billed charges,75% of total billed charges,4914,75,,,percent of total billed charges,75% of total billed charges,226.99,6355.44,
PF INTRODUCTION NEEDLE/INTRACATHETER VEIN,78001288P,CDM,975,RC,36000,HCPCS,Outpatient,,,198,148.5,,182.16,92,,,percent of total billed charges,92% of total billed charges,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.14,93,,,percent of total billed charges,93% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,192.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,192.06,97,,,percent of total billed charges,97% of total billed charges,148.5,75,,,percent of total billed charges,75% of total billed charges,190.08,96,,,percent of total billed charges,96% of total billed charges,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,148.5,75,,,percent of total billed charges,75% of total billed charges,148.5,75,,,percent of total billed charges,75% of total billed charges,0.85,192.06,
PF INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA,78001290P,CDM,975,RC,36010,HCPCS,Outpatient,,,893,669.75,,821.56,92,,,percent of total billed charges,92% of total billed charges,14.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,830.49,93,,,percent of total billed charges,93% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,866.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,866.21,97,,,percent of total billed charges,97% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,857.28,96,,,percent of total billed charges,96% of total billed charges,14.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,669.75,75,,,percent of total billed charges,75% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,14.5,866.21,
PF INTRO NEEDLE OR INTRACATHETER EXTREMITY ARTERY,78002255P,CDM,975,RC,36140,HCPCS,Outpatient,,,221,165.75,,203.32,92,,,percent of total billed charges,92% of total billed charges,12.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,205.53,93,,,percent of total billed charges,93% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,214.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.37,97,,,percent of total billed charges,97% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,212.16,96,,,percent of total billed charges,96% of total billed charges,12.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.75,75,,,percent of total billed charges,75% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,12.76,214.37,
PF INTRODUCTION OF CATHETER IN AORTA,78001291P,CDM,975,RC,36200,HCPCS,Outpatient,,,1341,1005.75,,1233.72,92,,,percent of total billed charges,92% of total billed charges,21.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1247.13,93,,,percent of total billed charges,93% of total billed charges,1206.9,90,,,percent of total billed charges,90% of total billed charges,1206.9,90,,,percent of total billed charges,90% of total billed charges,1300.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1300.77,97,,,percent of total billed charges,97% of total billed charges,1005.75,75,,,percent of total billed charges,75% of total billed charges,1287.36,96,,,percent of total billed charges,96% of total billed charges,21.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1005.75,75,,,percent of total billed charges,75% of total billed charges,1005.75,75,,,percent of total billed charges,75% of total billed charges,21.24,1300.77,
PF SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH,78001292P,CDM,975,RC,36245,HCPCS,Outpatient,,,1374,1030.5,,1264.08,92,,,percent of total billed charges,92% of total billed charges,30.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1277.82,93,,,percent of total billed charges,93% of total billed charges,1236.6,90,,,percent of total billed charges,90% of total billed charges,1236.6,90,,,percent of total billed charges,90% of total billed charges,1332.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1332.78,97,,,percent of total billed charges,97% of total billed charges,1030.5,75,,,percent of total billed charges,75% of total billed charges,1319.04,96,,,percent of total billed charges,96% of total billed charges,30.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1030.5,75,,,percent of total billed charges,75% of total billed charges,1030.5,75,,,percent of total billed charges,75% of total billed charges,30.44,1332.78,
PF VENIPUNCTURE <3 YRS PHY/QHP SKILL FEMRL/JGLR VN,78001293P,CDM,975,RC,36400,HCPCS,Outpatient,,,30,22.5,,27.6,92,,,percent of total billed charges,92% of total billed charges,1.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,27.9,93,,,percent of total billed charges,93% of total billed charges,27,90,,,percent of total billed charges,90% of total billed charges,27,90,,,percent of total billed charges,90% of total billed charges,29.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,29.1,97,,,percent of total billed charges,97% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges,28.8,96,,,percent of total billed charges,96% of total billed charges,1.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,22.5,75,,,percent of total billed charges,75% of total billed charges,22.5,75,,,percent of total billed charges,75% of total billed charges,1.45,29.1,
PF VENIPUNCTURE 3 YEARS/> PHYS/QHP SKILL,78001295P,CDM,975,RC,36410,HCPCS,Outpatient,,,37,27.75,,34.04,92,,,percent of total billed charges,92% of total billed charges,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,34.41,93,,,percent of total billed charges,93% of total billed charges,33.3,90,,,percent of total billed charges,90% of total billed charges,33.3,90,,,percent of total billed charges,90% of total billed charges,35.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,35.89,97,,,percent of total billed charges,97% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges,35.52,96,,,percent of total billed charges,96% of total billed charges,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,27.75,75,,,percent of total billed charges,75% of total billed charges,27.75,75,,,percent of total billed charges,75% of total billed charges,0.85,35.89,
PF VENIPUNCTURE CUTDOWN UNDER AGE 1 YR,78001300P,CDM,975,RC,36420,HCPCS,Outpatient,,,188,141,,172.96,92,,,percent of total billed charges,92% of total billed charges,7.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,174.84,93,,,percent of total billed charges,93% of total billed charges,169.2,90,,,percent of total billed charges,90% of total billed charges,169.2,90,,,percent of total billed charges,90% of total billed charges,182.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,182.36,97,,,percent of total billed charges,97% of total billed charges,141,75,,,percent of total billed charges,75% of total billed charges,180.48,96,,,percent of total billed charges,96% of total billed charges,7.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141,75,,,percent of total billed charges,75% of total billed charges,141,75,,,percent of total billed charges,75% of total billed charges,7.59,182.36,
PF VENIPUNCTURE CUTDOWN AGE 1 YR/>,78001302P,CDM,975,RC,36425,HCPCS,Outpatient,,,158,118.5,,145.36,92,,,percent of total billed charges,92% of total billed charges,4.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.94,93,,,percent of total billed charges,93% of total billed charges,142.2,90,,,percent of total billed charges,90% of total billed charges,142.2,90,,,percent of total billed charges,90% of total billed charges,153.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,153.26,97,,,percent of total billed charges,97% of total billed charges,118.5,75,,,percent of total billed charges,75% of total billed charges,151.68,96,,,percent of total billed charges,96% of total billed charges,4.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,118.5,75,,,percent of total billed charges,75% of total billed charges,118.5,75,,,percent of total billed charges,75% of total billed charges,4.33,153.26,
PF ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,78001326P,CDM,975,RC,36478,HCPCS,Outpatient,,,722,541.5,,664.24,92,,,percent of total billed charges,92% of total billed charges,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,671.46,93,,,percent of total billed charges,93% of total billed charges,649.8,90,,,percent of total billed charges,90% of total billed charges,649.8,90,,,percent of total billed charges,90% of total billed charges,700.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,700.34,97,,,percent of total billed charges,97% of total billed charges,541.5,75,,,percent of total billed charges,75% of total billed charges,693.12,96,,,percent of total billed charges,96% of total billed charges,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,541.5,75,,,percent of total billed charges,75% of total billed charges,541.5,75,,,percent of total billed charges,75% of total billed charges,38.95,700.34,
PF ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VNS,78001328P,CDM,975,RC,36479,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,19.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,19.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,19.5,343.38,
PF CATHETER UMBILICAL VEIN DX/THER NB,78001309P,CDM,975,RC,36510,HCPCS,Outpatient,,,141,105.75,,129.72,92,,,percent of total billed charges,92% of total billed charges,3.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.13,93,,,percent of total billed charges,93% of total billed charges,126.9,90,,,percent of total billed charges,90% of total billed charges,126.9,90,,,percent of total billed charges,90% of total billed charges,136.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,136.77,97,,,percent of total billed charges,97% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges,135.36,96,,,percent of total billed charges,96% of total billed charges,3.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,105.75,75,,,percent of total billed charges,75% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges,3.98,136.77,
PF INSERT NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y,78001311P,CDM,975,RC,36555,HCPCS,Outpatient,,,334,250.5,,307.28,92,,,percent of total billed charges,92% of total billed charges,7.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,310.62,93,,,percent of total billed charges,93% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,323.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,323.98,97,,,percent of total billed charges,97% of total billed charges,250.5,75,,,percent of total billed charges,75% of total billed charges,320.64,96,,,percent of total billed charges,96% of total billed charges,7.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,250.5,75,,,percent of total billed charges,75% of total billed charges,250.5,75,,,percent of total billed charges,75% of total billed charges,7.19,323.98,
PF INSERT NON-TUNNELD CENTRAL VENOUS CATH AGE 5 YR/>,78001313P,CDM,975,RC,36556,HCPCS,Outpatient,,,879,659.25,,808.68,92,,,percent of total billed charges,92% of total billed charges,9.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,817.47,93,,,percent of total billed charges,93% of total billed charges,791.1,90,,,percent of total billed charges,90% of total billed charges,791.1,90,,,percent of total billed charges,90% of total billed charges,852.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,852.63,97,,,percent of total billed charges,97% of total billed charges,659.25,75,,,percent of total billed charges,75% of total billed charges,843.84,96,,,percent of total billed charges,96% of total billed charges,9.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,659.25,75,,,percent of total billed charges,75% of total billed charges,659.25,75,,,percent of total billed charges,75% of total billed charges,9.11,852.63,
PF INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>,78001315P,CDM,975,RC,36558,HCPCS,Outpatient,,,5901,4425.75,,5428.92,92,,,percent of total billed charges,92% of total billed charges,26.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5487.93,93,,,percent of total billed charges,93% of total billed charges,5310.9,90,,,percent of total billed charges,90% of total billed charges,5310.9,90,,,percent of total billed charges,90% of total billed charges,5723.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5723.97,97,,,percent of total billed charges,97% of total billed charges,4425.75,75,,,percent of total billed charges,75% of total billed charges,5664.96,96,,,percent of total billed charges,96% of total billed charges,26.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4425.75,75,,,percent of total billed charges,75% of total billed charges,4425.75,75,,,percent of total billed charges,75% of total billed charges,26.14,5723.97,
PF INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>,78001317P,CDM,975,RC,36561,HCPCS,Outpatient,,,7089,5316.75,,6521.88,92,,,percent of total billed charges,92% of total billed charges,37.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6592.77,93,,,percent of total billed charges,93% of total billed charges,6380.1,90,,,percent of total billed charges,90% of total billed charges,6380.1,90,,,percent of total billed charges,90% of total billed charges,6876.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6876.33,97,,,percent of total billed charges,97% of total billed charges,5316.75,75,,,percent of total billed charges,75% of total billed charges,6805.44,96,,,percent of total billed charges,96% of total billed charges,37.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5316.75,75,,,percent of total billed charges,75% of total billed charges,5316.75,75,,,percent of total billed charges,75% of total billed charges,37.34,6876.33,
PF INSERT TUNNELED CVAD W/SUBQ PUMP,78002233P,CDM,975,RC,36563,HCPCS,Outpatient,,,3149,2361.75,,2897.08,92,,,percent of total billed charges,92% of total billed charges,45.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2928.57,93,,,percent of total billed charges,93% of total billed charges,2834.1,90,,,percent of total billed charges,90% of total billed charges,2834.1,90,,,percent of total billed charges,90% of total billed charges,3054.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3054.53,97,,,percent of total billed charges,97% of total billed charges,2361.75,75,,,percent of total billed charges,75% of total billed charges,3023.04,96,,,percent of total billed charges,96% of total billed charges,45.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2361.75,75,,,percent of total billed charges,75% of total billed charges,2361.75,75,,,percent of total billed charges,75% of total billed charges,45.71,3054.53,
PF INSERT TUNNELED CV CATH 2 SITES W/O PORT/PUMP,78002235P,CDM,975,RC,36565,HCPCS,Outpatient,,,883,662.25,,812.36,92,,,percent of total billed charges,92% of total billed charges,45.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,821.19,93,,,percent of total billed charges,93% of total billed charges,794.7,90,,,percent of total billed charges,90% of total billed charges,794.7,90,,,percent of total billed charges,90% of total billed charges,856.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,856.51,97,,,percent of total billed charges,97% of total billed charges,662.25,75,,,percent of total billed charges,75% of total billed charges,847.68,96,,,percent of total billed charges,96% of total billed charges,45.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,662.25,75,,,percent of total billed charges,75% of total billed charges,662.25,75,,,percent of total billed charges,75% of total billed charges,45.4,856.51,
PF INSERT TUNNELED CV CATH 2 SITES W/SUBQ PORT,78002237P,CDM,975,RC,36566,HCPCS,Outpatient,,,944,708,,868.48,92,,,percent of total billed charges,92% of total billed charges,42.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,877.92,93,,,percent of total billed charges,93% of total billed charges,849.6,90,,,percent of total billed charges,90% of total billed charges,849.6,90,,,percent of total billed charges,90% of total billed charges,915.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,42.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,915.68,97,,,percent of total billed charges,97% of total billed charges,708,75,,,percent of total billed charges,75% of total billed charges,906.24,96,,,percent of total billed charges,96% of total billed charges,42.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,708,75,,,percent of total billed charges,75% of total billed charges,708,75,,,percent of total billed charges,75% of total billed charges,42.53,915.68,
PF INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>,78001319P,CDM,975,RC,36569,HCPCS,Outpatient,,,932,699,,857.44,92,,,percent of total billed charges,92% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,866.76,93,,,percent of total billed charges,93% of total billed charges,838.8,90,,,percent of total billed charges,90% of total billed charges,838.8,90,,,percent of total billed charges,90% of total billed charges,904.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,904.04,97,,,percent of total billed charges,97% of total billed charges,699,75,,,percent of total billed charges,75% of total billed charges,894.72,96,,,percent of total billed charges,96% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699,75,,,percent of total billed charges,75% of total billed charges,699,75,,,percent of total billed charges,75% of total billed charges,11.08,904.04,
PF INSERT CENTRAL VENOUS CATHETER FOR INFUSION W/PORT AGE 5,78001321P,CDM,975,RC,36571,HCPCS,Outpatient,,,5901,4425.75,,5428.92,92,,,percent of total billed charges,92% of total billed charges,39.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5487.93,93,,,percent of total billed charges,93% of total billed charges,5310.9,90,,,percent of total billed charges,90% of total billed charges,5310.9,90,,,percent of total billed charges,90% of total billed charges,5723.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,39.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5723.97,97,,,percent of total billed charges,97% of total billed charges,4425.75,75,,,percent of total billed charges,75% of total billed charges,5664.96,96,,,percent of total billed charges,96% of total billed charges,39.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4425.75,75,,,percent of total billed charges,75% of total billed charges,4425.75,75,,,percent of total billed charges,75% of total billed charges,39.45,5723.97,
PF INSERTION PICC W/RS and I 5 YR/>,78001323P,CDM,975,RC,36573,HCPCS,Outpatient,,,932,699,,857.44,92,,,percent of total billed charges,92% of total billed charges,7.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,866.76,93,,,percent of total billed charges,93% of total billed charges,838.8,90,,,percent of total billed charges,90% of total billed charges,838.8,90,,,percent of total billed charges,90% of total billed charges,904.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,904.04,97,,,percent of total billed charges,97% of total billed charges,699,75,,,percent of total billed charges,75% of total billed charges,894.72,96,,,percent of total billed charges,96% of total billed charges,7.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699,75,,,percent of total billed charges,75% of total billed charges,699,75,,,percent of total billed charges,75% of total billed charges,7.42,904.04,
PF REPAIR TUNNELED CV CATHETER,78002239P,CDM,975,RC,36575,HCPCS,Outpatient,,,85,63.75,,78.2,92,,,percent of total billed charges,92% of total billed charges,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.05,93,,,percent of total billed charges,93% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,82.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,82.45,97,,,percent of total billed charges,97% of total billed charges,63.75,75,,,percent of total billed charges,75% of total billed charges,81.6,96,,,percent of total billed charges,96% of total billed charges,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63.75,75,,,percent of total billed charges,75% of total billed charges,63.75,75,,,percent of total billed charges,75% of total billed charges,3.03,82.45,
PF REPAIR CENTRAL VAD W/SUBQ PORT/PMP CTR/PRPH INSERT SITE,78002268P,CDM,975,RC,36576,HCPCS,Outpatient,,,1204,903,,1107.68,92,,,percent of total billed charges,92% of total billed charges,21.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1119.72,93,,,percent of total billed charges,93% of total billed charges,1083.6,90,,,percent of total billed charges,90% of total billed charges,1083.6,90,,,percent of total billed charges,90% of total billed charges,1167.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1167.88,97,,,percent of total billed charges,97% of total billed charges,903,75,,,percent of total billed charges,75% of total billed charges,1155.84,96,,,percent of total billed charges,96% of total billed charges,21.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,903,75,,,percent of total billed charges,75% of total billed charges,903,75,,,percent of total billed charges,75% of total billed charges,21.71,1167.88,
PF REPLACE TUNNELED CV CATHETER,78002241P,CDM,975,RC,36578,HCPCS,Outpatient,,,505,378.75,,464.6,92,,,percent of total billed charges,92% of total billed charges,24.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,469.65,93,,,percent of total billed charges,93% of total billed charges,454.5,90,,,percent of total billed charges,90% of total billed charges,454.5,90,,,percent of total billed charges,90% of total billed charges,489.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,489.85,97,,,percent of total billed charges,97% of total billed charges,378.75,75,,,percent of total billed charges,75% of total billed charges,484.8,96,,,percent of total billed charges,96% of total billed charges,24.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,378.75,75,,,percent of total billed charges,75% of total billed charges,378.75,75,,,percent of total billed charges,75% of total billed charges,24.86,489.85,
PF REPLACE NON-TUNNELED CV CATHETER,78002243P,CDM,975,RC,36580,HCPCS,Outpatient,,,165,123.75,,151.8,92,,,percent of total billed charges,92% of total billed charges,6.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,153.45,93,,,percent of total billed charges,93% of total billed charges,148.5,90,,,percent of total billed charges,90% of total billed charges,148.5,90,,,percent of total billed charges,90% of total billed charges,160.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,160.05,97,,,percent of total billed charges,97% of total billed charges,123.75,75,,,percent of total billed charges,75% of total billed charges,158.4,96,,,percent of total billed charges,96% of total billed charges,6.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,123.75,75,,,percent of total billed charges,75% of total billed charges,123.75,75,,,percent of total billed charges,75% of total billed charges,6.81,160.05,
PF REPLACE TUNNELED CV CATHETER,78002245P,CDM,975,RC,36581,HCPCS,Outpatient,,,458,343.5,,421.36,92,,,percent of total billed charges,92% of total billed charges,17.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,425.94,93,,,percent of total billed charges,93% of total billed charges,412.2,90,,,percent of total billed charges,90% of total billed charges,412.2,90,,,percent of total billed charges,90% of total billed charges,444.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,444.26,97,,,percent of total billed charges,97% of total billed charges,343.5,75,,,percent of total billed charges,75% of total billed charges,439.68,96,,,percent of total billed charges,96% of total billed charges,17.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.5,75,,,percent of total billed charges,75% of total billed charges,343.5,75,,,percent of total billed charges,75% of total billed charges,17.59,444.26,
PF REPLACE TUNNELED CV CATHETER W/SUBQ PORT,78002247P,CDM,975,RC,36582,HCPCS,Outpatient,,,718,538.5,,660.56,92,,,percent of total billed charges,92% of total billed charges,33.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,667.74,93,,,percent of total billed charges,93% of total billed charges,646.2,90,,,percent of total billed charges,90% of total billed charges,646.2,90,,,percent of total billed charges,90% of total billed charges,696.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,696.46,97,,,percent of total billed charges,97% of total billed charges,538.5,75,,,percent of total billed charges,75% of total billed charges,689.28,96,,,percent of total billed charges,96% of total billed charges,33.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,538.5,75,,,percent of total billed charges,75% of total billed charges,538.5,75,,,percent of total billed charges,75% of total billed charges,33.09,696.46,
PF REPLACE TUNNELED CV CATHETER W/SUBQ PUMP,78002249P,CDM,975,RC,36583,HCPCS,Outpatient,,,816,612,,750.72,92,,,percent of total billed charges,92% of total billed charges,46.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,758.88,93,,,percent of total billed charges,93% of total billed charges,734.4,90,,,percent of total billed charges,90% of total billed charges,734.4,90,,,percent of total billed charges,90% of total billed charges,791.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,791.52,97,,,percent of total billed charges,97% of total billed charges,612,75,,,percent of total billed charges,75% of total billed charges,783.36,96,,,percent of total billed charges,96% of total billed charges,46.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,612,75,,,percent of total billed charges,75% of total billed charges,612,75,,,percent of total billed charges,75% of total billed charges,46.33,791.52,
PF REPLACE PICC W/O PORT/PUMP THROUGH ACCESS SITE,78002251P,CDM,975,RC,36584,HCPCS,Outpatient,,,154,115.5,,141.68,92,,,percent of total billed charges,92% of total billed charges,5.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.22,93,,,percent of total billed charges,93% of total billed charges,138.6,90,,,percent of total billed charges,90% of total billed charges,138.6,90,,,percent of total billed charges,90% of total billed charges,149.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,149.38,97,,,percent of total billed charges,97% of total billed charges,115.5,75,,,percent of total billed charges,75% of total billed charges,147.84,96,,,percent of total billed charges,96% of total billed charges,5.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,115.5,75,,,percent of total billed charges,75% of total billed charges,115.5,75,,,percent of total billed charges,75% of total billed charges,5.22,149.38,
PF REPLACE PICC VAD CATH W/PORT THROUGH ACCESS SITE,78002253P,CDM,975,RC,36585,HCPCS,Outpatient,,,744,558,,684.48,92,,,percent of total billed charges,92% of total billed charges,28.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,691.92,93,,,percent of total billed charges,93% of total billed charges,669.6,90,,,percent of total billed charges,90% of total billed charges,669.6,90,,,percent of total billed charges,90% of total billed charges,721.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,721.68,97,,,percent of total billed charges,97% of total billed charges,558,75,,,percent of total billed charges,75% of total billed charges,714.24,96,,,percent of total billed charges,96% of total billed charges,28.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,558,75,,,percent of total billed charges,75% of total billed charges,558,75,,,percent of total billed charges,75% of total billed charges,28.21,721.68,
PF RMVL TUN CVC W/O SUBQ PORT/PMP,78001330P,CDM,975,RC,36589,HCPCS,Outpatient,,,932,699,,857.44,92,,,percent of total billed charges,92% of total billed charges,13.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,866.76,93,,,percent of total billed charges,93% of total billed charges,838.8,90,,,percent of total billed charges,90% of total billed charges,838.8,90,,,percent of total billed charges,90% of total billed charges,904.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,904.04,97,,,percent of total billed charges,97% of total billed charges,699,75,,,percent of total billed charges,75% of total billed charges,894.72,96,,,percent of total billed charges,96% of total billed charges,13.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699,75,,,percent of total billed charges,75% of total billed charges,699,75,,,percent of total billed charges,75% of total billed charges,13.86,904.04,
PF REMOVE TUNNELED CTR VAD W/SUBQ PORT/PUMP,78001332P,CDM,975,RC,36590,HCPCS,Outpatient,,,1113,834.75,,1023.96,92,,,percent of total billed charges,92% of total billed charges,21.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1035.09,93,,,percent of total billed charges,93% of total billed charges,1001.7,90,,,percent of total billed charges,90% of total billed charges,1001.7,90,,,percent of total billed charges,90% of total billed charges,1079.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1079.61,97,,,percent of total billed charges,97% of total billed charges,834.75,75,,,percent of total billed charges,75% of total billed charges,1068.48,96,,,percent of total billed charges,96% of total billed charges,21.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,834.75,75,,,percent of total billed charges,75% of total billed charges,834.75,75,,,percent of total billed charges,75% of total billed charges,21.12,1079.61,
PF COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE,78001334P,CDM,975,RC,36591,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges,1.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.96,93,,,percent of total billed charges,93% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,69.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.84,97,,,percent of total billed charges,97% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,69.12,96,,,percent of total billed charges,96% of total billed charges,1.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54,75,,,percent of total billed charges,75% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,1.23,69.84,
PF COLLECT BLOOD FROM CATHETER VENOUS NOS,78001336P,CDM,975,RC,36592,HCPCS,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges,1.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.4,93,,,percent of total billed charges,93% of total billed charges,72,90,,,percent of total billed charges,90% of total billed charges,72,90,,,percent of total billed charges,90% of total billed charges,77.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,77.6,97,,,percent of total billed charges,97% of total billed charges,60,75,,,percent of total billed charges,75% of total billed charges,76.8,96,,,percent of total billed charges,96% of total billed charges,1.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,60,75,,,percent of total billed charges,75% of total billed charges,60,75,,,percent of total billed charges,75% of total billed charges,1.31,77.6,
PF DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH,78001338P,CDM,975,RC,36593,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.74,85.36,
PF INJECTION CONTRAST TO EVALUATE CVA DEVICE,78002842P,CDM,975,RC,36598,HCPCS,Outpatient,,,306,229.5,,281.52,92,,,percent of total billed charges,92% of total billed charges,3.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.58,93,,,percent of total billed charges,93% of total billed charges,275.4,90,,,percent of total billed charges,90% of total billed charges,275.4,90,,,percent of total billed charges,90% of total billed charges,296.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.82,97,,,percent of total billed charges,97% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges,293.76,96,,,percent of total billed charges,96% of total billed charges,3.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,229.5,75,,,percent of total billed charges,75% of total billed charges,229.5,75,,,percent of total billed charges,75% of total billed charges,3.1,296.82,
PF ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,78001340P,CDM,975,RC,36600,HCPCS,Outpatient,,,169,126.75,,155.48,92,,,percent of total billed charges,92% of total billed charges,1.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,157.17,93,,,percent of total billed charges,93% of total billed charges,152.1,90,,,percent of total billed charges,90% of total billed charges,152.1,90,,,percent of total billed charges,90% of total billed charges,163.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.93,97,,,percent of total billed charges,97% of total billed charges,126.75,75,,,percent of total billed charges,75% of total billed charges,162.24,96,,,percent of total billed charges,96% of total billed charges,1.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126.75,75,,,percent of total billed charges,75% of total billed charges,126.75,75,,,percent of total billed charges,75% of total billed charges,1.05,163.93,
PF ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ,78001342P,CDM,975,RC,36620,HCPCS,Outpatient,,,174,130.5,,160.08,92,,,percent of total billed charges,92% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.82,93,,,percent of total billed charges,93% of total billed charges,156.6,90,,,percent of total billed charges,90% of total billed charges,156.6,90,,,percent of total billed charges,90% of total billed charges,168.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.78,97,,,percent of total billed charges,97% of total billed charges,130.5,75,,,percent of total billed charges,75% of total billed charges,167.04,96,,,percent of total billed charges,96% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.5,75,,,percent of total billed charges,75% of total billed charges,130.5,75,,,percent of total billed charges,75% of total billed charges,3.94,168.78,
PF INSERT ARTERIAL CATHETER FOR BLOOD SAMPLING OR INFUSION,78002266P,CDM,975,RC,36625,HCPCS,Outpatient,,,277,207.75,,254.84,92,,,percent of total billed charges,92% of total billed charges,12.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,257.61,93,,,percent of total billed charges,93% of total billed charges,249.3,90,,,percent of total billed charges,90% of total billed charges,249.3,90,,,percent of total billed charges,90% of total billed charges,268.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,268.69,97,,,percent of total billed charges,97% of total billed charges,207.75,75,,,percent of total billed charges,75% of total billed charges,265.92,96,,,percent of total billed charges,96% of total billed charges,12.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,207.75,75,,,percent of total billed charges,75% of total billed charges,207.75,75,,,percent of total billed charges,75% of total billed charges,12.52,268.69,
PF CATHETERIZATION UMBILICAL NEWBORN ARTERY,78001345P,CDM,975,RC,36660,HCPCS,Outpatient,,,1033,774.75,,950.36,92,,,percent of total billed charges,92% of total billed charges,5.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,960.69,93,,,percent of total billed charges,93% of total billed charges,929.7,90,,,percent of total billed charges,90% of total billed charges,929.7,90,,,percent of total billed charges,90% of total billed charges,1002.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1002.01,97,,,percent of total billed charges,97% of total billed charges,774.75,75,,,percent of total billed charges,75% of total billed charges,991.68,96,,,percent of total billed charges,96% of total billed charges,5.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,774.75,75,,,percent of total billed charges,75% of total billed charges,774.75,75,,,percent of total billed charges,75% of total billed charges,5.03,1002.01,
PF PLACEMENT NEEDLE INTRAOSSEOUS INFUSION,78001346P,CDM,975,RC,36680,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.48,93,,,percent of total billed charges,93% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,228.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.92,97,,,percent of total billed charges,97% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,226.56,96,,,percent of total billed charges,96% of total billed charges,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177,75,,,percent of total billed charges,75% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,8.01,228.92,
PF THROMBOLYSIS CEREBRAL IV INFUSION,78001348P,CDM,975,RC,37195,HCPCS,Outpatient,,,2584,1938,,2377.28,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,2403.12,93,,,percent of total billed charges,93% of total billed charges,2325.6,90,,,percent of total billed charges,90% of total billed charges,2325.6,90,,,percent of total billed charges,90% of total billed charges,2506.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2506.48,97,,,percent of total billed charges,97% of total billed charges,1938,75,,,percent of total billed charges,75% of total billed charges,2480.64,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,1938,75,,,percent of total billed charges,75% of total billed charges,1938,75,,,percent of total billed charges,75% of total billed charges,1938,2506.48,
PF VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE,78001350P,CDM,975,RC,37244,HCPCS,Outpatient,,,2639,1979.25,,2427.88,92,,,percent of total billed charges,92% of total billed charges,62.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2454.27,93,,,percent of total billed charges,93% of total billed charges,2375.1,90,,,percent of total billed charges,90% of total billed charges,2375.1,90,,,percent of total billed charges,90% of total billed charges,2559.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,62.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2559.83,97,,,percent of total billed charges,97% of total billed charges,1979.25,75,,,percent of total billed charges,75% of total billed charges,2533.44,96,,,percent of total billed charges,96% of total billed charges,62.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1979.25,75,,,percent of total billed charges,75% of total billed charges,1979.25,75,,,percent of total billed charges,75% of total billed charges,62.75,2559.83,
PF LIGATION/BIOPSY TEMPORAL ARTERY,78001351P,CDM,975,RC,37609,HCPCS,Outpatient,,,1200,900,,1104,92,,,percent of total billed charges,92% of total billed charges,24.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1116,93,,,percent of total billed charges,93% of total billed charges,1080,90,,,percent of total billed charges,90% of total billed charges,1080,90,,,percent of total billed charges,90% of total billed charges,1164,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1164,97,,,percent of total billed charges,97% of total billed charges,900,75,,,percent of total billed charges,75% of total billed charges,1152,96,,,percent of total billed charges,96% of total billed charges,24.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900,75,,,percent of total billed charges,75% of total billed charges,900,75,,,percent of total billed charges,75% of total billed charges,24.4,1164,
PF LIG and DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ,78001352P,CDM,975,RC,37700,HCPCS,Outpatient,,,1029,771.75,,946.68,92,,,percent of total billed charges,92% of total billed charges,34.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,956.97,93,,,percent of total billed charges,93% of total billed charges,926.1,90,,,percent of total billed charges,90% of total billed charges,926.1,90,,,percent of total billed charges,90% of total billed charges,998.13,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,34.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,998.13,97,,,percent of total billed charges,97% of total billed charges,771.75,75,,,percent of total billed charges,75% of total billed charges,987.84,96,,,percent of total billed charges,96% of total billed charges,34.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,771.75,75,,,percent of total billed charges,75% of total billed charges,771.75,75,,,percent of total billed charges,75% of total billed charges,34.13,998.13,
PF SPLENECTOMY TOTAL SEPARATE PROCEDURE,78001354P,CDM,975,RC,38100,HCPCS,Outpatient,,,5111,3833.25,,4702.12,92,,,percent of total billed charges,92% of total billed charges,167.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4753.23,93,,,percent of total billed charges,93% of total billed charges,4599.9,90,,,percent of total billed charges,90% of total billed charges,4599.9,90,,,percent of total billed charges,90% of total billed charges,4957.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,167.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4957.67,97,,,percent of total billed charges,97% of total billed charges,3833.25,75,,,percent of total billed charges,75% of total billed charges,4906.56,96,,,percent of total billed charges,96% of total billed charges,167.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3833.25,75,,,percent of total billed charges,75% of total billed charges,3833.25,75,,,percent of total billed charges,75% of total billed charges,167.17,4957.67,
PF MARROW ASPIRATION ONLY,78001355P,CDM,975,RC,38220,HCPCS,Outpatient,,,179,134.25,,164.68,92,,,percent of total billed charges,92% of total billed charges,5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,166.47,93,,,percent of total billed charges,93% of total billed charges,161.1,90,,,percent of total billed charges,90% of total billed charges,161.1,90,,,percent of total billed charges,90% of total billed charges,173.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,173.63,97,,,percent of total billed charges,97% of total billed charges,134.25,75,,,percent of total billed charges,75% of total billed charges,171.84,96,,,percent of total billed charges,96% of total billed charges,5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,134.25,75,,,percent of total billed charges,75% of total billed charges,134.25,75,,,percent of total billed charges,75% of total billed charges,5,173.63,
PF BONE MARROW BIOPSY NEEDLE/TROCAR,78001357P,CDM,975,RC,38221,HCPCS,Outpatient,,,187,140.25,,172.04,92,,,percent of total billed charges,92% of total billed charges,5.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,173.91,93,,,percent of total billed charges,93% of total billed charges,168.3,90,,,percent of total billed charges,90% of total billed charges,168.3,90,,,percent of total billed charges,90% of total billed charges,181.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.39,97,,,percent of total billed charges,97% of total billed charges,140.25,75,,,percent of total billed charges,75% of total billed charges,179.52,96,,,percent of total billed charges,96% of total billed charges,5.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,140.25,75,,,percent of total billed charges,75% of total billed charges,140.25,75,,,percent of total billed charges,75% of total billed charges,5.11,181.39,
PF BX/EXC LYMPH NODE OPEN SUPERFICIAL,78001359P,CDM,975,RC,38500,HCPCS,Outpatient,,,879,659.25,,808.68,92,,,percent of total billed charges,92% of total billed charges,33.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,817.47,93,,,percent of total billed charges,93% of total billed charges,791.1,90,,,percent of total billed charges,90% of total billed charges,791.1,90,,,percent of total billed charges,90% of total billed charges,852.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,852.63,97,,,percent of total billed charges,97% of total billed charges,659.25,75,,,percent of total billed charges,75% of total billed charges,843.84,96,,,percent of total billed charges,96% of total billed charges,33.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,659.25,75,,,percent of total billed charges,75% of total billed charges,659.25,75,,,percent of total billed charges,75% of total billed charges,33.28,852.63,
PF BIOPSY OR EXCISION OF LYMPH NODE(S) SUPERFICIAL,78002201P,CDM,975,RC,38505,HCPCS,Outpatient,,,225,168.75,,207,92,,,percent of total billed charges,92% of total billed charges,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,209.25,93,,,percent of total billed charges,93% of total billed charges,202.5,90,,,percent of total billed charges,90% of total billed charges,202.5,90,,,percent of total billed charges,90% of total billed charges,218.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.25,97,,,percent of total billed charges,97% of total billed charges,168.75,75,,,percent of total billed charges,75% of total billed charges,216,96,,,percent of total billed charges,96% of total billed charges,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.75,75,,,percent of total billed charges,75% of total billed charges,168.75,75,,,percent of total billed charges,75% of total billed charges,7.25,218.25,
PF OPEN BIOPSY/EXCISION OF LYMPH NODES OF GROIN,78002861P,CDM,975,RC,38531,HCPCS,Outpatient,,,1107,830.25,,1018.44,92,,,percent of total billed charges,92% of total billed charges,59.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1029.51,93,,,percent of total billed charges,93% of total billed charges,996.3,90,,,percent of total billed charges,90% of total billed charges,996.3,90,,,percent of total billed charges,90% of total billed charges,1073.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,59.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1073.79,97,,,percent of total billed charges,97% of total billed charges,830.25,75,,,percent of total billed charges,75% of total billed charges,1062.72,96,,,percent of total billed charges,96% of total billed charges,59.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,830.25,75,,,percent of total billed charges,75% of total billed charges,830.25,75,,,percent of total billed charges,75% of total billed charges,59.51,1073.79,
PF AXILLARY LYMPHADENECTOMY COMPLETE,78001361P,CDM,975,RC,38745,HCPCS,Outpatient,,,4356,3267,,4007.52,92,,,percent of total billed charges,92% of total billed charges,125.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4051.08,93,,,percent of total billed charges,93% of total billed charges,3920.4,90,,,percent of total billed charges,90% of total billed charges,3920.4,90,,,percent of total billed charges,90% of total billed charges,4225.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,125.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4225.32,97,,,percent of total billed charges,97% of total billed charges,3267,75,,,percent of total billed charges,75% of total billed charges,4181.76,96,,,percent of total billed charges,96% of total billed charges,125.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3267,75,,,percent of total billed charges,75% of total billed charges,3267,75,,,percent of total billed charges,75% of total billed charges,125.06,4225.32,
PF BIOPSY OF LIP,78001362P,CDM,975,RC,40490,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.05,93,,,percent of total billed charges,93% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,179.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.45,97,,,percent of total billed charges,97% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,177.6,96,,,percent of total billed charges,96% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,5.9,179.45,
PF DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL,78001364P,CDM,975,RC,40800,HCPCS,Outpatient,,,332,249,,305.44,92,,,percent of total billed charges,92% of total billed charges,7.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,308.76,93,,,percent of total billed charges,93% of total billed charges,298.8,90,,,percent of total billed charges,90% of total billed charges,298.8,90,,,percent of total billed charges,90% of total billed charges,322.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,322.04,97,,,percent of total billed charges,97% of total billed charges,249,75,,,percent of total billed charges,75% of total billed charges,318.72,96,,,percent of total billed charges,96% of total billed charges,7.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249,75,,,percent of total billed charges,75% of total billed charges,249,75,,,percent of total billed charges,75% of total billed charges,7.65,322.04,
PF REMOVE EMBEDDED FB VESTIBULE MOUTH SIMPLE,78001366P,CDM,975,RC,40804,HCPCS,Outpatient,,,464,348,,426.88,92,,,percent of total billed charges,92% of total billed charges,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,431.52,93,,,percent of total billed charges,93% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,450.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,450.08,97,,,percent of total billed charges,97% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,445.44,96,,,percent of total billed charges,96% of total billed charges,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,348,75,,,percent of total billed charges,75% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,8.03,450.08,
PF REMOVE EMBEDDED FB VESTIBULE MOUTH COMP,78001368P,CDM,975,RC,40805,HCPCS,Outpatient,,,822,616.5,,756.24,92,,,percent of total billed charges,92% of total billed charges,13.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,764.46,93,,,percent of total billed charges,93% of total billed charges,739.8,90,,,percent of total billed charges,90% of total billed charges,739.8,90,,,percent of total billed charges,90% of total billed charges,797.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,797.34,97,,,percent of total billed charges,97% of total billed charges,616.5,75,,,percent of total billed charges,75% of total billed charges,789.12,96,,,percent of total billed charges,96% of total billed charges,13.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,616.5,75,,,percent of total billed charges,75% of total billed charges,616.5,75,,,percent of total billed charges,75% of total billed charges,13.89,797.34,
PF BIOPSY VESTIBULE OF MOUTH,78002452P,CDM,975,RC,40808,HCPCS,Outpatient,,,435,326.25,,400.2,92,,,percent of total billed charges,92% of total billed charges,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,404.55,93,,,percent of total billed charges,93% of total billed charges,391.5,90,,,percent of total billed charges,90% of total billed charges,391.5,90,,,percent of total billed charges,90% of total billed charges,421.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,421.95,97,,,percent of total billed charges,97% of total billed charges,326.25,75,,,percent of total billed charges,75% of total billed charges,417.6,96,,,percent of total billed charges,96% of total billed charges,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,326.25,75,,,percent of total billed charges,75% of total billed charges,326.25,75,,,percent of total billed charges,75% of total billed charges,6.62,421.95,
PF CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<,78001370P,CDM,975,RC,40830,HCPCS,Outpatient,,,729,546.75,,670.68,92,,,percent of total billed charges,92% of total billed charges,10.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,677.97,93,,,percent of total billed charges,93% of total billed charges,656.1,90,,,percent of total billed charges,90% of total billed charges,656.1,90,,,percent of total billed charges,90% of total billed charges,707.13,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,707.13,97,,,percent of total billed charges,97% of total billed charges,546.75,75,,,percent of total billed charges,75% of total billed charges,699.84,96,,,percent of total billed charges,96% of total billed charges,10.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546.75,75,,,percent of total billed charges,75% of total billed charges,546.75,75,,,percent of total billed charges,75% of total billed charges,10.72,707.13,
PF CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL,78001372P,CDM,975,RC,40831,HCPCS,Outpatient,,,1744,1308,,1604.48,92,,,percent of total billed charges,92% of total billed charges,14.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1621.92,93,,,percent of total billed charges,93% of total billed charges,1569.6,90,,,percent of total billed charges,90% of total billed charges,1569.6,90,,,percent of total billed charges,90% of total billed charges,1691.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1691.68,97,,,percent of total billed charges,97% of total billed charges,1308,75,,,percent of total billed charges,75% of total billed charges,1674.24,96,,,percent of total billed charges,96% of total billed charges,14.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1308,75,,,percent of total billed charges,75% of total billed charges,1308,75,,,percent of total billed charges,75% of total billed charges,14.8,1691.68,
PF INCISION OF TONGUE FOLD,78002803P,CDM,975,RC,41010,HCPCS,Outpatient,,,567.8,425.85,,522.38,92,,,percent of total billed charges,92% of total billed charges,8.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,528.05,93,,,percent of total billed charges,93% of total billed charges,511.02,90,,,percent of total billed charges,90% of total billed charges,511.02,90,,,percent of total billed charges,90% of total billed charges,550.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,550.77,97,,,percent of total billed charges,97% of total billed charges,425.85,75,,,percent of total billed charges,75% of total billed charges,545.09,96,,,percent of total billed charges,96% of total billed charges,8.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,425.85,75,,,percent of total billed charges,75% of total billed charges,425.85,75,,,percent of total billed charges,75% of total billed charges,8.17,550.77,
PF EXCISION OF TONGUE FOLD,78002267P,CDM,975,RC,41115,HCPCS,Outpatient,,,680,510,,625.6,92,,,percent of total billed charges,92% of total billed charges,11.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,632.4,93,,,percent of total billed charges,93% of total billed charges,612,90,,,percent of total billed charges,90% of total billed charges,612,90,,,percent of total billed charges,90% of total billed charges,659.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,659.6,97,,,percent of total billed charges,97% of total billed charges,510,75,,,percent of total billed charges,75% of total billed charges,652.8,96,,,percent of total billed charges,96% of total billed charges,11.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,510,75,,,percent of total billed charges,75% of total billed charges,510,75,,,percent of total billed charges,75% of total billed charges,11.87,659.6,
PF REPAIR LAC 2.5 CM/< MOUTH and /ANT TWO-THIRDS TONG,78001374P,CDM,975,RC,41250,HCPCS,Outpatient,,,604,453,,555.68,92,,,percent of total billed charges,92% of total billed charges,15.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,561.72,93,,,percent of total billed charges,93% of total billed charges,543.6,90,,,percent of total billed charges,90% of total billed charges,543.6,90,,,percent of total billed charges,90% of total billed charges,585.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,585.88,97,,,percent of total billed charges,97% of total billed charges,453,75,,,percent of total billed charges,75% of total billed charges,579.84,96,,,percent of total billed charges,96% of total billed charges,15.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,453,75,,,percent of total billed charges,75% of total billed charges,453,75,,,percent of total billed charges,75% of total billed charges,15.65,585.88,
PF RPR LAC 2.5 CM/< PST ONE-THIRD TONGUE,78001376P,CDM,975,RC,41251,HCPCS,Outpatient,,,717,537.75,,659.64,92,,,percent of total billed charges,92% of total billed charges,19.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,666.81,93,,,percent of total billed charges,93% of total billed charges,645.3,90,,,percent of total billed charges,90% of total billed charges,645.3,90,,,percent of total billed charges,90% of total billed charges,695.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,695.49,97,,,percent of total billed charges,97% of total billed charges,537.75,75,,,percent of total billed charges,75% of total billed charges,688.32,96,,,percent of total billed charges,96% of total billed charges,19.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,537.75,75,,,percent of total billed charges,75% of total billed charges,537.75,75,,,percent of total billed charges,75% of total billed charges,19.67,695.49,
PF REPAIR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX,78001378P,CDM,975,RC,41252,HCPCS,Outpatient,,,820,615,,754.4,92,,,percent of total billed charges,92% of total billed charges,20.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,762.6,93,,,percent of total billed charges,93% of total billed charges,738,90,,,percent of total billed charges,90% of total billed charges,738,90,,,percent of total billed charges,90% of total billed charges,795.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,795.4,97,,,percent of total billed charges,97% of total billed charges,615,75,,,percent of total billed charges,75% of total billed charges,787.2,96,,,percent of total billed charges,96% of total billed charges,20.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,615,75,,,percent of total billed charges,75% of total billed charges,615,75,,,percent of total billed charges,75% of total billed charges,20.8,795.4,
PF DRAINAGE OF GUM LESION,78001380P,CDM,975,RC,41800,HCPCS,Outpatient,,,332,249,,305.44,92,,,percent of total billed charges,92% of total billed charges,11.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,308.76,93,,,percent of total billed charges,93% of total billed charges,298.8,90,,,percent of total billed charges,90% of total billed charges,298.8,90,,,percent of total billed charges,90% of total billed charges,322.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,322.04,97,,,percent of total billed charges,97% of total billed charges,249,75,,,percent of total billed charges,75% of total billed charges,318.72,96,,,percent of total billed charges,96% of total billed charges,11.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249,75,,,percent of total billed charges,75% of total billed charges,249,75,,,percent of total billed charges,75% of total billed charges,11.33,322.04,
PF DRAINAGE ABSCESS PALATE UVULA,78001382P,CDM,975,RC,42000,HCPCS,Outpatient,,,334,250.5,,307.28,92,,,percent of total billed charges,92% of total billed charges,8.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,310.62,93,,,percent of total billed charges,93% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,300.6,90,,,percent of total billed charges,90% of total billed charges,323.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,323.98,97,,,percent of total billed charges,97% of total billed charges,250.5,75,,,percent of total billed charges,75% of total billed charges,320.64,96,,,percent of total billed charges,96% of total billed charges,8.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,250.5,75,,,percent of total billed charges,75% of total billed charges,250.5,75,,,percent of total billed charges,75% of total billed charges,8.96,323.98,
PF BIOPSY OROPHARYNX,78001386P,CDM,975,RC,42800,HCPCS,Outpatient,,,567,425.25,,521.64,92,,,percent of total billed charges,92% of total billed charges,9.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,527.31,93,,,percent of total billed charges,93% of total billed charges,510.3,90,,,percent of total billed charges,90% of total billed charges,510.3,90,,,percent of total billed charges,90% of total billed charges,549.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,549.99,97,,,percent of total billed charges,97% of total billed charges,425.25,75,,,percent of total billed charges,75% of total billed charges,544.32,96,,,percent of total billed charges,96% of total billed charges,9.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,425.25,75,,,percent of total billed charges,75% of total billed charges,425.25,75,,,percent of total billed charges,75% of total billed charges,9.78,549.99,
PF REMOVAL FOREIGN BODY PHARYNX,78001388P,CDM,975,RC,42809,HCPCS,Outpatient,,,486,364.5,,447.12,92,,,percent of total billed charges,92% of total billed charges,12.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,451.98,93,,,percent of total billed charges,93% of total billed charges,437.4,90,,,percent of total billed charges,90% of total billed charges,437.4,90,,,percent of total billed charges,90% of total billed charges,471.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,471.42,97,,,percent of total billed charges,97% of total billed charges,364.5,75,,,percent of total billed charges,75% of total billed charges,466.56,96,,,percent of total billed charges,96% of total billed charges,12.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,364.5,75,,,percent of total billed charges,75% of total billed charges,364.5,75,,,percent of total billed charges,75% of total billed charges,12.56,471.42,
PF TONSILLECTOMY  and  ADENOIDECTOMY <AGE 12,78001390P,CDM,975,RC,42820,HCPCS,Outpatient,,,773,579.75,,711.16,92,,,percent of total billed charges,92% of total billed charges,26.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,718.89,93,,,percent of total billed charges,93% of total billed charges,695.7,90,,,percent of total billed charges,90% of total billed charges,695.7,90,,,percent of total billed charges,90% of total billed charges,749.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,749.81,97,,,percent of total billed charges,97% of total billed charges,579.75,75,,,percent of total billed charges,75% of total billed charges,742.08,96,,,percent of total billed charges,96% of total billed charges,26.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,579.75,75,,,percent of total billed charges,75% of total billed charges,579.75,75,,,percent of total billed charges,75% of total billed charges,26.73,749.81,
PF TONSILLECTOMY  and  ADENOIDECTOMY AGE 12/>,78001393P,CDM,975,RC,42821,HCPCS,Outpatient,,,808,606,,743.36,92,,,percent of total billed charges,92% of total billed charges,27.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,751.44,93,,,percent of total billed charges,93% of total billed charges,727.2,90,,,percent of total billed charges,90% of total billed charges,727.2,90,,,percent of total billed charges,90% of total billed charges,783.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,783.76,97,,,percent of total billed charges,97% of total billed charges,606,75,,,percent of total billed charges,75% of total billed charges,775.68,96,,,percent of total billed charges,96% of total billed charges,27.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,606,75,,,percent of total billed charges,75% of total billed charges,606,75,,,percent of total billed charges,75% of total billed charges,27.72,783.76,
PF TONSILLECTOMY ONE-HALF <AGE 12,78001396P,CDM,975,RC,42825,HCPCS,Outpatient,,,1490,1117.5,,1370.8,92,,,percent of total billed charges,92% of total billed charges,22.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1385.7,93,,,percent of total billed charges,93% of total billed charges,1341,90,,,percent of total billed charges,90% of total billed charges,1341,90,,,percent of total billed charges,90% of total billed charges,1445.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1445.3,97,,,percent of total billed charges,97% of total billed charges,1117.5,75,,,percent of total billed charges,75% of total billed charges,1430.4,96,,,percent of total billed charges,96% of total billed charges,22.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1117.5,75,,,percent of total billed charges,75% of total billed charges,1117.5,75,,,percent of total billed charges,75% of total billed charges,22.97,1445.3,
PF TONSILLECTOMY ONE-HALF AGE 12/>,78001397P,CDM,975,RC,42826,HCPCS,Outpatient,,,1631,1223.25,,1500.52,92,,,percent of total billed charges,92% of total billed charges,22.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1516.83,93,,,percent of total billed charges,93% of total billed charges,1467.9,90,,,percent of total billed charges,90% of total billed charges,1467.9,90,,,percent of total billed charges,90% of total billed charges,1582.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1582.07,97,,,percent of total billed charges,97% of total billed charges,1223.25,75,,,percent of total billed charges,75% of total billed charges,1565.76,96,,,percent of total billed charges,96% of total billed charges,22.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1223.25,75,,,percent of total billed charges,75% of total billed charges,1223.25,75,,,percent of total billed charges,75% of total billed charges,22.52,1582.07,
PF CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE,78001398P,CDM,975,RC,42960,HCPCS,Outpatient,,,720,540,,662.4,92,,,percent of total billed charges,92% of total billed charges,15.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,669.6,93,,,percent of total billed charges,93% of total billed charges,648,90,,,percent of total billed charges,90% of total billed charges,648,90,,,percent of total billed charges,90% of total billed charges,698.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,698.4,97,,,percent of total billed charges,97% of total billed charges,540,75,,,percent of total billed charges,75% of total billed charges,691.2,96,,,percent of total billed charges,96% of total billed charges,15.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,540,75,,,percent of total billed charges,75% of total billed charges,540,75,,,percent of total billed charges,75% of total billed charges,15.37,698.4,
PF CONTROL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS,78001400P,CDM,975,RC,42970,HCPCS,Outpatient,,,1097,822.75,,1009.24,92,,,percent of total billed charges,92% of total billed charges,37.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1020.21,93,,,percent of total billed charges,93% of total billed charges,987.3,90,,,percent of total billed charges,90% of total billed charges,987.3,90,,,percent of total billed charges,90% of total billed charges,1064.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1064.09,97,,,percent of total billed charges,97% of total billed charges,822.75,75,,,percent of total billed charges,75% of total billed charges,1053.12,96,,,percent of total billed charges,96% of total billed charges,37.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,822.75,75,,,percent of total billed charges,75% of total billed charges,822.75,75,,,percent of total billed charges,75% of total billed charges,37.41,1064.09,
PF CRICOPHARYNGEAL MYOTOMY,78001404P,CDM,975,RC,43030,HCPCS,Outpatient,,,3940,2955,,3624.8,92,,,percent of total billed charges,92% of total billed charges,51.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3664.2,93,,,percent of total billed charges,93% of total billed charges,3546,90,,,percent of total billed charges,90% of total billed charges,3546,90,,,percent of total billed charges,90% of total billed charges,3821.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,51.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3821.8,97,,,percent of total billed charges,97% of total billed charges,2955,75,,,percent of total billed charges,75% of total billed charges,3782.4,96,,,percent of total billed charges,96% of total billed charges,51.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2955,75,,,percent of total billed charges,75% of total billed charges,2955,75,,,percent of total billed charges,75% of total billed charges,51.88,3821.8,
PF DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR,78001405P,CDM,975,RC,43130,HCPCS,Outpatient,,,2940,2205,,2704.8,92,,,percent of total billed charges,92% of total billed charges,89.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2734.2,93,,,percent of total billed charges,93% of total billed charges,2646,90,,,percent of total billed charges,90% of total billed charges,2646,90,,,percent of total billed charges,90% of total billed charges,2851.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,89.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2851.8,97,,,percent of total billed charges,97% of total billed charges,2205,75,,,percent of total billed charges,75% of total billed charges,2822.4,96,,,percent of total billed charges,96% of total billed charges,89.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2205,75,,,percent of total billed charges,75% of total billed charges,2205,75,,,percent of total billed charges,75% of total billed charges,89.1,2851.8,
PF ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BDY,78001406P,CDM,975,RC,43194,HCPCS,Outpatient,,,843,632.25,,775.56,92,,,percent of total billed charges,92% of total billed charges,21.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,783.99,93,,,percent of total billed charges,93% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,817.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,817.71,97,,,percent of total billed charges,97% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,809.28,96,,,percent of total billed charges,96% of total billed charges,21.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,632.25,75,,,percent of total billed charges,75% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,21.73,817.71,
PF ESOPHAGOSCOPY FLEXIBLE W/BRUSH,78002354P,CDM,975,RC,43200,HCPCS,Outpatient,,,222,166.5,,204.24,92,,,percent of total billed charges,92% of total billed charges,8.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,206.46,93,,,percent of total billed charges,93% of total billed charges,199.8,90,,,percent of total billed charges,90% of total billed charges,199.8,90,,,percent of total billed charges,90% of total billed charges,215.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,215.34,97,,,percent of total billed charges,97% of total billed charges,166.5,75,,,percent of total billed charges,75% of total billed charges,213.12,96,,,percent of total billed charges,96% of total billed charges,8.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,166.5,75,,,percent of total billed charges,75% of total billed charges,166.5,75,,,percent of total billed charges,75% of total billed charges,8.98,215.34,
PF ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,78001407P,CDM,975,RC,43235,HCPCS,Outpatient,,,1343,1007.25,,1235.56,92,,,percent of total billed charges,92% of total billed charges,11.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1248.99,93,,,percent of total billed charges,93% of total billed charges,1208.7,90,,,percent of total billed charges,90% of total billed charges,1208.7,90,,,percent of total billed charges,90% of total billed charges,1302.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1302.71,97,,,percent of total billed charges,97% of total billed charges,1007.25,75,,,percent of total billed charges,75% of total billed charges,1289.28,96,,,percent of total billed charges,96% of total billed charges,11.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1007.25,75,,,percent of total billed charges,75% of total billed charges,1007.25,75,,,percent of total billed charges,75% of total billed charges,11.23,1302.71,
PF ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION,78001408P,CDM,975,RC,43236,HCPCS,Outpatient,,,1464,1098,,1346.88,92,,,percent of total billed charges,92% of total billed charges,12.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1361.52,93,,,percent of total billed charges,93% of total billed charges,1317.6,90,,,percent of total billed charges,90% of total billed charges,1317.6,90,,,percent of total billed charges,90% of total billed charges,1420.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1420.08,97,,,percent of total billed charges,97% of total billed charges,1098,75,,,percent of total billed charges,75% of total billed charges,1405.44,96,,,percent of total billed charges,96% of total billed charges,12.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1098,75,,,percent of total billed charges,75% of total billed charges,1098,75,,,percent of total billed charges,75% of total billed charges,12.86,1420.08,
PF EGD TRANSORAL BIOPSY SINGLE/MULTIPLE,78001409P,CDM,975,RC,43239,HCPCS,Outpatient,,,1974,1480.5,,1816.08,92,,,percent of total billed charges,92% of total billed charges,12.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1835.82,93,,,percent of total billed charges,93% of total billed charges,1776.6,90,,,percent of total billed charges,90% of total billed charges,1776.6,90,,,percent of total billed charges,90% of total billed charges,1914.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1914.78,97,,,percent of total billed charges,97% of total billed charges,1480.5,75,,,percent of total billed charges,75% of total billed charges,1895.04,96,,,percent of total billed charges,96% of total billed charges,12.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1480.5,75,,,percent of total billed charges,75% of total billed charges,1480.5,75,,,percent of total billed charges,75% of total billed charges,12.86,1914.78,
PF EGD DILATION GASTRIC/DUODENAL STRICTURE,78001410P,CDM,975,RC,43245,HCPCS,Outpatient,,,1642,1231.5,,1510.64,92,,,percent of total billed charges,92% of total billed charges,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1527.06,93,,,percent of total billed charges,93% of total billed charges,1477.8,90,,,percent of total billed charges,90% of total billed charges,1477.8,90,,,percent of total billed charges,90% of total billed charges,1592.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1592.74,97,,,percent of total billed charges,97% of total billed charges,1231.5,75,,,percent of total billed charges,75% of total billed charges,1576.32,96,,,percent of total billed charges,96% of total billed charges,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1231.5,75,,,percent of total billed charges,75% of total billed charges,1231.5,75,,,percent of total billed charges,75% of total billed charges,17.91,1592.74,
PF EGD PLACE GASTROSTOMY TUBE,78002404P,CDM,975,RC,43246,HCPCS,Outpatient,,,508,381,,467.36,92,,,percent of total billed charges,92% of total billed charges,21.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,472.44,93,,,percent of total billed charges,93% of total billed charges,457.2,90,,,percent of total billed charges,90% of total billed charges,457.2,90,,,percent of total billed charges,90% of total billed charges,492.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,492.76,97,,,percent of total billed charges,97% of total billed charges,381,75,,,percent of total billed charges,75% of total billed charges,487.68,96,,,percent of total billed charges,96% of total billed charges,21.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,381,75,,,percent of total billed charges,75% of total billed charges,381,75,,,percent of total billed charges,75% of total billed charges,21.73,492.76,
PF EGD FLEXIBLE FOREIGN BODY REMOVAL,78001411P,CDM,975,RC,43247,HCPCS,Outpatient,,,486,364.5,,447.12,92,,,percent of total billed charges,92% of total billed charges,16.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,451.98,93,,,percent of total billed charges,93% of total billed charges,437.4,90,,,percent of total billed charges,90% of total billed charges,437.4,90,,,percent of total billed charges,90% of total billed charges,471.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,471.42,97,,,percent of total billed charges,97% of total billed charges,364.5,75,,,percent of total billed charges,75% of total billed charges,466.56,96,,,percent of total billed charges,96% of total billed charges,16.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,364.5,75,,,percent of total billed charges,75% of total billed charges,364.5,75,,,percent of total billed charges,75% of total billed charges,16.86,471.42,
PF EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS,78001412P,CDM,975,RC,43248,HCPCS,Outpatient,,,1517,1137.75,,1395.64,92,,,percent of total billed charges,92% of total billed charges,15.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1410.81,93,,,percent of total billed charges,93% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,1365.3,90,,,percent of total billed charges,90% of total billed charges,1471.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1471.49,97,,,percent of total billed charges,97% of total billed charges,1137.75,75,,,percent of total billed charges,75% of total billed charges,1456.32,96,,,percent of total billed charges,96% of total billed charges,15.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1137.75,75,,,percent of total billed charges,75% of total billed charges,1137.75,75,,,percent of total billed charges,75% of total billed charges,15.42,1471.49,
PF EGD BALLOON DILATION <30 MM,78002371P,CDM,975,RC,43249,HCPCS,Outpatient,,,388,291,,356.96,92,,,percent of total billed charges,92% of total billed charges,14.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,360.84,93,,,percent of total billed charges,93% of total billed charges,349.2,90,,,percent of total billed charges,90% of total billed charges,349.2,90,,,percent of total billed charges,90% of total billed charges,376.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,376.36,97,,,percent of total billed charges,97% of total billed charges,291,75,,,percent of total billed charges,75% of total billed charges,372.48,96,,,percent of total billed charges,96% of total billed charges,14.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,291,75,,,percent of total billed charges,75% of total billed charges,291,75,,,percent of total billed charges,75% of total billed charges,14.45,376.36,
PF EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEP,78001413P,CDM,975,RC,43250,HCPCS,Outpatient,,,464,348,,426.88,92,,,percent of total billed charges,92% of total billed charges,17.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,431.52,93,,,percent of total billed charges,93% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,450.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,450.08,97,,,percent of total billed charges,97% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,445.44,96,,,percent of total billed charges,96% of total billed charges,17.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,348,75,,,percent of total billed charges,75% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,17.45,450.08,
PF EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH,78001414P,CDM,975,RC,43251,HCPCS,Outpatient,,,1741,1305.75,,1601.72,92,,,percent of total billed charges,92% of total billed charges,18.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1619.13,93,,,percent of total billed charges,93% of total billed charges,1566.9,90,,,percent of total billed charges,90% of total billed charges,1566.9,90,,,percent of total billed charges,90% of total billed charges,1688.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1688.77,97,,,percent of total billed charges,97% of total billed charges,1305.75,75,,,percent of total billed charges,75% of total billed charges,1671.36,96,,,percent of total billed charges,96% of total billed charges,18.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1305.75,75,,,percent of total billed charges,75% of total billed charges,1305.75,75,,,percent of total billed charges,75% of total billed charges,18.05,1688.77,
PF EGD TRANSORAL CONTROL BLEEDING ANY METHOD,78001415P,CDM,975,RC,43255,HCPCS,Outpatient,,,688,516,,632.96,92,,,percent of total billed charges,92% of total billed charges,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,639.84,93,,,percent of total billed charges,93% of total billed charges,619.2,90,,,percent of total billed charges,90% of total billed charges,619.2,90,,,percent of total billed charges,90% of total billed charges,667.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,667.36,97,,,percent of total billed charges,97% of total billed charges,516,75,,,percent of total billed charges,75% of total billed charges,660.48,96,,,percent of total billed charges,96% of total billed charges,17.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,516,75,,,percent of total billed charges,75% of total billed charges,516,75,,,percent of total billed charges,75% of total billed charges,17.91,667.36,
PF DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MLT PASS,78001416P,CDM,975,RC,43450,HCPCS,Outpatient,,,1642,1231.5,,1510.64,92,,,percent of total billed charges,92% of total billed charges,7.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1527.06,93,,,percent of total billed charges,93% of total billed charges,1477.8,90,,,percent of total billed charges,90% of total billed charges,1477.8,90,,,percent of total billed charges,90% of total billed charges,1592.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1592.74,97,,,percent of total billed charges,97% of total billed charges,1231.5,75,,,percent of total billed charges,75% of total billed charges,1576.32,96,,,percent of total billed charges,96% of total billed charges,7.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1231.5,75,,,percent of total billed charges,75% of total billed charges,1231.5,75,,,percent of total billed charges,75% of total billed charges,7.07,1592.74,
PF GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER,78001417P,CDM,975,RC,43501,HCPCS,Outpatient,,,4955,3716.25,,4558.6,92,,,percent of total billed charges,92% of total billed charges,200.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4608.15,93,,,percent of total billed charges,93% of total billed charges,4459.5,90,,,percent of total billed charges,90% of total billed charges,4459.5,90,,,percent of total billed charges,90% of total billed charges,4806.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,200.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4806.35,97,,,percent of total billed charges,97% of total billed charges,3716.25,75,,,percent of total billed charges,75% of total billed charges,4756.8,96,,,percent of total billed charges,96% of total billed charges,200.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3716.25,75,,,percent of total billed charges,75% of total billed charges,3716.25,75,,,percent of total billed charges,75% of total billed charges,200.82,4806.35,
PF GASTRICT PARTIAL DISTAL W/GASTROJEJUNOSTOMY,78001418P,CDM,975,RC,43632,HCPCS,Outpatient,,,7672,5754,,7058.24,92,,,percent of total billed charges,92% of total billed charges,309.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7134.96,93,,,percent of total billed charges,93% of total billed charges,6904.8,90,,,percent of total billed charges,90% of total billed charges,6904.8,90,,,percent of total billed charges,90% of total billed charges,7441.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,309.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7441.84,97,,,percent of total billed charges,97% of total billed charges,5754,75,,,percent of total billed charges,75% of total billed charges,7365.12,96,,,percent of total billed charges,96% of total billed charges,309.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5754,75,,,percent of total billed charges,75% of total billed charges,5754,75,,,percent of total billed charges,75% of total billed charges,309.68,7441.84,
PF NASO/ORO-GASTRIC TUBE PLMT REQ PHYS  and  FLUOR GUIDE,78001419P,CDM,975,RC,43752,HCPCS,Outpatient,,,467,350.25,,429.64,92,,,percent of total billed charges,92% of total billed charges,4.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,434.31,93,,,percent of total billed charges,93% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,452.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,452.99,97,,,percent of total billed charges,97% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,448.32,96,,,percent of total billed charges,96% of total billed charges,4.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,350.25,75,,,percent of total billed charges,75% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,4.07,452.99,
PF GASTRIC INTUBATTION  and  ASPIRATION W/PHYS SKILL/LAVAGE,78001421P,CDM,975,RC,43753,HCPCS,Outpatient,,,396,297,,364.32,92,,,percent of total billed charges,92% of total billed charges,2.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,368.28,93,,,percent of total billed charges,93% of total billed charges,356.4,90,,,percent of total billed charges,90% of total billed charges,356.4,90,,,percent of total billed charges,90% of total billed charges,384.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,384.12,97,,,percent of total billed charges,97% of total billed charges,297,75,,,percent of total billed charges,75% of total billed charges,380.16,96,,,percent of total billed charges,96% of total billed charges,2.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297,75,,,percent of total billed charges,75% of total billed charges,297,75,,,percent of total billed charges,75% of total billed charges,2.91,384.12,
PF PERQ REPLACEMENT GTUBE NOT REQ REVISION GASTRICT TRACK,78001423P,CDM,975,RC,43762,HCPCS,Outpatient,,,149,111.75,,137.08,92,,,percent of total billed charges,92% of total billed charges,5.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.57,93,,,percent of total billed charges,93% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,134.1,90,,,percent of total billed charges,90% of total billed charges,144.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.53,97,,,percent of total billed charges,97% of total billed charges,111.75,75,,,percent of total billed charges,75% of total billed charges,143.04,96,,,percent of total billed charges,96% of total billed charges,5.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.75,75,,,percent of total billed charges,75% of total billed charges,111.75,75,,,percent of total billed charges,75% of total billed charges,5.08,144.53,
PF LAPAROSCOPY GASTRIC RESTRICTIVE DEVICE(S) REMVL,78002222P,CDM,975,RC,43774,HCPCS,Outpatient,,,1429,1071.75,,1314.68,92,,,percent of total billed charges,92% of total billed charges,142.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1328.97,93,,,percent of total billed charges,93% of total billed charges,1286.1,90,,,percent of total billed charges,90% of total billed charges,1286.1,90,,,percent of total billed charges,90% of total billed charges,1386.13,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,142.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1386.13,97,,,percent of total billed charges,97% of total billed charges,1071.75,75,,,percent of total billed charges,75% of total billed charges,1371.84,96,,,percent of total billed charges,96% of total billed charges,142.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1071.75,75,,,percent of total billed charges,75% of total billed charges,1071.75,75,,,percent of total billed charges,75% of total billed charges,142.34,1386.13,
PF GASTROSTOMY OPEN W/O CONSTRUCTION GASTRIC TUBE,78001425P,CDM,975,RC,43830,HCPCS,Outpatient,,,2560,1920,,2355.2,92,,,percent of total billed charges,92% of total billed charges,96.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2380.8,93,,,percent of total billed charges,93% of total billed charges,2304,90,,,percent of total billed charges,90% of total billed charges,2304,90,,,percent of total billed charges,90% of total billed charges,2483.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,96.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2483.2,97,,,percent of total billed charges,97% of total billed charges,1920,75,,,percent of total billed charges,75% of total billed charges,2457.6,96,,,percent of total billed charges,96% of total billed charges,96.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1920,75,,,percent of total billed charges,75% of total billed charges,1920,75,,,percent of total billed charges,75% of total billed charges,96.83,2483.2,
PF GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ,78001426P,CDM,975,RC,43840,HCPCS,Outpatient,,,4946,3709.5,,4550.32,92,,,percent of total billed charges,92% of total billed charges,200.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4599.78,93,,,percent of total billed charges,93% of total billed charges,4451.4,90,,,percent of total billed charges,90% of total billed charges,4451.4,90,,,percent of total billed charges,90% of total billed charges,4797.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,200.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4797.62,97,,,percent of total billed charges,97% of total billed charges,3709.5,75,,,percent of total billed charges,75% of total billed charges,4748.16,96,,,percent of total billed charges,96% of total billed charges,200.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3709.5,75,,,percent of total billed charges,75% of total billed charges,3709.5,75,,,percent of total billed charges,75% of total billed charges,200.8,4797.62,
PF ENTEROLSS FRING INTESTINAL ADHESION,78001427P,CDM,975,RC,44005,HCPCS,Outpatient,,,4335,3251.25,,3988.2,92,,,percent of total billed charges,92% of total billed charges,159.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4031.55,93,,,percent of total billed charges,93% of total billed charges,3901.5,90,,,percent of total billed charges,90% of total billed charges,3901.5,90,,,percent of total billed charges,90% of total billed charges,4204.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,159.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4204.95,97,,,percent of total billed charges,97% of total billed charges,3251.25,75,,,percent of total billed charges,75% of total billed charges,4161.6,96,,,percent of total billed charges,96% of total billed charges,159.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3251.25,75,,,percent of total billed charges,75% of total billed charges,3251.25,75,,,percent of total billed charges,75% of total billed charges,159.2,4204.95,
"PF REDUCTION OF VOLVULUS, INTUSSUSCEPTION, INTERNAL HERNIA,",78002843P,CDM,975,RC,44050,HCPCS,Outpatient,,,2302,1726.5,,2117.84,92,,,percent of total billed charges,92% of total billed charges,136.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2140.86,93,,,percent of total billed charges,93% of total billed charges,2071.8,90,,,percent of total billed charges,90% of total billed charges,2071.8,90,,,percent of total billed charges,90% of total billed charges,2232.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,136.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2232.94,97,,,percent of total billed charges,97% of total billed charges,1726.5,75,,,percent of total billed charges,75% of total billed charges,2209.92,96,,,percent of total billed charges,96% of total billed charges,136.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1726.5,75,,,percent of total billed charges,75% of total billed charges,1726.5,75,,,percent of total billed charges,75% of total billed charges,136.01,2232.94,
PF ENTERECTOMY RESECTION SMALL INTESTINE 1 RESCJ  and  ANAST,78001428P,CDM,975,RC,44120,HCPCS,Outpatient,,,3135,2351.25,,2884.2,92,,,percent of total billed charges,92% of total billed charges,179.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2915.55,93,,,percent of total billed charges,93% of total billed charges,2821.5,90,,,percent of total billed charges,90% of total billed charges,2821.5,90,,,percent of total billed charges,90% of total billed charges,3040.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,179.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3040.95,97,,,percent of total billed charges,97% of total billed charges,2351.25,75,,,percent of total billed charges,75% of total billed charges,3009.6,96,,,percent of total billed charges,96% of total billed charges,179.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2351.25,75,,,percent of total billed charges,75% of total billed charges,2351.25,75,,,percent of total billed charges,75% of total billed charges,179.4,3040.95,
PF ENTERECTOMY RESECT SMALL INTESTNE EA RESECT  and  ANASTAMOSIS,78001429P,CDM,975,RC,44121,HCPCS,Outpatient,,,952,714,,875.84,92,,,percent of total billed charges,92% of total billed charges,37.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,885.36,93,,,percent of total billed charges,93% of total billed charges,856.8,90,,,percent of total billed charges,90% of total billed charges,856.8,90,,,percent of total billed charges,90% of total billed charges,923.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,37.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,923.44,97,,,percent of total billed charges,97% of total billed charges,714,75,,,percent of total billed charges,75% of total billed charges,913.92,96,,,percent of total billed charges,96% of total billed charges,37.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,714,75,,,percent of total billed charges,75% of total billed charges,714,75,,,percent of total billed charges,75% of total billed charges,37.26,923.44,
PF ENTERECTOMY RESCJ SMALL INTESTINE W/ENTEROSTOMY,78001430P,CDM,975,RC,44125,HCPCS,Outpatient,,,3005,2253.75,,2764.6,92,,,percent of total billed charges,92% of total billed charges,165.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2794.65,93,,,percent of total billed charges,93% of total billed charges,2704.5,90,,,percent of total billed charges,90% of total billed charges,2704.5,90,,,percent of total billed charges,90% of total billed charges,2914.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,165.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2914.85,97,,,percent of total billed charges,97% of total billed charges,2253.75,75,,,percent of total billed charges,75% of total billed charges,2884.8,96,,,percent of total billed charges,96% of total billed charges,165.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2253.75,75,,,percent of total billed charges,75% of total billed charges,2253.75,75,,,percent of total billed charges,75% of total billed charges,165.05,2914.85,
PF MOBLJ SPLENIC FLXR ASRMD CONJUNCT W/PRTL COLCT,78001431P,CDM,975,RC,44139,HCPCS,Outpatient,,,333,249.75,,306.36,92,,,percent of total billed charges,92% of total billed charges,17.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,309.69,93,,,percent of total billed charges,93% of total billed charges,299.7,90,,,percent of total billed charges,90% of total billed charges,299.7,90,,,percent of total billed charges,90% of total billed charges,323.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,323.01,97,,,percent of total billed charges,97% of total billed charges,249.75,75,,,percent of total billed charges,75% of total billed charges,319.68,96,,,percent of total billed charges,96% of total billed charges,17.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249.75,75,,,percent of total billed charges,75% of total billed charges,249.75,75,,,percent of total billed charges,75% of total billed charges,17.66,323.01,
PF COLECTOMY PARTIAL W/ANASTOMOSIS,78001432P,CDM,975,RC,44140,HCPCS,Outpatient,,,3395,2546.25,,3123.4,92,,,percent of total billed charges,92% of total billed charges,191.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3157.35,93,,,percent of total billed charges,93% of total billed charges,3055.5,90,,,percent of total billed charges,90% of total billed charges,3055.5,90,,,percent of total billed charges,90% of total billed charges,3293.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,191.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3293.15,97,,,percent of total billed charges,97% of total billed charges,2546.25,75,,,percent of total billed charges,75% of total billed charges,3259.2,96,,,percent of total billed charges,96% of total billed charges,191.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2546.25,75,,,percent of total billed charges,75% of total billed charges,2546.25,75,,,percent of total billed charges,75% of total billed charges,191.4,3293.15,
PF COLECTOMY PARTIAL W/RESECTION,78002896P,CDM,975,RC,44144,HCPCS,Outpatient,,,3330,2497.5,,3063.6,92,,,percent of total billed charges,92% of total billed charges,248.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3096.9,93,,,percent of total billed charges,93% of total billed charges,2997,90,,,percent of total billed charges,90% of total billed charges,2997,90,,,percent of total billed charges,90% of total billed charges,3230.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,248.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3230.1,97,,,percent of total billed charges,97% of total billed charges,2497.5,75,,,percent of total billed charges,75% of total billed charges,3196.8,96,,,percent of total billed charges,96% of total billed charges,248.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2497.5,75,,,percent of total billed charges,75% of total billed charges,2497.5,75,,,percent of total billed charges,75% of total billed charges,248.91,3230.1,
PF LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE,78001435P,CDM,975,RC,44180,HCPCS,Outpatient,,,2439,1829.25,,2243.88,92,,,percent of total billed charges,92% of total billed charges,133.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2268.27,93,,,percent of total billed charges,93% of total billed charges,2195.1,90,,,percent of total billed charges,90% of total billed charges,2195.1,90,,,percent of total billed charges,90% of total billed charges,2365.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,133.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2365.83,97,,,percent of total billed charges,97% of total billed charges,1829.25,75,,,percent of total billed charges,75% of total billed charges,2341.44,96,,,percent of total billed charges,96% of total billed charges,133.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1829.25,75,,,percent of total billed charges,75% of total billed charges,1829.25,75,,,percent of total billed charges,75% of total billed charges,133.26,2365.83,
LAPAROSCOPY PROCEDURE INTESTINE NOS,78002899P,CDM,975,RC,44238,HCPCS,Outpatient,,,2623,1967.25,,2413.16,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,2439.39,93,,,percent of total billed charges,93% of total billed charges,2360.7,90,,,percent of total billed charges,90% of total billed charges,2360.7,90,,,percent of total billed charges,90% of total billed charges,2544.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2544.31,97,,,percent of total billed charges,97% of total billed charges,1967.25,75,,,percent of total billed charges,75% of total billed charges,2518.08,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,1967.25,75,,,percent of total billed charges,75% of total billed charges,1967.25,75,,,percent of total billed charges,75% of total billed charges,1967.25,2544.31,
PF ILEOSTOMY/JEJUNOSTOMY NON-TUBE,78001436P,CDM,975,RC,44310,HCPCS,Outpatient,,,4103,3077.25,,3774.76,92,,,percent of total billed charges,92% of total billed charges,139.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3815.79,93,,,percent of total billed charges,93% of total billed charges,3692.7,90,,,percent of total billed charges,90% of total billed charges,3692.7,90,,,percent of total billed charges,90% of total billed charges,3979.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,139.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3979.91,97,,,percent of total billed charges,97% of total billed charges,3077.25,75,,,percent of total billed charges,75% of total billed charges,3938.88,96,,,percent of total billed charges,96% of total billed charges,139.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3077.25,75,,,percent of total billed charges,75% of total billed charges,3077.25,75,,,percent of total billed charges,75% of total billed charges,139.17,3979.91,
PF REVISION OF ILEOSTOMY,78002751P,CDM,975,RC,44314,HCPCS,Outpatient,,,2534,1900.5,,2331.28,92,,,percent of total billed charges,92% of total billed charges,124.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2356.62,93,,,percent of total billed charges,93% of total billed charges,2280.6,90,,,percent of total billed charges,90% of total billed charges,2280.6,90,,,percent of total billed charges,90% of total billed charges,2457.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,124.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2457.98,97,,,percent of total billed charges,97% of total billed charges,1900.5,75,,,percent of total billed charges,75% of total billed charges,2432.64,96,,,percent of total billed charges,96% of total billed charges,124.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1900.5,75,,,percent of total billed charges,75% of total billed charges,1900.5,75,,,percent of total billed charges,75% of total billed charges,124.15,2457.98,
PF COLOSTOMY OR SKIN LEVEL CECOSTOMY,78001437P,CDM,975,RC,44320,HCPCS,Outpatient,,,4731,3548.25,,4352.52,92,,,percent of total billed charges,92% of total billed charges,162.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4399.83,93,,,percent of total billed charges,93% of total billed charges,4257.9,90,,,percent of total billed charges,90% of total billed charges,4257.9,90,,,percent of total billed charges,90% of total billed charges,4589.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,162.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4589.07,97,,,percent of total billed charges,97% of total billed charges,3548.25,75,,,percent of total billed charges,75% of total billed charges,4541.76,96,,,percent of total billed charges,96% of total billed charges,162.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3548.25,75,,,percent of total billed charges,75% of total billed charges,3548.25,75,,,percent of total billed charges,75% of total billed charges,162.93,4589.07,
PF COLONOSCOPY STOMA DX INCLUDING COLLECT SPECIMEN,78001438P,CDM,975,RC,44388,HCPCS,Outpatient,,,2188,1641,,2012.96,92,,,percent of total billed charges,92% of total billed charges,16.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2034.84,93,,,percent of total billed charges,93% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,2122.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2122.36,97,,,percent of total billed charges,97% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,2100.48,96,,,percent of total billed charges,96% of total billed charges,16.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1641,75,,,percent of total billed charges,75% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,16.44,2122.36,
PF INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE,78001439P,CDM,975,RC,44500,HCPCS,Outpatient,,,1451,1088.25,,1334.92,92,,,percent of total billed charges,92% of total billed charges,1.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1349.43,93,,,percent of total billed charges,93% of total billed charges,1305.9,90,,,percent of total billed charges,90% of total billed charges,1305.9,90,,,percent of total billed charges,90% of total billed charges,1407.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1407.47,97,,,percent of total billed charges,97% of total billed charges,1088.25,75,,,percent of total billed charges,75% of total billed charges,1392.96,96,,,percent of total billed charges,96% of total billed charges,1.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1088.25,75,,,percent of total billed charges,75% of total billed charges,1088.25,75,,,percent of total billed charges,75% of total billed charges,1.73,1407.47,
PF ENTERORRHAPHY SINGLE PERFORATION,78001440P,CDM,975,RC,44602,HCPCS,Outpatient,,,4527,3395.25,,4164.84,92,,,percent of total billed charges,92% of total billed charges,210.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4210.11,93,,,percent of total billed charges,93% of total billed charges,4074.3,90,,,percent of total billed charges,90% of total billed charges,4074.3,90,,,percent of total billed charges,90% of total billed charges,4391.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,210.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4391.19,97,,,percent of total billed charges,97% of total billed charges,3395.25,75,,,percent of total billed charges,75% of total billed charges,4345.92,96,,,percent of total billed charges,96% of total billed charges,210.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3395.25,75,,,percent of total billed charges,75% of total billed charges,3395.25,75,,,percent of total billed charges,75% of total billed charges,210.06,4391.19,
"PF CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE",78002425P,CDM,975,RC,44620,HCPCS,Outpatient,,,2177,1632.75,,2002.84,92,,,percent of total billed charges,92% of total billed charges,113.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2024.61,93,,,percent of total billed charges,93% of total billed charges,1959.3,90,,,percent of total billed charges,90% of total billed charges,1959.3,90,,,percent of total billed charges,90% of total billed charges,2111.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,113.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2111.69,97,,,percent of total billed charges,97% of total billed charges,1632.75,75,,,percent of total billed charges,75% of total billed charges,2089.92,96,,,percent of total billed charges,96% of total billed charges,113.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1632.75,75,,,percent of total billed charges,75% of total billed charges,1632.75,75,,,percent of total billed charges,75% of total billed charges,113.06,2111.69,
PF APPENDECTOMY,78001441P,CDM,975,RC,44950,HCPCS,Outpatient,,,6371,4778.25,,5861.32,92,,,percent of total billed charges,92% of total billed charges,93.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5925.03,93,,,percent of total billed charges,93% of total billed charges,5733.9,90,,,percent of total billed charges,90% of total billed charges,5733.9,90,,,percent of total billed charges,90% of total billed charges,6179.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,93.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6179.87,97,,,percent of total billed charges,97% of total billed charges,4778.25,75,,,percent of total billed charges,75% of total billed charges,6116.16,96,,,percent of total billed charges,96% of total billed charges,93.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4778.25,75,,,percent of total billed charges,75% of total billed charges,4778.25,75,,,percent of total billed charges,75% of total billed charges,93.05,6179.87,
PF APPENDECOMY FOR RUPTURED APPENDIX,78001442P,CDM,975,RC,44960,HCPCS,Outpatient,,,2114,1585.5,,1944.88,92,,,percent of total billed charges,92% of total billed charges,128.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1966.02,93,,,percent of total billed charges,93% of total billed charges,1902.6,90,,,percent of total billed charges,90% of total billed charges,1902.6,90,,,percent of total billed charges,90% of total billed charges,2050.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,128.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2050.58,97,,,percent of total billed charges,97% of total billed charges,1585.5,75,,,percent of total billed charges,75% of total billed charges,2029.44,96,,,percent of total billed charges,96% of total billed charges,128.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1585.5,75,,,percent of total billed charges,75% of total billed charges,1585.5,75,,,percent of total billed charges,75% of total billed charges,128.82,2050.58,
PF LAPAROSCOPIC APPENDECTOMY,78001443P,CDM,975,RC,44970,HCPCS,Outpatient,,,3294,2470.5,,3030.48,92,,,percent of total billed charges,92% of total billed charges,84.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3063.42,93,,,percent of total billed charges,93% of total billed charges,2964.6,90,,,percent of total billed charges,90% of total billed charges,2964.6,90,,,percent of total billed charges,90% of total billed charges,3195.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,84.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3195.18,97,,,percent of total billed charges,97% of total billed charges,2470.5,75,,,percent of total billed charges,75% of total billed charges,3162.24,96,,,percent of total billed charges,96% of total billed charges,84.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2470.5,75,,,percent of total billed charges,75% of total billed charges,2470.5,75,,,percent of total billed charges,75% of total billed charges,84.41,3195.18,
PF BX ANORECTAL WALL ANAL APPROACH,78001444P,CDM,975,RC,45100,HCPCS,Outpatient,,,1288,966,,1184.96,92,,,percent of total billed charges,92% of total billed charges,30.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1197.84,93,,,percent of total billed charges,93% of total billed charges,1159.2,90,,,percent of total billed charges,90% of total billed charges,1159.2,90,,,percent of total billed charges,90% of total billed charges,1249.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1249.36,97,,,percent of total billed charges,97% of total billed charges,966,75,,,percent of total billed charges,75% of total billed charges,1236.48,96,,,percent of total billed charges,96% of total billed charges,30.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,966,75,,,percent of total billed charges,75% of total billed charges,966,75,,,percent of total billed charges,75% of total billed charges,30.91,1249.36,
PF PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX,78001445P,CDM,975,RC,45300,HCPCS,Outpatient,,,1453,1089.75,,1336.76,92,,,percent of total billed charges,92% of total billed charges,5.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1351.29,93,,,percent of total billed charges,93% of total billed charges,1307.7,90,,,percent of total billed charges,90% of total billed charges,1307.7,90,,,percent of total billed charges,90% of total billed charges,1409.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1409.41,97,,,percent of total billed charges,97% of total billed charges,1089.75,75,,,percent of total billed charges,75% of total billed charges,1394.88,96,,,percent of total billed charges,96% of total billed charges,5.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1089.75,75,,,percent of total billed charges,75% of total billed charges,1089.75,75,,,percent of total billed charges,75% of total billed charges,5.18,1409.41,
PF PROCTOSIGMOIDOSCOPY RIGID W/BIOPSY(S),78002887P,CDM,975,RC,45305,HCPCS,Outpatient,,,369,276.75,,339.48,92,,,percent of total billed charges,92% of total billed charges,7.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.17,93,,,percent of total billed charges,93% of total billed charges,332.1,90,,,percent of total billed charges,90% of total billed charges,332.1,90,,,percent of total billed charges,90% of total billed charges,357.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,357.93,97,,,percent of total billed charges,97% of total billed charges,276.75,75,,,percent of total billed charges,75% of total billed charges,354.24,96,,,percent of total billed charges,96% of total billed charges,7.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,276.75,75,,,percent of total billed charges,75% of total billed charges,276.75,75,,,percent of total billed charges,75% of total billed charges,7.93,357.93,
PF SIGMOIDOSCOPY AND BIOPSY,78002353P,CDM,975,RC,45331,HCPCS,Outpatient,,,763,572.25,,701.96,92,,,percent of total billed charges,92% of total billed charges,6.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,709.59,93,,,percent of total billed charges,93% of total billed charges,686.7,90,,,percent of total billed charges,90% of total billed charges,686.7,90,,,percent of total billed charges,90% of total billed charges,740.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,740.11,97,,,percent of total billed charges,97% of total billed charges,572.25,75,,,percent of total billed charges,75% of total billed charges,732.48,96,,,percent of total billed charges,96% of total billed charges,6.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,572.25,75,,,percent of total billed charges,75% of total billed charges,572.25,75,,,percent of total billed charges,75% of total billed charges,6.54,740.11,
PF SIGMOIDOSCOPY W/TUMOR REMOVAL FORCEP,78002384P,CDM,975,RC,45333,HCPCS,Outpatient,,,238,178.5,,218.96,92,,,percent of total billed charges,92% of total billed charges,9.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,221.34,93,,,percent of total billed charges,93% of total billed charges,214.2,90,,,percent of total billed charges,90% of total billed charges,214.2,90,,,percent of total billed charges,90% of total billed charges,230.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,230.86,97,,,percent of total billed charges,97% of total billed charges,178.5,75,,,percent of total billed charges,75% of total billed charges,228.48,96,,,percent of total billed charges,96% of total billed charges,9.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.5,75,,,percent of total billed charges,75% of total billed charges,178.5,75,,,percent of total billed charges,75% of total billed charges,9.73,230.86,
PF COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD,78001446P,CDM,975,RC,45378,HCPCS,Outpatient,,,2188,1641,,2012.96,92,,,percent of total billed charges,92% of total billed charges,17.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2034.84,93,,,percent of total billed charges,93% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,2122.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2122.36,97,,,percent of total billed charges,97% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,2100.48,96,,,percent of total billed charges,96% of total billed charges,17.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1641,75,,,percent of total billed charges,75% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,17.67,2122.36,
PF COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE,78001447P,CDM,975,RC,45380,HCPCS,Outpatient,,,2188,1641,,2012.96,92,,,percent of total billed charges,92% of total billed charges,18.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2034.84,93,,,percent of total billed charges,93% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,2122.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2122.36,97,,,percent of total billed charges,97% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,2100.48,96,,,percent of total billed charges,96% of total billed charges,18.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1641,75,,,percent of total billed charges,75% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,18.75,2122.36,
PF COLSC FLX WITH DIRECTED SUBMUCOSAL INJECTION ANY SBST,78001448P,CDM,975,RC,45381,HCPCS,Outpatient,,,1807,1355.25,,1662.44,92,,,percent of total billed charges,92% of total billed charges,18.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1680.51,93,,,percent of total billed charges,93% of total billed charges,1626.3,90,,,percent of total billed charges,90% of total billed charges,1626.3,90,,,percent of total billed charges,90% of total billed charges,1752.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1752.79,97,,,percent of total billed charges,97% of total billed charges,1355.25,75,,,percent of total billed charges,75% of total billed charges,1734.72,96,,,percent of total billed charges,96% of total billed charges,18.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1355.25,75,,,percent of total billed charges,75% of total billed charges,1355.25,75,,,percent of total billed charges,75% of total billed charges,18.74,1752.79,
PF COLONOSCOPY W/CONTROL BLEEDING,78002399P,CDM,975,RC,45382,HCPCS,Outpatient,,,657,492.75,,604.44,92,,,percent of total billed charges,92% of total billed charges,23.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,611.01,93,,,percent of total billed charges,93% of total billed charges,591.3,90,,,percent of total billed charges,90% of total billed charges,591.3,90,,,percent of total billed charges,90% of total billed charges,637.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,637.29,97,,,percent of total billed charges,97% of total billed charges,492.75,75,,,percent of total billed charges,75% of total billed charges,630.72,96,,,percent of total billed charges,96% of total billed charges,23.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,492.75,75,,,percent of total billed charges,75% of total billed charges,492.75,75,,,percent of total billed charges,75% of total billed charges,23.69,637.29,
PF COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS,78001449P,CDM,975,RC,45384,HCPCS,Outpatient,,,1783,1337.25,,1640.36,92,,,percent of total billed charges,92% of total billed charges,24.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1658.19,93,,,percent of total billed charges,93% of total billed charges,1604.7,90,,,percent of total billed charges,90% of total billed charges,1604.7,90,,,percent of total billed charges,90% of total billed charges,1729.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1729.51,97,,,percent of total billed charges,97% of total billed charges,1337.25,75,,,percent of total billed charges,75% of total billed charges,1711.68,96,,,percent of total billed charges,96% of total billed charges,24.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1337.25,75,,,percent of total billed charges,75% of total billed charges,1337.25,75,,,percent of total billed charges,75% of total billed charges,24.58,1729.51,
PF COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ,78001450P,CDM,975,RC,45385,HCPCS,Outpatient,,,2188,1641,,2012.96,92,,,percent of total billed charges,92% of total billed charges,23.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2034.84,93,,,percent of total billed charges,93% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,2122.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2122.36,97,,,percent of total billed charges,97% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,2100.48,96,,,percent of total billed charges,96% of total billed charges,23.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1641,75,,,percent of total billed charges,75% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,23.81,2122.36,
PF COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES,78001451P,CDM,975,RC,45388,HCPCS,Outpatient,,,2188,1641,,2012.96,92,,,percent of total billed charges,92% of total billed charges,26.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2034.84,93,,,percent of total billed charges,93% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,2122.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2122.36,97,,,percent of total billed charges,97% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,2100.48,96,,,percent of total billed charges,96% of total billed charges,26.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1641,75,,,percent of total billed charges,75% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,26.26,2122.36,
PF COLONOSCOPY FLEXIBLE WITH ENDOSCOPIC STENT PLACEMENT,78002878P,CDM,975,RC,45389,HCPCS,Outpatient,,,567.5,425.63,,522.1,92,,,percent of total billed charges,92% of total billed charges,26.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,527.78,93,,,percent of total billed charges,93% of total billed charges,510.75,90,,,percent of total billed charges,90% of total billed charges,510.75,90,,,percent of total billed charges,90% of total billed charges,550.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,550.48,97,,,percent of total billed charges,97% of total billed charges,425.63,75,,,percent of total billed charges,75% of total billed charges,544.8,96,,,percent of total billed charges,96% of total billed charges,26.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,425.63,75,,,percent of total billed charges,75% of total billed charges,425.63,75,,,percent of total billed charges,75% of total billed charges,26.91,550.48,
PF PROCTOPEXY ABDOMINAL APPROACH,78001452P,CDM,975,RC,45540,HCPCS,Outpatient,,,3923,2942.25,,3609.16,92,,,percent of total billed charges,92% of total billed charges,117.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3648.39,93,,,percent of total billed charges,93% of total billed charges,3530.7,90,,,percent of total billed charges,90% of total billed charges,3530.7,90,,,percent of total billed charges,90% of total billed charges,3805.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,117.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3805.31,97,,,percent of total billed charges,97% of total billed charges,2942.25,75,,,percent of total billed charges,75% of total billed charges,3766.08,96,,,percent of total billed charges,96% of total billed charges,117.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2942.25,75,,,percent of total billed charges,75% of total billed charges,2942.25,75,,,percent of total billed charges,75% of total billed charges,117.45,3805.31,
PF REPAIR RECTOCELE SEPARATE PROCEDURE,78001453P,CDM,975,RC,45560,HCPCS,Outpatient,,,2639,1979.25,,2427.88,92,,,percent of total billed charges,92% of total billed charges,74.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2454.27,93,,,percent of total billed charges,93% of total billed charges,2375.1,90,,,percent of total billed charges,90% of total billed charges,2375.1,90,,,percent of total billed charges,90% of total billed charges,2559.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,74.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2559.83,97,,,percent of total billed charges,97% of total billed charges,1979.25,75,,,percent of total billed charges,75% of total billed charges,2533.44,96,,,percent of total billed charges,96% of total billed charges,74.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1979.25,75,,,percent of total billed charges,75% of total billed charges,1979.25,75,,,percent of total billed charges,75% of total billed charges,74.09,2559.83,
PF REMOVAL FECAL IMPACTION/FB  UNDER ANESTHESIA,78001454P,CDM,975,RC,45915,HCPCS,Outpatient,,,1638,1228.5,,1506.96,92,,,percent of total billed charges,92% of total billed charges,24.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1523.34,93,,,percent of total billed charges,93% of total billed charges,1474.2,90,,,percent of total billed charges,90% of total billed charges,1474.2,90,,,percent of total billed charges,90% of total billed charges,1588.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1588.86,97,,,percent of total billed charges,97% of total billed charges,1228.5,75,,,percent of total billed charges,75% of total billed charges,1572.48,96,,,percent of total billed charges,96% of total billed charges,24.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1228.5,75,,,percent of total billed charges,75% of total billed charges,1228.5,75,,,percent of total billed charges,75% of total billed charges,24.21,1588.86,
PF ANORECTAL EXAM DX REQUIRING ANESTHESIA,78001455P,CDM,975,RC,45990,HCPCS,Outpatient,,,5708,4281,,5251.36,92,,,percent of total billed charges,92% of total billed charges,12.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5308.44,93,,,percent of total billed charges,93% of total billed charges,5137.2,90,,,percent of total billed charges,90% of total billed charges,5137.2,90,,,percent of total billed charges,90% of total billed charges,5536.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5536.76,97,,,percent of total billed charges,97% of total billed charges,4281,75,,,percent of total billed charges,75% of total billed charges,5479.68,96,,,percent of total billed charges,96% of total billed charges,12.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4281,75,,,percent of total billed charges,75% of total billed charges,4281,75,,,percent of total billed charges,75% of total billed charges,12.32,5536.76,
PF ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX,78001456P,CDM,975,RC,45999,HCPCS,Outpatient,,,919,689.25,,845.48,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,854.67,93,,,percent of total billed charges,93% of total billed charges,827.1,90,,,percent of total billed charges,90% of total billed charges,827.1,90,,,percent of total billed charges,90% of total billed charges,891.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,891.43,97,,,percent of total billed charges,97% of total billed charges,689.25,75,,,percent of total billed charges,75% of total billed charges,882.24,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,689.25,75,,,percent of total billed charges,75% of total billed charges,689.25,75,,,percent of total billed charges,75% of total billed charges,689.25,891.43,
PF ID ISCHIORECTAL/PERIRECTAL ABSCESS SPX,78001457P,CDM,975,RC,46040,HCPCS,Outpatient,,,1656,1242,,1523.52,92,,,percent of total billed charges,92% of total billed charges,46.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1540.08,93,,,percent of total billed charges,93% of total billed charges,1490.4,90,,,percent of total billed charges,90% of total billed charges,1490.4,90,,,percent of total billed charges,90% of total billed charges,1606.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,46.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1606.32,97,,,percent of total billed charges,97% of total billed charges,1242,75,,,percent of total billed charges,75% of total billed charges,1589.76,96,,,percent of total billed charges,96% of total billed charges,46.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1242,75,,,percent of total billed charges,75% of total billed charges,1242,75,,,percent of total billed charges,75% of total billed charges,46.59,1606.32,
PF I and D PERIANAL ABSCESS SUPERFICIAL,78001459P,CDM,975,RC,46050,HCPCS,Outpatient,,,389,291.75,,357.88,92,,,percent of total billed charges,92% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,361.77,93,,,percent of total billed charges,93% of total billed charges,350.1,90,,,percent of total billed charges,90% of total billed charges,350.1,90,,,percent of total billed charges,90% of total billed charges,377.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,377.33,97,,,percent of total billed charges,97% of total billed charges,291.75,75,,,percent of total billed charges,75% of total billed charges,373.44,96,,,percent of total billed charges,96% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,291.75,75,,,percent of total billed charges,75% of total billed charges,291.75,75,,,percent of total billed charges,75% of total billed charges,10.04,377.33,
PF SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX,78001461P,CDM,975,RC,46080,HCPCS,Outpatient,,,1334,1000.5,,1227.28,92,,,percent of total billed charges,92% of total billed charges,18.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1240.62,93,,,percent of total billed charges,93% of total billed charges,1200.6,90,,,percent of total billed charges,90% of total billed charges,1200.6,90,,,percent of total billed charges,90% of total billed charges,1293.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1293.98,97,,,percent of total billed charges,97% of total billed charges,1000.5,75,,,percent of total billed charges,75% of total billed charges,1280.64,96,,,percent of total billed charges,96% of total billed charges,18.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1000.5,75,,,percent of total billed charges,75% of total billed charges,1000.5,75,,,percent of total billed charges,75% of total billed charges,18.76,1293.98,
PF INCISION THROMBOSED HEMORRHOID EXTERNAL,78001462P,CDM,975,RC,46083,HCPCS,Outpatient,,,321,240.75,,295.32,92,,,percent of total billed charges,92% of total billed charges,11.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,298.53,93,,,percent of total billed charges,93% of total billed charges,288.9,90,,,percent of total billed charges,90% of total billed charges,288.9,90,,,percent of total billed charges,90% of total billed charges,311.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,311.37,97,,,percent of total billed charges,97% of total billed charges,240.75,75,,,percent of total billed charges,75% of total billed charges,308.16,96,,,percent of total billed charges,96% of total billed charges,11.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,240.75,75,,,percent of total billed charges,75% of total billed charges,240.75,75,,,percent of total billed charges,75% of total billed charges,11.16,311.37,
PF EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS,78001464P,CDM,975,RC,46220,HCPCS,Outpatient,,,385,288.75,,354.2,92,,,percent of total billed charges,92% of total billed charges,12.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,358.05,93,,,percent of total billed charges,93% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,373.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,373.45,97,,,percent of total billed charges,97% of total billed charges,288.75,75,,,percent of total billed charges,75% of total billed charges,369.6,96,,,percent of total billed charges,96% of total billed charges,12.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.75,75,,,percent of total billed charges,75% of total billed charges,288.75,75,,,percent of total billed charges,75% of total billed charges,12.37,373.45,
PF HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS,78001466P,CDM,975,RC,46221,HCPCS,Outpatient,,,1341,1005.75,,1233.72,92,,,percent of total billed charges,92% of total billed charges,16.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1247.13,93,,,percent of total billed charges,93% of total billed charges,1206.9,90,,,percent of total billed charges,90% of total billed charges,1206.9,90,,,percent of total billed charges,90% of total billed charges,1300.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1300.77,97,,,percent of total billed charges,97% of total billed charges,1005.75,75,,,percent of total billed charges,75% of total billed charges,1287.36,96,,,percent of total billed charges,96% of total billed charges,16.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1005.75,75,,,percent of total billed charges,75% of total billed charges,1005.75,75,,,percent of total billed charges,75% of total billed charges,16.17,1300.77,
PF EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS,78001467P,CDM,975,RC,46230,HCPCS,Outpatient,,,458,343.5,,421.36,92,,,percent of total billed charges,92% of total billed charges,18.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,425.94,93,,,percent of total billed charges,93% of total billed charges,412.2,90,,,percent of total billed charges,90% of total billed charges,412.2,90,,,percent of total billed charges,90% of total billed charges,444.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,444.26,97,,,percent of total billed charges,97% of total billed charges,343.5,75,,,percent of total billed charges,75% of total billed charges,439.68,96,,,percent of total billed charges,96% of total billed charges,18.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.5,75,,,percent of total billed charges,75% of total billed charges,343.5,75,,,percent of total billed charges,75% of total billed charges,18.78,444.26,
PF HEMORRHOIDECTOMY INTERNAL  and  EXTERNAL 2/> COLUMN/GROUP,78001469P,CDM,975,RC,46260,HCPCS,Outpatient,,,3007,2255.25,,2766.44,92,,,percent of total billed charges,92% of total billed charges,52.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2796.51,93,,,percent of total billed charges,93% of total billed charges,2706.3,90,,,percent of total billed charges,90% of total billed charges,2706.3,90,,,percent of total billed charges,90% of total billed charges,2916.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,52.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2916.79,97,,,percent of total billed charges,97% of total billed charges,2255.25,75,,,percent of total billed charges,75% of total billed charges,2886.72,96,,,percent of total billed charges,96% of total billed charges,52.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2255.25,75,,,percent of total billed charges,75% of total billed charges,2255.25,75,,,percent of total billed charges,75% of total billed charges,52.84,2916.79,
PF SURGICAL TX ANAL FISTULA SUBCUTANEOUS,78001470P,CDM,975,RC,46270,HCPCS,Outpatient,,,2126,1594.5,,1955.92,92,,,percent of total billed charges,92% of total billed charges,40.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1977.18,93,,,percent of total billed charges,93% of total billed charges,1913.4,90,,,percent of total billed charges,90% of total billed charges,1913.4,90,,,percent of total billed charges,90% of total billed charges,2062.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2062.22,97,,,percent of total billed charges,97% of total billed charges,1594.5,75,,,percent of total billed charges,75% of total billed charges,2040.96,96,,,percent of total billed charges,96% of total billed charges,40.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1594.5,75,,,percent of total billed charges,75% of total billed charges,1594.5,75,,,percent of total billed charges,75% of total billed charges,40.57,2062.22,
PF TX ANAL FISTULA TRANS/SUPRA/XTRASPHNCTR,78001471P,CDM,975,RC,46280,HCPCS,Outpatient,,,2745,2058.75,,2525.4,92,,,percent of total billed charges,92% of total billed charges,47.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2552.85,93,,,percent of total billed charges,93% of total billed charges,2470.5,90,,,percent of total billed charges,90% of total billed charges,2470.5,90,,,percent of total billed charges,90% of total billed charges,2662.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,47.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2662.65,97,,,percent of total billed charges,97% of total billed charges,2058.75,75,,,percent of total billed charges,75% of total billed charges,2635.2,96,,,percent of total billed charges,96% of total billed charges,47.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2058.75,75,,,percent of total billed charges,75% of total billed charges,2058.75,75,,,percent of total billed charges,75% of total billed charges,47.38,2662.65,
PF EXCISE THROMBOSED HEMORRHOID EXTERNAL,78001472P,CDM,975,RC,46320,HCPCS,Outpatient,,,4397,3297.75,,4045.24,92,,,percent of total billed charges,92% of total billed charges,11.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4089.21,93,,,percent of total billed charges,93% of total billed charges,3957.3,90,,,percent of total billed charges,90% of total billed charges,3957.3,90,,,percent of total billed charges,90% of total billed charges,4265.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4265.09,97,,,percent of total billed charges,97% of total billed charges,3297.75,75,,,percent of total billed charges,75% of total billed charges,4221.12,96,,,percent of total billed charges,96% of total billed charges,11.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3297.75,75,,,percent of total billed charges,75% of total billed charges,3297.75,75,,,percent of total billed charges,75% of total billed charges,11.81,4265.09,
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER,78002902P,CDM,975,RC,46505,HCPCS,Outpatient,,,485.2,363.9,,446.38,92,,,percent of total billed charges,92% of total billed charges,23.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,451.24,93,,,percent of total billed charges,93% of total billed charges,436.68,90,,,percent of total billed charges,90% of total billed charges,436.68,90,,,percent of total billed charges,90% of total billed charges,470.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,470.64,97,,,percent of total billed charges,97% of total billed charges,363.9,75,,,percent of total billed charges,75% of total billed charges,465.79,96,,,percent of total billed charges,96% of total billed charges,23.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,363.9,75,,,percent of total billed charges,75% of total billed charges,363.9,75,,,percent of total billed charges,75% of total billed charges,23.34,470.64,
PF ANOSCOPY DIAGNOSTIC,78001474P,CDM,975,RC,46600,HCPCS,Outpatient,,,160,120,,147.2,92,,,percent of total billed charges,92% of total billed charges,3.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,148.8,93,,,percent of total billed charges,93% of total billed charges,144,90,,,percent of total billed charges,90% of total billed charges,144,90,,,percent of total billed charges,90% of total billed charges,155.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,155.2,97,,,percent of total billed charges,97% of total billed charges,120,75,,,percent of total billed charges,75% of total billed charges,153.6,96,,,percent of total billed charges,96% of total billed charges,3.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,120,75,,,percent of total billed charges,75% of total billed charges,120,75,,,percent of total billed charges,75% of total billed charges,3.87,155.2,
PF ANOSCOPY WITH REMOVAL OF FOREIGN BODY,78001476P,CDM,975,RC,46608,HCPCS,Outpatient,,,331,248.25,,304.52,92,,,percent of total billed charges,92% of total billed charges,12.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,307.83,93,,,percent of total billed charges,93% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,321.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321.07,97,,,percent of total billed charges,97% of total billed charges,248.25,75,,,percent of total billed charges,75% of total billed charges,317.76,96,,,percent of total billed charges,96% of total billed charges,12.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,248.25,75,,,percent of total billed charges,75% of total billed charges,248.25,75,,,percent of total billed charges,75% of total billed charges,12.15,321.07,
PF EXCISION OF ANAL LESION(S),78002865P,CDM,960,RC,46922,HCPCS,Outpatient,,,275,206.25,,253,92,,,percent of total billed charges,92% of total billed charges,14.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.75,93,,,percent of total billed charges,93% of total billed charges,247.5,90,,,percent of total billed charges,90% of total billed charges,247.5,90,,,percent of total billed charges,90% of total billed charges,266.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,266.75,97,,,percent of total billed charges,97% of total billed charges,206.25,75,,,percent of total billed charges,75% of total billed charges,264,96,,,percent of total billed charges,96% of total billed charges,14.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,206.25,75,,,percent of total billed charges,75% of total billed charges,206.25,75,,,percent of total billed charges,75% of total billed charges,14.57,266.75,
PF DESTRUCTION OF ANUS LESION(S) EXTENSIVE,78001478P,CDM,975,RC,46924,HCPCS,Outpatient,,,1953,1464.75,,1796.76,92,,,percent of total billed charges,92% of total billed charges,17.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1816.29,93,,,percent of total billed charges,93% of total billed charges,1757.7,90,,,percent of total billed charges,90% of total billed charges,1757.7,90,,,percent of total billed charges,90% of total billed charges,1894.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1894.41,97,,,percent of total billed charges,97% of total billed charges,1464.75,75,,,percent of total billed charges,75% of total billed charges,1874.88,96,,,percent of total billed charges,96% of total billed charges,17.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1464.75,75,,,percent of total billed charges,75% of total billed charges,1464.75,75,,,percent of total billed charges,75% of total billed charges,17.95,1894.41,
PF DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY,78001480P,CDM,975,RC,46930,HCPCS,Outpatient,,,1288,966,,1184.96,92,,,percent of total billed charges,92% of total billed charges,11.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1197.84,93,,,percent of total billed charges,93% of total billed charges,1159.2,90,,,percent of total billed charges,90% of total billed charges,1159.2,90,,,percent of total billed charges,90% of total billed charges,1249.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1249.36,97,,,percent of total billed charges,97% of total billed charges,966,75,,,percent of total billed charges,75% of total billed charges,1236.48,96,,,percent of total billed charges,96% of total billed charges,11.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,966,75,,,percent of total billed charges,75% of total billed charges,966,75,,,percent of total billed charges,75% of total billed charges,11.51,1249.36,
PF HEMORRHOIDECTOY INTERNAL BY LIGATION 2+ HEMMORRHOIDS W/O,78002858P,CDM,975,RC,46946,HCPCS,Outpatient,,,956,717,,879.52,92,,,percent of total billed charges,92% of total billed charges,32.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,889.08,93,,,percent of total billed charges,93% of total billed charges,860.4,90,,,percent of total billed charges,90% of total billed charges,860.4,90,,,percent of total billed charges,90% of total billed charges,927.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,927.32,97,,,percent of total billed charges,97% of total billed charges,717,75,,,percent of total billed charges,75% of total billed charges,917.76,96,,,percent of total billed charges,96% of total billed charges,32.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717,75,,,percent of total billed charges,75% of total billed charges,717,75,,,percent of total billed charges,75% of total billed charges,32.47,927.32,
PF BIOPSY LIVER NEEDLE PERCUTANEOUS,78001482P,CDM,975,RC,47000,HCPCS,Outpatient,,,950,712.5,,874,92,,,percent of total billed charges,92% of total billed charges,7.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,883.5,93,,,percent of total billed charges,93% of total billed charges,855,90,,,percent of total billed charges,90% of total billed charges,855,90,,,percent of total billed charges,90% of total billed charges,921.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,921.5,97,,,percent of total billed charges,97% of total billed charges,712.5,75,,,percent of total billed charges,75% of total billed charges,912,96,,,percent of total billed charges,96% of total billed charges,7.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,712.5,75,,,percent of total billed charges,75% of total billed charges,712.5,75,,,percent of total billed charges,75% of total billed charges,7.58,921.5,
PF HEPATECTOMY RESECTION OF LIVER PARTIAL LOBECTOMY,78002836P,CDM,975,RC,47120,HCPCS,Outpatient,,,5730,4297.5,,5271.6,92,,,percent of total billed charges,92% of total billed charges,342.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5328.9,93,,,percent of total billed charges,93% of total billed charges,5157,90,,,percent of total billed charges,90% of total billed charges,5157,90,,,percent of total billed charges,90% of total billed charges,5558.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,342.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5558.1,97,,,percent of total billed charges,97% of total billed charges,4297.5,75,,,percent of total billed charges,75% of total billed charges,5500.8,96,,,percent of total billed charges,96% of total billed charges,342.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4297.5,75,,,percent of total billed charges,75% of total billed charges,4297.5,75,,,percent of total billed charges,75% of total billed charges,342.83,5558.1,
PF NJX CHOLANGIO PRQ W/IMG GID RSI EXISTING ACCSS,78001484P,CDM,975,RC,47531,HCPCS,Outpatient,,,183,137.25,,168.36,92,,,percent of total billed charges,92% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,170.19,93,,,percent of total billed charges,93% of total billed charges,164.7,90,,,percent of total billed charges,90% of total billed charges,164.7,90,,,percent of total billed charges,90% of total billed charges,177.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.51,97,,,percent of total billed charges,97% of total billed charges,137.25,75,,,percent of total billed charges,75% of total billed charges,175.68,96,,,percent of total billed charges,96% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,137.25,75,,,percent of total billed charges,75% of total billed charges,137.25,75,,,percent of total billed charges,75% of total billed charges,5.9,177.51,
PF PRQ PLMT BILIARY DRG CATH W/IMG GID RS and I EXTRNL,78001486P,CDM,975,RC,47533,HCPCS,Outpatient,,,689,516.75,,633.88,92,,,percent of total billed charges,92% of total billed charges,23.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,640.77,93,,,percent of total billed charges,93% of total billed charges,620.1,90,,,percent of total billed charges,90% of total billed charges,620.1,90,,,percent of total billed charges,90% of total billed charges,668.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,668.33,97,,,percent of total billed charges,97% of total billed charges,516.75,75,,,percent of total billed charges,75% of total billed charges,661.44,96,,,percent of total billed charges,96% of total billed charges,23.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,516.75,75,,,percent of total billed charges,75% of total billed charges,516.75,75,,,percent of total billed charges,75% of total billed charges,23.71,668.33,
PF REMOVAL BILIARY DUCT  and /GLBLDR CALCULI PERQ RS and I,78001487P,CDM,975,RC,47544,HCPCS,Outpatient,,,404,303,,371.68,92,,,percent of total billed charges,92% of total billed charges,14.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375.72,93,,,percent of total billed charges,93% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,391.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,391.88,97,,,percent of total billed charges,97% of total billed charges,303,75,,,percent of total billed charges,75% of total billed charges,387.84,96,,,percent of total billed charges,96% of total billed charges,14.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,303,75,,,percent of total billed charges,75% of total billed charges,303,75,,,percent of total billed charges,75% of total billed charges,14.71,391.88,
PF LAPAROSCOPY SURG CHOLECYSTECTOMY,78001488P,CDM,975,RC,47562,HCPCS,Outpatient,,,11196,8397,,10300.32,92,,,percent of total billed charges,92% of total billed charges,94.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,10412.28,93,,,percent of total billed charges,93% of total billed charges,10076.4,90,,,percent of total billed charges,90% of total billed charges,10076.4,90,,,percent of total billed charges,90% of total billed charges,10860.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,94.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,10860.12,97,,,percent of total billed charges,97% of total billed charges,8397,75,,,percent of total billed charges,75% of total billed charges,10748.16,96,,,percent of total billed charges,96% of total billed charges,94.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,8397,75,,,percent of total billed charges,75% of total billed charges,8397,75,,,percent of total billed charges,75% of total billed charges,94.56,10860.12,
PF LAP CHOLECYSTECTOMY W/CHOLANGIOGRAPHY,78001490P,CDM,975,RC,47563,HCPCS,Outpatient,,,11196,8397,,10300.32,92,,,percent of total billed charges,92% of total billed charges,103.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,10412.28,93,,,percent of total billed charges,93% of total billed charges,10076.4,90,,,percent of total billed charges,90% of total billed charges,10076.4,90,,,percent of total billed charges,90% of total billed charges,10860.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,103.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,10860.12,97,,,percent of total billed charges,97% of total billed charges,8397,75,,,percent of total billed charges,75% of total billed charges,10748.16,96,,,percent of total billed charges,96% of total billed charges,103.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,8397,75,,,percent of total billed charges,75% of total billed charges,8397,75,,,percent of total billed charges,75% of total billed charges,103.33,10860.12,
PF LAPAROSCOPY CHOLECYSTECTOMY W/EXPLORATION OF COMMON DUCT,78002879P,CDM,975,RC,47564,HCPCS,Outpatient,,,2203,1652.25,,2026.76,92,,,percent of total billed charges,92% of total billed charges,162.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2048.79,93,,,percent of total billed charges,93% of total billed charges,1982.7,90,,,percent of total billed charges,90% of total billed charges,1982.7,90,,,percent of total billed charges,90% of total billed charges,2136.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,162.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2136.91,97,,,percent of total billed charges,97% of total billed charges,1652.25,75,,,percent of total billed charges,75% of total billed charges,2114.88,96,,,percent of total billed charges,96% of total billed charges,162.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1652.25,75,,,percent of total billed charges,75% of total billed charges,1652.25,75,,,percent of total billed charges,75% of total billed charges,162.45,2136.91,
PF CHOLECYSTECTOMY,78001491P,CDM,975,RC,47600,HCPCS,Outpatient,,,4375,3281.25,,4025,92,,,percent of total billed charges,92% of total billed charges,154.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4068.75,93,,,percent of total billed charges,93% of total billed charges,3937.5,90,,,percent of total billed charges,90% of total billed charges,3937.5,90,,,percent of total billed charges,90% of total billed charges,4243.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,154.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4243.75,97,,,percent of total billed charges,97% of total billed charges,3281.25,75,,,percent of total billed charges,75% of total billed charges,4200,96,,,percent of total billed charges,96% of total billed charges,154.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3281.25,75,,,percent of total billed charges,75% of total billed charges,3281.25,75,,,percent of total billed charges,75% of total billed charges,154.78,4243.75,
PF EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY,78001492P,CDM,975,RC,49000,HCPCS,Outpatient,,,3603,2702.25,,3314.76,92,,,percent of total billed charges,92% of total billed charges,106.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3350.79,93,,,percent of total billed charges,93% of total billed charges,3242.7,90,,,percent of total billed charges,90% of total billed charges,3242.7,90,,,percent of total billed charges,90% of total billed charges,3494.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,106.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3494.91,97,,,percent of total billed charges,97% of total billed charges,2702.25,75,,,percent of total billed charges,75% of total billed charges,3458.88,96,,,percent of total billed charges,96% of total billed charges,106.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2702.25,75,,,percent of total billed charges,75% of total billed charges,2702.25,75,,,percent of total billed charges,75% of total billed charges,106.63,3494.91,
PF EXPLORE RETROPERITONEUM W/WO BIOPSY,78001493P,CDM,975,RC,49010,HCPCS,Outpatient,,,3852,2889,,3543.84,92,,,percent of total billed charges,92% of total billed charges,133.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3582.36,93,,,percent of total billed charges,93% of total billed charges,3466.8,90,,,percent of total billed charges,90% of total billed charges,3466.8,90,,,percent of total billed charges,90% of total billed charges,3736.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,133.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3736.44,97,,,percent of total billed charges,97% of total billed charges,2889,75,,,percent of total billed charges,75% of total billed charges,3697.92,96,,,percent of total billed charges,96% of total billed charges,133.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2889,75,,,percent of total billed charges,75% of total billed charges,2889,75,,,percent of total billed charges,75% of total billed charges,133.52,3736.44,
PF DRAIN RETROPERITONEAL ABSCESS OPEN,78001494P,CDM,975,RC,49060,HCPCS,Outpatient,,,2909,2181.75,,2676.28,92,,,percent of total billed charges,92% of total billed charges,151.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2705.37,93,,,percent of total billed charges,93% of total billed charges,2618.1,90,,,percent of total billed charges,90% of total billed charges,2618.1,90,,,percent of total billed charges,90% of total billed charges,2821.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,151.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2821.73,97,,,percent of total billed charges,97% of total billed charges,2181.75,75,,,percent of total billed charges,75% of total billed charges,2792.64,96,,,percent of total billed charges,96% of total billed charges,151.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2181.75,75,,,percent of total billed charges,75% of total billed charges,2181.75,75,,,percent of total billed charges,75% of total billed charges,151.45,2821.73,
PF ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE,78001495P,CDM,975,RC,49082,HCPCS,Outpatient,,,660,495,,607.2,92,,,percent of total billed charges,92% of total billed charges,7.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,613.8,93,,,percent of total billed charges,93% of total billed charges,594,90,,,percent of total billed charges,90% of total billed charges,594,90,,,percent of total billed charges,90% of total billed charges,640.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,640.2,97,,,percent of total billed charges,97% of total billed charges,495,75,,,percent of total billed charges,75% of total billed charges,633.6,96,,,percent of total billed charges,96% of total billed charges,7.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,495,75,,,percent of total billed charges,75% of total billed charges,495,75,,,percent of total billed charges,75% of total billed charges,7.66,640.2,
PF ABDOMINAL PARACENTESIS DX/THER W/IMAGING GUIDANCE,78001497P,CDM,975,RC,49083,HCPCS,Outpatient,,,447,335.25,,411.24,92,,,percent of total billed charges,92% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,415.71,93,,,percent of total billed charges,93% of total billed charges,402.3,90,,,percent of total billed charges,90% of total billed charges,402.3,90,,,percent of total billed charges,90% of total billed charges,433.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,433.59,97,,,percent of total billed charges,97% of total billed charges,335.25,75,,,percent of total billed charges,75% of total billed charges,429.12,96,,,percent of total billed charges,96% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,335.25,75,,,percent of total billed charges,75% of total billed charges,335.25,75,,,percent of total billed charges,75% of total billed charges,9.02,433.59,
PF PERITONEAL LAVAGE W/WO IMAGING GUIDANCE,78001499P,CDM,975,RC,49084,HCPCS,Outpatient,,,428,321,,393.76,92,,,percent of total billed charges,92% of total billed charges,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,398.04,93,,,percent of total billed charges,93% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,415.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,415.16,97,,,percent of total billed charges,97% of total billed charges,321,75,,,percent of total billed charges,75% of total billed charges,410.88,96,,,percent of total billed charges,96% of total billed charges,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321,75,,,percent of total billed charges,75% of total billed charges,321,75,,,percent of total billed charges,75% of total billed charges,15.86,415.16,
PF BIOPSY ABDOMINAL OR RETROPERITONEAL MASS,78002203P,CDM,975,RC,49180,HCPCS,Outpatient,,,217,162.75,,199.64,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.81,93,,,percent of total billed charges,93% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,210.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,210.49,97,,,percent of total billed charges,97% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,208.32,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.75,75,,,percent of total billed charges,75% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,7.4,210.49,
PF EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5CM/<,78001501P,CDM,975,RC,49203,HCPCS,Outpatient,,,5423,4067.25,,4989.16,92,,,percent of total billed charges,92% of total billed charges,162,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5043.39,93,,,percent of total billed charges,93% of total billed charges,4880.7,90,,,percent of total billed charges,90% of total billed charges,4880.7,90,,,percent of total billed charges,90% of total billed charges,5260.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,162,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5260.31,97,,,percent of total billed charges,97% of total billed charges,4067.25,75,,,percent of total billed charges,75% of total billed charges,5206.08,96,,,percent of total billed charges,96% of total billed charges,162,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4067.25,75,,,percent of total billed charges,75% of total billed charges,4067.25,75,,,percent of total billed charges,75% of total billed charges,162,5260.31,
PF UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX,78001502P,CDM,975,RC,49250,HCPCS,Outpatient,,,2875,2156.25,,2645,92,,,percent of total billed charges,92% of total billed charges,77.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2673.75,93,,,percent of total billed charges,93% of total billed charges,2587.5,90,,,percent of total billed charges,90% of total billed charges,2587.5,90,,,percent of total billed charges,90% of total billed charges,2788.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,77.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2788.75,97,,,percent of total billed charges,97% of total billed charges,2156.25,75,,,percent of total billed charges,75% of total billed charges,2760,96,,,percent of total billed charges,96% of total billed charges,77.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2156.25,75,,,percent of total billed charges,75% of total billed charges,2156.25,75,,,percent of total billed charges,75% of total billed charges,77.38,2788.75,
PF OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX,78001503P,CDM,975,RC,49255,HCPCS,Outpatient,,,1884,1413,,1733.28,92,,,percent of total billed charges,92% of total billed charges,101.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1752.12,93,,,percent of total billed charges,93% of total billed charges,1695.6,90,,,percent of total billed charges,90% of total billed charges,1695.6,90,,,percent of total billed charges,90% of total billed charges,1827.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,101.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1827.48,97,,,percent of total billed charges,97% of total billed charges,1413,75,,,percent of total billed charges,75% of total billed charges,1808.64,96,,,percent of total billed charges,96% of total billed charges,101.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1413,75,,,percent of total billed charges,75% of total billed charges,1413,75,,,percent of total billed charges,75% of total billed charges,101.55,1827.48,
PF LAPAROSCOPY ABDOMEN PERITONEUM AND OMENTUM DX,78002224P,CDM,975,RC,49320,HCPCS,Outpatient,,,6075,4556.25,,5589,92,,,percent of total billed charges,92% of total billed charges,44.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5649.75,93,,,percent of total billed charges,93% of total billed charges,5467.5,90,,,percent of total billed charges,90% of total billed charges,5467.5,90,,,percent of total billed charges,90% of total billed charges,5892.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,44.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5892.75,97,,,percent of total billed charges,97% of total billed charges,4556.25,75,,,percent of total billed charges,75% of total billed charges,5832,96,,,percent of total billed charges,96% of total billed charges,44.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4556.25,75,,,percent of total billed charges,75% of total billed charges,4556.25,75,,,percent of total billed charges,75% of total billed charges,44.54,5892.75,
PF LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE,78001504P,CDM,975,RC,49321,HCPCS,Outpatient,,,2831,2123.25,,2604.52,92,,,percent of total billed charges,92% of total billed charges,45.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2632.83,93,,,percent of total billed charges,93% of total billed charges,2547.9,90,,,percent of total billed charges,90% of total billed charges,2547.9,90,,,percent of total billed charges,90% of total billed charges,2746.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,45.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2746.07,97,,,percent of total billed charges,97% of total billed charges,2123.25,75,,,percent of total billed charges,75% of total billed charges,2717.76,96,,,percent of total billed charges,96% of total billed charges,45.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2123.25,75,,,percent of total billed charges,75% of total billed charges,2123.25,75,,,percent of total billed charges,75% of total billed charges,45.06,2746.07,
PF IMG-GUIDE FLUID COLLXN DRAIN CATH PERITON PERQ,78001505P,CDM,975,RC,49406,HCPCS,Outpatient,,,3585,2688.75,,3298.2,92,,,percent of total billed charges,92% of total billed charges,17.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3334.05,93,,,percent of total billed charges,93% of total billed charges,3226.5,90,,,percent of total billed charges,90% of total billed charges,3226.5,90,,,percent of total billed charges,90% of total billed charges,3477.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3477.45,97,,,percent of total billed charges,97% of total billed charges,2688.75,75,,,percent of total billed charges,75% of total billed charges,3441.6,96,,,percent of total billed charges,96% of total billed charges,17.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2688.75,75,,,percent of total billed charges,75% of total billed charges,2688.75,75,,,percent of total billed charges,75% of total billed charges,17.38,3477.45,
PF INSERT GASTROSTOMY TUBE PERCUTANEOUS,78001507P,CDM,975,RC,49440,HCPCS,Outpatient,,,530,397.5,,487.6,92,,,percent of total billed charges,92% of total billed charges,17.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,492.9,93,,,percent of total billed charges,93% of total billed charges,477,90,,,percent of total billed charges,90% of total billed charges,477,90,,,percent of total billed charges,90% of total billed charges,514.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,514.1,97,,,percent of total billed charges,97% of total billed charges,397.5,75,,,percent of total billed charges,75% of total billed charges,508.8,96,,,percent of total billed charges,96% of total billed charges,17.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,397.5,75,,,percent of total billed charges,75% of total billed charges,397.5,75,,,percent of total billed charges,75% of total billed charges,17.95,514.1,
PF OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE,78001508P,CDM,975,RC,49460,HCPCS,Outpatient,,,2839,2129.25,,2611.88,92,,,percent of total billed charges,92% of total billed charges,5.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2640.27,93,,,percent of total billed charges,93% of total billed charges,2555.1,90,,,percent of total billed charges,90% of total billed charges,2555.1,90,,,percent of total billed charges,90% of total billed charges,2753.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2753.83,97,,,percent of total billed charges,97% of total billed charges,2129.25,75,,,percent of total billed charges,75% of total billed charges,2725.44,96,,,percent of total billed charges,96% of total billed charges,5.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2129.25,75,,,percent of total billed charges,75% of total billed charges,2129.25,75,,,percent of total billed charges,75% of total billed charges,5.24,2753.83,
PF REPAIR 1ST INGUINAL HERNIA AGE 5 YRS/> REDUCIBLE,78001509P,CDM,975,RC,49505,HCPCS,Outpatient,,,3703,2777.25,,3406.76,92,,,percent of total billed charges,92% of total billed charges,72.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3443.79,93,,,percent of total billed charges,93% of total billed charges,3332.7,90,,,percent of total billed charges,90% of total billed charges,3332.7,90,,,percent of total billed charges,90% of total billed charges,3591.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,72.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3591.91,97,,,percent of total billed charges,97% of total billed charges,2777.25,75,,,percent of total billed charges,75% of total billed charges,3554.88,96,,,percent of total billed charges,96% of total billed charges,72.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2777.25,75,,,percent of total billed charges,75% of total billed charges,2777.25,75,,,percent of total billed charges,75% of total billed charges,72.74,3591.91,
PF REPAIR INITIAL INGUINAL HERNIA >5 YEARS OLD,78002756P,CDM,975,RC,49507,HCPCS,Outpatient,,,1490,1117.5,,1370.8,92,,,percent of total billed charges,92% of total billed charges,82.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1385.7,93,,,percent of total billed charges,93% of total billed charges,1341,90,,,percent of total billed charges,90% of total billed charges,1341,90,,,percent of total billed charges,90% of total billed charges,1445.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,82.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1445.3,97,,,percent of total billed charges,97% of total billed charges,1117.5,75,,,percent of total billed charges,75% of total billed charges,1430.4,96,,,percent of total billed charges,96% of total billed charges,82.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1117.5,75,,,percent of total billed charges,75% of total billed charges,1117.5,75,,,percent of total billed charges,75% of total billed charges,82.31,1445.3,
PF REPAIR RECURRENT INGUINAL HERNIA REDUCIBLE,78002754P,CDM,975,RC,49520,HCPCS,Outpatient,,,1607,1205.25,,1478.44,92,,,percent of total billed charges,92% of total billed charges,90.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1494.51,93,,,percent of total billed charges,93% of total billed charges,1446.3,90,,,percent of total billed charges,90% of total billed charges,1446.3,90,,,percent of total billed charges,90% of total billed charges,1558.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,90.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1558.79,97,,,percent of total billed charges,97% of total billed charges,1205.25,75,,,percent of total billed charges,75% of total billed charges,1542.72,96,,,percent of total billed charges,96% of total billed charges,90.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1205.25,75,,,percent of total billed charges,75% of total billed charges,1205.25,75,,,percent of total billed charges,75% of total billed charges,90.67,1558.79,
PF REPAIR RECURRENT INGUINAL HERNIA ANY AGE INCARCERATED,78001510P,CDM,975,RC,49521,HCPCS,Outpatient,,,4692,3519,,4316.64,92,,,percent of total billed charges,92% of total billed charges,103.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4363.56,93,,,percent of total billed charges,93% of total billed charges,4222.8,90,,,percent of total billed charges,90% of total billed charges,4222.8,90,,,percent of total billed charges,90% of total billed charges,4551.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,103.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4551.24,97,,,percent of total billed charges,97% of total billed charges,3519,75,,,percent of total billed charges,75% of total billed charges,4504.32,96,,,percent of total billed charges,96% of total billed charges,103.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3519,75,,,percent of total billed charges,75% of total billed charges,3519,75,,,percent of total billed charges,75% of total billed charges,103.02,4551.24,
PF REPAIR 1ST FEMORAL HERNIA ANY AGE INCARCERATED,78001511P,CDM,975,RC,49553,HCPCS,Outpatient,,,4013,3009.75,,3691.96,92,,,percent of total billed charges,92% of total billed charges,89.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3732.09,93,,,percent of total billed charges,93% of total billed charges,3611.7,90,,,percent of total billed charges,90% of total billed charges,3611.7,90,,,percent of total billed charges,90% of total billed charges,3892.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,89.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3892.61,97,,,percent of total billed charges,97% of total billed charges,3009.75,75,,,percent of total billed charges,75% of total billed charges,3852.48,96,,,percent of total billed charges,96% of total billed charges,89.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3009.75,75,,,percent of total billed charges,75% of total billed charges,3009.75,75,,,percent of total billed charges,75% of total billed charges,89.27,3892.61,
PF REPAIR ANTERIOR ABDOMINAL HERNIA INITIAL <3CM REDUCIBLE,78002837P,CDM,975,RC,49591,HCPCS,Outpatient,,,838,628.5,,770.96,92,,,percent of total billed charges,92% of total billed charges,52.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,779.34,93,,,percent of total billed charges,93% of total billed charges,754.2,90,,,percent of total billed charges,90% of total billed charges,754.2,90,,,percent of total billed charges,90% of total billed charges,812.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,52.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,812.86,97,,,percent of total billed charges,97% of total billed charges,628.5,75,,,percent of total billed charges,75% of total billed charges,804.48,96,,,percent of total billed charges,96% of total billed charges,52.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,628.5,75,,,percent of total billed charges,75% of total billed charges,628.5,75,,,percent of total billed charges,75% of total billed charges,52.23,812.86,
REPAIR ANTERIOR ABDOMINAL HERNIA(S) <3CM,78002900P,CDM,975,RC,49592,HCPCS,Outpatient,,,896,672,,824.32,92,,,percent of total billed charges,92% of total billed charges,74.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,833.28,93,,,percent of total billed charges,93% of total billed charges,806.4,90,,,percent of total billed charges,90% of total billed charges,806.4,90,,,percent of total billed charges,90% of total billed charges,869.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,74.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,869.12,97,,,percent of total billed charges,97% of total billed charges,672,75,,,percent of total billed charges,75% of total billed charges,860.16,96,,,percent of total billed charges,96% of total billed charges,74.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,672,75,,,percent of total billed charges,75% of total billed charges,672,75,,,percent of total billed charges,75% of total billed charges,74.18,869.12,
PF REPAIR AA HERNIA(S) INITIAL 3-10CM REDUCIBLE,78002155P,CDM,975,RC,49593,HCPCS,Outpatient,,,1123,842.25,,1033.16,92,,,percent of total billed charges,92% of total billed charges,89.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1044.39,93,,,percent of total billed charges,93% of total billed charges,1010.7,90,,,percent of total billed charges,90% of total billed charges,1010.7,90,,,percent of total billed charges,90% of total billed charges,1089.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,89.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1089.31,97,,,percent of total billed charges,97% of total billed charges,842.25,75,,,percent of total billed charges,75% of total billed charges,1078.08,96,,,percent of total billed charges,96% of total billed charges,89.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.25,75,,,percent of total billed charges,75% of total billed charges,842.25,75,,,percent of total billed charges,75% of total billed charges,89.2,1089.31,
PF REPAIR ANETRIOR ABDOMINAL HERNIA INITIAL 3-10CM INCARCERA,78002885P,CDM,975,RC,49594,HCPCS,Outpatient,,,1461,1095.75,,1344.12,92,,,percent of total billed charges,92% of total billed charges,117.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1358.73,93,,,percent of total billed charges,93% of total billed charges,1314.9,90,,,percent of total billed charges,90% of total billed charges,1314.9,90,,,percent of total billed charges,90% of total billed charges,1417.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,117.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1417.17,97,,,percent of total billed charges,97% of total billed charges,1095.75,75,,,percent of total billed charges,75% of total billed charges,1402.56,96,,,percent of total billed charges,96% of total billed charges,117.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1095.75,75,,,percent of total billed charges,75% of total billed charges,1095.75,75,,,percent of total billed charges,75% of total billed charges,117.4,1417.17,
PF AA HERNIA RECURRENT 3-10CM INCARCERATED OR STRANGULATED,78002880P,CDM,975,RC,49616,HCPCS,Outpatient,,,1682,1261.5,,1547.44,92,,,percent of total billed charges,92% of total billed charges,134.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1564.26,93,,,percent of total billed charges,93% of total billed charges,1513.8,90,,,percent of total billed charges,90% of total billed charges,1513.8,90,,,percent of total billed charges,90% of total billed charges,1631.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,134.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1631.54,97,,,percent of total billed charges,97% of total billed charges,1261.5,75,,,percent of total billed charges,75% of total billed charges,1614.72,96,,,percent of total billed charges,96% of total billed charges,134.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1261.5,75,,,percent of total billed charges,75% of total billed charges,1261.5,75,,,percent of total billed charges,75% of total billed charges,134.84,1631.54,
PF SECONDARY ABDOMINAL WALL SUTURE EVISCERATION/DEHISCENCE,78001524P,CDM,975,RC,49900,HCPCS,Outpatient,,,3408,2556,,3135.36,92,,,percent of total billed charges,92% of total billed charges,108.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3169.44,93,,,percent of total billed charges,93% of total billed charges,3067.2,90,,,percent of total billed charges,90% of total billed charges,3067.2,90,,,percent of total billed charges,90% of total billed charges,3305.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,108.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3305.76,97,,,percent of total billed charges,97% of total billed charges,2556,75,,,percent of total billed charges,75% of total billed charges,3271.68,96,,,percent of total billed charges,96% of total billed charges,108.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2556,75,,,percent of total billed charges,75% of total billed charges,2556,75,,,percent of total billed charges,75% of total billed charges,108.64,3305.76,
PF OMENTAL FLAP INTRA-ABDOMINAL,78001525P,CDM,975,RC,49905,HCPCS,Outpatient,,,1284,963,,1181.28,92,,,percent of total billed charges,92% of total billed charges,53.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1194.12,93,,,percent of total billed charges,93% of total billed charges,1155.6,90,,,percent of total billed charges,90% of total billed charges,1155.6,90,,,percent of total billed charges,90% of total billed charges,1245.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1245.48,97,,,percent of total billed charges,97% of total billed charges,963,75,,,percent of total billed charges,75% of total billed charges,1232.64,96,,,percent of total billed charges,96% of total billed charges,53.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,963,75,,,percent of total billed charges,75% of total billed charges,963,75,,,percent of total billed charges,75% of total billed charges,53.02,1245.48,
PF INCISION & DRAINAGE ABSCESS IN INGUINAL GROIN AREA,78002889P,CDM,975,RC,49999,HCPCS,Outpatient,,,366.4,274.8,,337.09,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,340.75,93,,,percent of total billed charges,93% of total billed charges,329.76,90,,,percent of total billed charges,90% of total billed charges,329.76,90,,,percent of total billed charges,90% of total billed charges,355.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,355.41,97,,,percent of total billed charges,97% of total billed charges,274.8,75,,,percent of total billed charges,75% of total billed charges,351.74,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,274.8,75,,,percent of total billed charges,75% of total billed charges,274.8,75,,,percent of total billed charges,75% of total billed charges,274.8,355.41,
PF ASPIRATION OF BLADDER CATH W/SURAPUBLIC CATH,78001527P,CDM,975,RC,51102,HCPCS,Outpatient,,,1200,900,,1104,92,,,percent of total billed charges,92% of total billed charges,13.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1116,93,,,percent of total billed charges,93% of total billed charges,1080,90,,,percent of total billed charges,90% of total billed charges,1080,90,,,percent of total billed charges,90% of total billed charges,1164,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1164,97,,,percent of total billed charges,97% of total billed charges,900,75,,,percent of total billed charges,75% of total billed charges,1152,96,,,percent of total billed charges,96% of total billed charges,13.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900,75,,,percent of total billed charges,75% of total billed charges,900,75,,,percent of total billed charges,75% of total billed charges,13.27,1164,
PF INJECTION CYSTOGRAPHY OR URETHROCYSTOGRAPHY,78001528P,CDM,975,RC,51600,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,3.91,289.06,
PF BLADDER IRRIGATION SIMPLE LAVAGE IRRIGATION,78001530P,CDM,975,RC,51700,HCPCS,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.4,93,,,percent of total billed charges,93% of total billed charges,72,90,,,percent of total billed charges,90% of total billed charges,72,90,,,percent of total billed charges,90% of total billed charges,77.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,77.6,97,,,percent of total billed charges,97% of total billed charges,60,75,,,percent of total billed charges,75% of total billed charges,76.8,96,,,percent of total billed charges,96% of total billed charges,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,60,75,,,percent of total billed charges,75% of total billed charges,60,75,,,percent of total billed charges,75% of total billed charges,3.19,77.6,
PF INSERT NON-INDWELLING BLADDER CATHETER,78001532P,CDM,975,RC,51701,HCPCS,Outpatient,,,68,51,,62.56,92,,,percent of total billed charges,92% of total billed charges,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63.24,93,,,percent of total billed charges,93% of total billed charges,61.2,90,,,percent of total billed charges,90% of total billed charges,61.2,90,,,percent of total billed charges,90% of total billed charges,65.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.96,97,,,percent of total billed charges,97% of total billed charges,51,75,,,percent of total billed charges,75% of total billed charges,65.28,96,,,percent of total billed charges,96% of total billed charges,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,51,75,,,percent of total billed charges,75% of total billed charges,51,75,,,percent of total billed charges,75% of total billed charges,2.77,65.96,
PF INSERT TEMP INDWELLING BLADDER CATHETER SIMPLE,78001534P,CDM,975,RC,51702,HCPCS,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,2.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,2.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,2.49,97.97,
PF INSERT TEMP INDWELLING BLADDER CATHETER COMPLICATED,78001536P,CDM,975,RC,51703,HCPCS,Outpatient,,,260,195,,239.2,92,,,percent of total billed charges,92% of total billed charges,7.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,241.8,93,,,percent of total billed charges,93% of total billed charges,234,90,,,percent of total billed charges,90% of total billed charges,234,90,,,percent of total billed charges,90% of total billed charges,252.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,252.2,97,,,percent of total billed charges,97% of total billed charges,195,75,,,percent of total billed charges,75% of total billed charges,249.6,96,,,percent of total billed charges,96% of total billed charges,7.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195,75,,,percent of total billed charges,75% of total billed charges,195,75,,,percent of total billed charges,75% of total billed charges,7.48,252.2,
PF CHANGE CYSTOSTOMY TUBE SIMPLE,78001538P,CDM,975,RC,51705,HCPCS,Outpatient,,,457,342.75,,420.44,92,,,percent of total billed charges,92% of total billed charges,4.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,425.01,93,,,percent of total billed charges,93% of total billed charges,411.3,90,,,percent of total billed charges,90% of total billed charges,411.3,90,,,percent of total billed charges,90% of total billed charges,443.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,443.29,97,,,percent of total billed charges,97% of total billed charges,342.75,75,,,percent of total billed charges,75% of total billed charges,438.72,96,,,percent of total billed charges,96% of total billed charges,4.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,342.75,75,,,percent of total billed charges,75% of total billed charges,342.75,75,,,percent of total billed charges,75% of total billed charges,4.76,443.29,
PF MEAS POST-VOIDING RESIDUAL URINE and /BLADDER CAP,78001540P,CDM,975,RC,51798,HCPCS,Outpatient,,,39,29.25,,35.88,92,,,percent of total billed charges,92% of total billed charges,0.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,36.27,93,,,percent of total billed charges,93% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,37.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,37.83,97,,,percent of total billed charges,97% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges,37.44,96,,,percent of total billed charges,96% of total billed charges,0.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,29.25,75,,,percent of total billed charges,75% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges,0.66,37.83,
PF CYSTORRHAPHY SUTURE BLADDER WOUND INJ/RPT COMPLICATED,78001542P,CDM,975,RC,51865,HCPCS,Outpatient,,,4809,3606.75,,4424.28,92,,,percent of total billed charges,92% of total billed charges,89.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4472.37,93,,,percent of total billed charges,93% of total billed charges,4328.1,90,,,percent of total billed charges,90% of total billed charges,4328.1,90,,,percent of total billed charges,90% of total billed charges,4664.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,89.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4664.73,97,,,percent of total billed charges,97% of total billed charges,3606.75,75,,,percent of total billed charges,75% of total billed charges,4616.64,96,,,percent of total billed charges,96% of total billed charges,89.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3606.75,75,,,percent of total billed charges,75% of total billed charges,3606.75,75,,,percent of total billed charges,75% of total billed charges,89.65,4664.73,
PF CYSTOURETHROSCOPY,78001543P,CDM,975,RC,52000,HCPCS,Outpatient,,,352,264,,323.84,92,,,percent of total billed charges,92% of total billed charges,7.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,327.36,93,,,percent of total billed charges,93% of total billed charges,316.8,90,,,percent of total billed charges,90% of total billed charges,316.8,90,,,percent of total billed charges,90% of total billed charges,341.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,341.44,97,,,percent of total billed charges,97% of total billed charges,264,75,,,percent of total billed charges,75% of total billed charges,337.92,96,,,percent of total billed charges,96% of total billed charges,7.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,264,75,,,percent of total billed charges,75% of total billed charges,264,75,,,percent of total billed charges,75% of total billed charges,7.89,341.44,
PF CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH,78001544P,CDM,975,RC,52260,HCPCS,Outpatient,,,549,411.75,,505.08,92,,,percent of total billed charges,92% of total billed charges,20.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,510.57,93,,,percent of total billed charges,93% of total billed charges,494.1,90,,,percent of total billed charges,90% of total billed charges,494.1,90,,,percent of total billed charges,90% of total billed charges,532.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,532.53,97,,,percent of total billed charges,97% of total billed charges,411.75,75,,,percent of total billed charges,75% of total billed charges,527.04,96,,,percent of total billed charges,96% of total billed charges,20.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.75,75,,,percent of total billed charges,75% of total billed charges,411.75,75,,,percent of total billed charges,75% of total billed charges,20.72,532.53,
PF SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN,78001545P,CDM,975,RC,54001,HCPCS,Outpatient,,,604,453,,555.68,92,,,percent of total billed charges,92% of total billed charges,12.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,561.72,93,,,percent of total billed charges,93% of total billed charges,543.6,90,,,percent of total billed charges,90% of total billed charges,543.6,90,,,percent of total billed charges,90% of total billed charges,585.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,585.88,97,,,percent of total billed charges,97% of total billed charges,453,75,,,percent of total billed charges,75% of total billed charges,579.84,96,,,percent of total billed charges,96% of total billed charges,12.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,453,75,,,percent of total billed charges,75% of total billed charges,453,75,,,percent of total billed charges,75% of total billed charges,12.19,585.88,
PF CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK,78001546P,CDM,975,RC,54150,HCPCS,Outpatient,,,863,647.25,,793.96,92,,,percent of total billed charges,92% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,802.59,93,,,percent of total billed charges,93% of total billed charges,776.7,90,,,percent of total billed charges,90% of total billed charges,776.7,90,,,percent of total billed charges,90% of total billed charges,837.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,837.11,97,,,percent of total billed charges,97% of total billed charges,647.25,75,,,percent of total billed charges,75% of total billed charges,828.48,96,,,percent of total billed charges,96% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,647.25,75,,,percent of total billed charges,75% of total billed charges,647.25,75,,,percent of total billed charges,75% of total billed charges,9.79,837.11,
PF CIRCUMCISION AGE >28 DAYS,78001548P,CDM,975,RC,54161,HCPCS,Outpatient,,,1243,932.25,,1143.56,92,,,percent of total billed charges,92% of total billed charges,17.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1155.99,93,,,percent of total billed charges,93% of total billed charges,1118.7,90,,,percent of total billed charges,90% of total billed charges,1118.7,90,,,percent of total billed charges,90% of total billed charges,1205.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1205.71,97,,,percent of total billed charges,97% of total billed charges,932.25,75,,,percent of total billed charges,75% of total billed charges,1193.28,96,,,percent of total billed charges,96% of total billed charges,17.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,932.25,75,,,percent of total billed charges,75% of total billed charges,932.25,75,,,percent of total billed charges,75% of total billed charges,17.66,1205.71,
PF LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESNS,78001549P,CDM,975,RC,54162,HCPCS,Outpatient,,,527,395.25,,484.84,92,,,percent of total billed charges,92% of total billed charges,17.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,490.11,93,,,percent of total billed charges,93% of total billed charges,474.3,90,,,percent of total billed charges,90% of total billed charges,474.3,90,,,percent of total billed charges,90% of total billed charges,511.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,511.19,97,,,percent of total billed charges,97% of total billed charges,395.25,75,,,percent of total billed charges,75% of total billed charges,505.92,96,,,percent of total billed charges,96% of total billed charges,17.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,395.25,75,,,percent of total billed charges,75% of total billed charges,395.25,75,,,percent of total billed charges,75% of total billed charges,17.78,511.19,
PF TREATMENT OF PENIS LESION,78001551P,CDM,975,RC,54220,HCPCS,Outpatient,,,502,376.5,,461.84,92,,,percent of total billed charges,92% of total billed charges,15.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,466.86,93,,,percent of total billed charges,93% of total billed charges,451.8,90,,,percent of total billed charges,90% of total billed charges,451.8,90,,,percent of total billed charges,90% of total billed charges,486.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,486.94,97,,,percent of total billed charges,97% of total billed charges,376.5,75,,,percent of total billed charges,75% of total billed charges,481.92,96,,,percent of total billed charges,96% of total billed charges,15.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,376.5,75,,,percent of total billed charges,75% of total billed charges,376.5,75,,,percent of total billed charges,75% of total billed charges,15.48,486.94,
PF ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH,78001553P,CDM,975,RC,54520,HCPCS,Outpatient,,,2186,1639.5,,2011.12,92,,,percent of total billed charges,92% of total billed charges,30.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2032.98,93,,,percent of total billed charges,93% of total billed charges,1967.4,90,,,percent of total billed charges,90% of total billed charges,1967.4,90,,,percent of total billed charges,90% of total billed charges,2120.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2120.42,97,,,percent of total billed charges,97% of total billed charges,1639.5,75,,,percent of total billed charges,75% of total billed charges,2098.56,96,,,percent of total billed charges,96% of total billed charges,30.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1639.5,75,,,percent of total billed charges,75% of total billed charges,1639.5,75,,,percent of total billed charges,75% of total billed charges,30.91,2120.42,
PF EXCISION OF HYDROCELE UNILATERAL,78002838P,CDM,975,RC,55040,HCPCS,Outpatient,,,838,628.5,,770.96,92,,,percent of total billed charges,92% of total billed charges,30.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,779.34,93,,,percent of total billed charges,93% of total billed charges,754.2,90,,,percent of total billed charges,90% of total billed charges,754.2,90,,,percent of total billed charges,90% of total billed charges,812.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,812.86,97,,,percent of total billed charges,97% of total billed charges,628.5,75,,,percent of total billed charges,75% of total billed charges,804.48,96,,,percent of total billed charges,96% of total billed charges,30.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,628.5,75,,,percent of total billed charges,75% of total billed charges,628.5,75,,,percent of total billed charges,75% of total billed charges,30.74,812.86,
PF DRAINAGE SCROTAL WALL ABSCESS,78001554P,CDM,975,RC,55100,HCPCS,Outpatient,,,655,491.25,,602.6,92,,,percent of total billed charges,92% of total billed charges,15.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,609.15,93,,,percent of total billed charges,93% of total billed charges,589.5,90,,,percent of total billed charges,90% of total billed charges,589.5,90,,,percent of total billed charges,90% of total billed charges,635.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,635.35,97,,,percent of total billed charges,97% of total billed charges,491.25,75,,,percent of total billed charges,75% of total billed charges,628.8,96,,,percent of total billed charges,96% of total billed charges,15.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,491.25,75,,,percent of total billed charges,75% of total billed charges,491.25,75,,,percent of total billed charges,75% of total billed charges,15.6,635.35,
PF VASECTOMY W/POSTOP SEMEN EXAMS,78001556P,CDM,975,RC,55250,HCPCS,Outpatient,,,603,452.25,,554.76,92,,,percent of total billed charges,92% of total billed charges,18.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,560.79,93,,,percent of total billed charges,93% of total billed charges,542.7,90,,,percent of total billed charges,90% of total billed charges,542.7,90,,,percent of total billed charges,90% of total billed charges,584.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,584.91,97,,,percent of total billed charges,97% of total billed charges,452.25,75,,,percent of total billed charges,75% of total billed charges,578.88,96,,,percent of total billed charges,96% of total billed charges,18.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,452.25,75,,,percent of total billed charges,75% of total billed charges,452.25,75,,,percent of total billed charges,75% of total billed charges,18.83,584.91,
PF UNLISTED PROCEDURE MALE GENITAL SYSTEM,78001558P,CDM,975,RC,55899,HCPCS,Outpatient,,,1390,1042.5,,1278.8,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,1292.7,93,,,percent of total billed charges,93% of total billed charges,1251,90,,,percent of total billed charges,90% of total billed charges,1251,90,,,percent of total billed charges,90% of total billed charges,1348.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1348.3,97,,,percent of total billed charges,97% of total billed charges,1042.5,75,,,percent of total billed charges,75% of total billed charges,1334.4,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,1042.5,75,,,percent of total billed charges,75% of total billed charges,1042.5,75,,,percent of total billed charges,75% of total billed charges,1042.5,1348.3,
PF I and D VULVA/PERINEAL ABSCESS,78001560P,CDM,975,RC,56405,HCPCS,Outpatient,,,468,351,,430.56,92,,,percent of total billed charges,92% of total billed charges,11.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,435.24,93,,,percent of total billed charges,93% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,453.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,453.96,97,,,percent of total billed charges,97% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,449.28,96,,,percent of total billed charges,96% of total billed charges,11.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,351,75,,,percent of total billed charges,75% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,11.21,453.96,
PF I and D OF BARTHOLINS GLAND ABSCESS,78001561P,CDM,975,RC,56420,HCPCS,Outpatient,,,405,303.75,,372.6,92,,,percent of total billed charges,92% of total billed charges,10.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,376.65,93,,,percent of total billed charges,93% of total billed charges,364.5,90,,,percent of total billed charges,90% of total billed charges,364.5,90,,,percent of total billed charges,90% of total billed charges,392.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,392.85,97,,,percent of total billed charges,97% of total billed charges,303.75,75,,,percent of total billed charges,75% of total billed charges,388.8,96,,,percent of total billed charges,96% of total billed charges,10.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,303.75,75,,,percent of total billed charges,75% of total billed charges,303.75,75,,,percent of total billed charges,75% of total billed charges,10.37,392.85,
PF DESTRUCTION LESIONS VULVA SIMPLE,78001563P,CDM,975,RC,56501,HCPCS,Outpatient,,,442,331.5,,406.64,92,,,percent of total billed charges,92% of total billed charges,11.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.06,93,,,percent of total billed charges,93% of total billed charges,397.8,90,,,percent of total billed charges,90% of total billed charges,397.8,90,,,percent of total billed charges,90% of total billed charges,428.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.74,97,,,percent of total billed charges,97% of total billed charges,331.5,75,,,percent of total billed charges,75% of total billed charges,424.32,96,,,percent of total billed charges,96% of total billed charges,11.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,331.5,75,,,percent of total billed charges,75% of total billed charges,331.5,75,,,percent of total billed charges,75% of total billed charges,11.17,428.74,
PF DESTRUCTION LESIONS VULVA EXTENSIVE,78001565P,CDM,975,RC,56515,HCPCS,Outpatient,,,569,426.75,,523.48,92,,,percent of total billed charges,92% of total billed charges,20.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,529.17,93,,,percent of total billed charges,93% of total billed charges,512.1,90,,,percent of total billed charges,90% of total billed charges,512.1,90,,,percent of total billed charges,90% of total billed charges,551.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,551.93,97,,,percent of total billed charges,97% of total billed charges,426.75,75,,,percent of total billed charges,75% of total billed charges,546.24,96,,,percent of total billed charges,96% of total billed charges,20.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,426.75,75,,,percent of total billed charges,75% of total billed charges,426.75,75,,,percent of total billed charges,75% of total billed charges,20.96,551.93,
PF BIOPSY VULVA/PERINEUM 1 LESION,78001567P,CDM,975,RC,56605,HCPCS,Outpatient,,,156,117,,143.52,92,,,percent of total billed charges,92% of total billed charges,6.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,145.08,93,,,percent of total billed charges,93% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,151.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,151.32,97,,,percent of total billed charges,97% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,149.76,96,,,percent of total billed charges,96% of total billed charges,6.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117,75,,,percent of total billed charges,75% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,6.92,151.32,
PF BIOPSY VULVA/PERINEUM EACH ADDL LESION,78001569P,CDM,975,RC,56606,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.61,93,,,percent of total billed charges,93% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,74.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.69,97,,,percent of total billed charges,97% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,73.92,96,,,percent of total billed charges,96% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.75,75,,,percent of total billed charges,75% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,3.44,74.69,
PF VULVECTOMY SIMPLE PARTIAL,78001571P,CDM,975,RC,56620,HCPCS,Outpatient,,,1023,767.25,,941.16,92,,,percent of total billed charges,92% of total billed charges,54.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,951.39,93,,,percent of total billed charges,93% of total billed charges,920.7,90,,,percent of total billed charges,90% of total billed charges,920.7,90,,,percent of total billed charges,90% of total billed charges,992.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,54.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,992.31,97,,,percent of total billed charges,97% of total billed charges,767.25,75,,,percent of total billed charges,75% of total billed charges,982.08,96,,,percent of total billed charges,96% of total billed charges,54.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,767.25,75,,,percent of total billed charges,75% of total billed charges,767.25,75,,,percent of total billed charges,75% of total billed charges,54.95,992.31,
PF PARTIAL HYMENECTOMY/REVISION HYMENAL RING,78001573P,CDM,975,RC,56700,HCPCS,Outpatient,,,1023,767.25,,941.16,92,,,percent of total billed charges,92% of total billed charges,19.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,951.39,93,,,percent of total billed charges,93% of total billed charges,920.7,90,,,percent of total billed charges,90% of total billed charges,920.7,90,,,percent of total billed charges,90% of total billed charges,992.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,992.31,97,,,percent of total billed charges,97% of total billed charges,767.25,75,,,percent of total billed charges,75% of total billed charges,982.08,96,,,percent of total billed charges,96% of total billed charges,19.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,767.25,75,,,percent of total billed charges,75% of total billed charges,767.25,75,,,percent of total billed charges,75% of total billed charges,19.83,992.31,
PF PERINEOPLASTY REPAIR PERINEUM NONOBSTETRICAL,78001574P,CDM,975,RC,56810,HCPCS,Outpatient,,,1035,776.25,,952.2,92,,,percent of total billed charges,92% of total billed charges,28.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,962.55,93,,,percent of total billed charges,93% of total billed charges,931.5,90,,,percent of total billed charges,90% of total billed charges,931.5,90,,,percent of total billed charges,90% of total billed charges,1003.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1003.95,97,,,percent of total billed charges,97% of total billed charges,776.25,75,,,percent of total billed charges,75% of total billed charges,993.6,96,,,percent of total billed charges,96% of total billed charges,28.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,776.25,75,,,percent of total billed charges,75% of total billed charges,776.25,75,,,percent of total billed charges,75% of total billed charges,28.77,1003.95,
PF COLPOTOMY W/DRAINAGE PELVIC ABSCESS,78001575P,CDM,975,RC,57010,HCPCS,Outpatient,,,1226,919.5,,1127.92,92,,,percent of total billed charges,92% of total billed charges,47.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1140.18,93,,,percent of total billed charges,93% of total billed charges,1103.4,90,,,percent of total billed charges,90% of total billed charges,1103.4,90,,,percent of total billed charges,90% of total billed charges,1189.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,47.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1189.22,97,,,percent of total billed charges,97% of total billed charges,919.5,75,,,percent of total billed charges,75% of total billed charges,1176.96,96,,,percent of total billed charges,96% of total billed charges,47.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,919.5,75,,,percent of total billed charges,75% of total billed charges,919.5,75,,,percent of total billed charges,75% of total billed charges,47.7,1189.22,
PF VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL,78001576P,CDM,975,RC,57110,HCPCS,Outpatient,,,2410,1807.5,,2217.2,92,,,percent of total billed charges,92% of total billed charges,99.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2241.3,93,,,percent of total billed charges,93% of total billed charges,2169,90,,,percent of total billed charges,90% of total billed charges,2169,90,,,percent of total billed charges,90% of total billed charges,2337.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,99.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2337.7,97,,,percent of total billed charges,97% of total billed charges,1807.5,75,,,percent of total billed charges,75% of total billed charges,2313.6,96,,,percent of total billed charges,96% of total billed charges,99.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1807.5,75,,,percent of total billed charges,75% of total billed charges,1807.5,75,,,percent of total billed charges,75% of total billed charges,99.97,2337.7,
PF COLPOCLEISIS LE FORT TYPE,78001577P,CDM,975,RC,57120,HCPCS,Outpatient,,,1638,1228.5,,1506.96,92,,,percent of total billed charges,92% of total billed charges,54.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1523.34,93,,,percent of total billed charges,93% of total billed charges,1474.2,90,,,percent of total billed charges,90% of total billed charges,1474.2,90,,,percent of total billed charges,90% of total billed charges,1588.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,54.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1588.86,97,,,percent of total billed charges,97% of total billed charges,1228.5,75,,,percent of total billed charges,75% of total billed charges,1572.48,96,,,percent of total billed charges,96% of total billed charges,54.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1228.5,75,,,percent of total billed charges,75% of total billed charges,1228.5,75,,,percent of total billed charges,75% of total billed charges,54.55,1588.86,
PF FIT AND INSERTION OF VAGINAL SUPPORT DEVICE,78001578P,CDM,975,RC,57160,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges,5.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.6,93,,,percent of total billed charges,93% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,116.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.4,97,,,percent of total billed charges,97% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,115.2,96,,,percent of total billed charges,96% of total billed charges,5.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90,75,,,percent of total billed charges,75% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,5.38,116.4,
PF DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS,78001580P,CDM,975,RC,57170,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges,5.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,93,,,percent of total billed charges,93% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,121.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,121.25,97,,,percent of total billed charges,97% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,120,96,,,percent of total billed charges,96% of total billed charges,5.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.75,75,,,percent of total billed charges,75% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,5.69,121.25,
PF COLPOPERINEORRHAPHY SUTURE INJ VAGINA and /PERINEU,78001582P,CDM,975,RC,57210,HCPCS,Outpatient,,,1058,793.5,,973.36,92,,,percent of total billed charges,92% of total billed charges,39.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,983.94,93,,,percent of total billed charges,93% of total billed charges,952.2,90,,,percent of total billed charges,90% of total billed charges,952.2,90,,,percent of total billed charges,90% of total billed charges,1026.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,39.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1026.26,97,,,percent of total billed charges,97% of total billed charges,793.5,75,,,percent of total billed charges,75% of total billed charges,1015.68,96,,,percent of total billed charges,96% of total billed charges,39.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,793.5,75,,,percent of total billed charges,75% of total billed charges,793.5,75,,,percent of total billed charges,75% of total billed charges,39.49,1026.26,
PF ANT COLPORRHAPHY CYSTOCELE W/WO RPR URETHROCELE,78001583P,CDM,975,RC,57240,HCPCS,Outpatient,,,1636,1227,,1505.12,92,,,percent of total billed charges,92% of total billed charges,63.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1521.48,93,,,percent of total billed charges,93% of total billed charges,1472.4,90,,,percent of total billed charges,90% of total billed charges,1472.4,90,,,percent of total billed charges,90% of total billed charges,1586.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,63.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1586.92,97,,,percent of total billed charges,97% of total billed charges,1227,75,,,percent of total billed charges,75% of total billed charges,1570.56,96,,,percent of total billed charges,96% of total billed charges,63.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1227,75,,,percent of total billed charges,75% of total billed charges,1227,75,,,percent of total billed charges,75% of total billed charges,63.9,1586.92,
PF POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY,78001584P,CDM,975,RC,57250,HCPCS,Outpatient,,,2785,2088.75,,2562.2,92,,,percent of total billed charges,92% of total billed charges,65.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2590.05,93,,,percent of total billed charges,93% of total billed charges,2506.5,90,,,percent of total billed charges,90% of total billed charges,2506.5,90,,,percent of total billed charges,90% of total billed charges,2701.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,65.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2701.45,97,,,percent of total billed charges,97% of total billed charges,2088.75,75,,,percent of total billed charges,75% of total billed charges,2673.6,96,,,percent of total billed charges,96% of total billed charges,65.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2088.75,75,,,percent of total billed charges,75% of total billed charges,2088.75,75,,,percent of total billed charges,75% of total billed charges,65.62,2701.45,
PF COMBINED ANTEROPOSTERIOR COLPORRHAPHY,78001585P,CDM,975,RC,57260,HCPCS,Outpatient,,,2077,1557.75,,1910.84,92,,,percent of total billed charges,92% of total billed charges,85.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1931.61,93,,,percent of total billed charges,93% of total billed charges,1869.3,90,,,percent of total billed charges,90% of total billed charges,1869.3,90,,,percent of total billed charges,90% of total billed charges,2014.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,85.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2014.69,97,,,percent of total billed charges,97% of total billed charges,1557.75,75,,,percent of total billed charges,75% of total billed charges,1993.92,96,,,percent of total billed charges,96% of total billed charges,85.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1557.75,75,,,percent of total billed charges,75% of total billed charges,1557.75,75,,,percent of total billed charges,75% of total billed charges,85.34,2014.69,
PF COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH,78001587P,CDM,975,RC,57283,HCPCS,Outpatient,,,1864,1398,,1714.88,92,,,percent of total billed charges,92% of total billed charges,75.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1733.52,93,,,percent of total billed charges,93% of total billed charges,1677.6,90,,,percent of total billed charges,90% of total billed charges,1677.6,90,,,percent of total billed charges,90% of total billed charges,1808.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,75.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1808.08,97,,,percent of total billed charges,97% of total billed charges,1398,75,,,percent of total billed charges,75% of total billed charges,1789.44,96,,,percent of total billed charges,96% of total billed charges,75.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1398,75,,,percent of total billed charges,75% of total billed charges,1398,75,,,percent of total billed charges,75% of total billed charges,75.8,1808.08,
PF COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX,78001588P,CDM,975,RC,57421,HCPCS,Outpatient,,,320,240,,294.4,92,,,percent of total billed charges,92% of total billed charges,14.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297.6,93,,,percent of total billed charges,93% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,310.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,310.4,97,,,percent of total billed charges,97% of total billed charges,240,75,,,percent of total billed charges,75% of total billed charges,307.2,96,,,percent of total billed charges,96% of total billed charges,14.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,240,75,,,percent of total billed charges,75% of total billed charges,240,75,,,percent of total billed charges,75% of total billed charges,14.51,310.4,
PF COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA,78001590P,CDM,975,RC,57452,HCPCS,Outpatient,,,239,179.25,,219.88,92,,,percent of total billed charges,92% of total billed charges,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222.27,93,,,percent of total billed charges,93% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,231.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.83,97,,,percent of total billed charges,97% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,229.44,96,,,percent of total billed charges,96% of total billed charges,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.25,75,,,percent of total billed charges,75% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,9.65,231.83,
PF COLPOSCOPY CERVIX BX CERVIX  and  ENDOCRV CURRETAGE,78001592P,CDM,975,RC,57454,HCPCS,Outpatient,,,353,264.75,,324.76,92,,,percent of total billed charges,92% of total billed charges,15.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,328.29,93,,,percent of total billed charges,93% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,342.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,342.41,97,,,percent of total billed charges,97% of total billed charges,264.75,75,,,percent of total billed charges,75% of total billed charges,338.88,96,,,percent of total billed charges,96% of total billed charges,15.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,264.75,75,,,percent of total billed charges,75% of total billed charges,264.75,75,,,percent of total billed charges,75% of total billed charges,15.2,342.41,
PF COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX,78001594P,CDM,975,RC,57460,HCPCS,Outpatient,,,483,362.25,,444.36,92,,,percent of total billed charges,92% of total billed charges,18.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,449.19,93,,,percent of total billed charges,93% of total billed charges,434.7,90,,,percent of total billed charges,90% of total billed charges,434.7,90,,,percent of total billed charges,90% of total billed charges,468.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,468.51,97,,,percent of total billed charges,97% of total billed charges,362.25,75,,,percent of total billed charges,75% of total billed charges,463.68,96,,,percent of total billed charges,96% of total billed charges,18.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,362.25,75,,,percent of total billed charges,75% of total billed charges,362.25,75,,,percent of total billed charges,75% of total billed charges,18.25,468.51,
PF BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESN SPX,78001596P,CDM,975,RC,57500,HCPCS,Outpatient,,,237,177.75,,218.04,92,,,percent of total billed charges,92% of total billed charges,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,220.41,93,,,percent of total billed charges,93% of total billed charges,213.3,90,,,percent of total billed charges,90% of total billed charges,213.3,90,,,percent of total billed charges,90% of total billed charges,229.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,229.89,97,,,percent of total billed charges,97% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges,227.52,96,,,percent of total billed charges,96% of total billed charges,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.75,75,,,percent of total billed charges,75% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges,8.03,229.89,
PF CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT,78001598P,CDM,975,RC,57511,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,14.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,14.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,14.1,383.15,
PF CONIZATION CERVIX W/WO D and C RPR KNIFE/LASER,78001600P,CDM,975,RC,57520,HCPCS,Outpatient,,,2067,1550.25,,1901.64,92,,,percent of total billed charges,92% of total billed charges,29.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1922.31,93,,,percent of total billed charges,93% of total billed charges,1860.3,90,,,percent of total billed charges,90% of total billed charges,1860.3,90,,,percent of total billed charges,90% of total billed charges,2004.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2004.99,97,,,percent of total billed charges,97% of total billed charges,1550.25,75,,,percent of total billed charges,75% of total billed charges,1984.32,96,,,percent of total billed charges,96% of total billed charges,29.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1550.25,75,,,percent of total billed charges,75% of total billed charges,1550.25,75,,,percent of total billed charges,75% of total billed charges,29.35,2004.99,
PF CONIZATION CERVIX W/WO D and C RPR ELTRD EXC,78001601P,CDM,975,RC,57522,HCPCS,Outpatient,,,459,344.25,,422.28,92,,,percent of total billed charges,92% of total billed charges,25.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,426.87,93,,,percent of total billed charges,93% of total billed charges,413.1,90,,,percent of total billed charges,90% of total billed charges,413.1,90,,,percent of total billed charges,90% of total billed charges,445.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,445.23,97,,,percent of total billed charges,97% of total billed charges,344.25,75,,,percent of total billed charges,75% of total billed charges,440.64,96,,,percent of total billed charges,96% of total billed charges,25.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,344.25,75,,,percent of total billed charges,75% of total billed charges,344.25,75,,,percent of total billed charges,75% of total billed charges,25.46,445.23,
PF EXC CRV STUMP VAG APPR W/ANT  and /POST REPAIR,78001603P,CDM,975,RC,57555,HCPCS,Outpatient,,,2059,1544.25,,1894.28,92,,,percent of total billed charges,92% of total billed charges,67.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1914.87,93,,,percent of total billed charges,93% of total billed charges,1853.1,90,,,percent of total billed charges,90% of total billed charges,1853.1,90,,,percent of total billed charges,90% of total billed charges,1997.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,67.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1997.23,97,,,percent of total billed charges,97% of total billed charges,1544.25,75,,,percent of total billed charges,75% of total billed charges,1976.64,96,,,percent of total billed charges,96% of total billed charges,67.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1544.25,75,,,percent of total billed charges,75% of total billed charges,1544.25,75,,,percent of total billed charges,75% of total billed charges,67.11,1997.23,
PF ENDOMETRIAL SAMPLING W/O CERVICAL DILATION,78001604P,CDM,975,RC,58100,HCPCS,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges,7.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156.24,93,,,percent of total billed charges,93% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,162.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.96,97,,,percent of total billed charges,97% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,161.28,96,,,percent of total billed charges,96% of total billed charges,7.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126,75,,,percent of total billed charges,75% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,7.6,162.96,
PF ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY,78001606P,CDM,975,RC,58110,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges,4.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,98.58,93,,,percent of total billed charges,93% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,102.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102.82,97,,,percent of total billed charges,97% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges,101.76,96,,,percent of total billed charges,96% of total billed charges,4.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.5,75,,,percent of total billed charges,75% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges,4.91,102.82,
PF DILATION  and  CURETTAGE DX and /THER NONOBSTETRIC,78001608P,CDM,975,RC,58120,HCPCS,Outpatient,,,1607,1205.25,,1478.44,92,,,percent of total billed charges,92% of total billed charges,24.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1494.51,93,,,percent of total billed charges,93% of total billed charges,1446.3,90,,,percent of total billed charges,90% of total billed charges,1446.3,90,,,percent of total billed charges,90% of total billed charges,1558.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1558.79,97,,,percent of total billed charges,97% of total billed charges,1205.25,75,,,percent of total billed charges,75% of total billed charges,1542.72,96,,,percent of total billed charges,96% of total billed charges,24.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1205.25,75,,,percent of total billed charges,75% of total billed charges,1205.25,75,,,percent of total billed charges,75% of total billed charges,24.4,1558.79,
PF TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY,78001611P,CDM,975,RC,58150,HCPCS,Outpatient,,,5418,4063.5,,4984.56,92,,,percent of total billed charges,92% of total billed charges,114.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5038.74,93,,,percent of total billed charges,93% of total billed charges,4876.2,90,,,percent of total billed charges,90% of total billed charges,4876.2,90,,,percent of total billed charges,90% of total billed charges,5255.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,114.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5255.46,97,,,percent of total billed charges,97% of total billed charges,4063.5,75,,,percent of total billed charges,75% of total billed charges,5201.28,96,,,percent of total billed charges,96% of total billed charges,114.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4063.5,75,,,percent of total billed charges,75% of total billed charges,4063.5,75,,,percent of total billed charges,75% of total billed charges,114.19,5255.46,
PF VAGINAL HYSTERECTOMY UTERUS 250 GM/<,78001613P,CDM,975,RC,58260,HCPCS,Outpatient,,,4750,3562.5,,4370,92,,,percent of total billed charges,92% of total billed charges,93.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4417.5,93,,,percent of total billed charges,93% of total billed charges,4275,90,,,percent of total billed charges,90% of total billed charges,4275,90,,,percent of total billed charges,90% of total billed charges,4607.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,93.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4607.5,97,,,percent of total billed charges,97% of total billed charges,3562.5,75,,,percent of total billed charges,75% of total billed charges,4560,96,,,percent of total billed charges,96% of total billed charges,93.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3562.5,75,,,percent of total billed charges,75% of total billed charges,3562.5,75,,,percent of total billed charges,75% of total billed charges,93.43,4607.5,
PF VAG HYST 250 GM/< W/RMVL TUBE and /OVARY,78001615P,CDM,975,RC,58262,HCPCS,Outpatient,,,2471,1853.25,,2273.32,92,,,percent of total billed charges,92% of total billed charges,104.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2298.03,93,,,percent of total billed charges,93% of total billed charges,2223.9,90,,,percent of total billed charges,90% of total billed charges,2223.9,90,,,percent of total billed charges,90% of total billed charges,2396.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,104.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2396.87,97,,,percent of total billed charges,97% of total billed charges,1853.25,75,,,percent of total billed charges,75% of total billed charges,2372.16,96,,,percent of total billed charges,96% of total billed charges,104.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1853.25,75,,,percent of total billed charges,75% of total billed charges,1853.25,75,,,percent of total billed charges,75% of total billed charges,104.07,2396.87,
PF VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL,78001616P,CDM,975,RC,58263,HCPCS,Outpatient,,,2648,1986,,2436.16,92,,,percent of total billed charges,92% of total billed charges,112.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2462.64,93,,,percent of total billed charges,93% of total billed charges,2383.2,90,,,percent of total billed charges,90% of total billed charges,2383.2,90,,,percent of total billed charges,90% of total billed charges,2568.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,112.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2568.56,97,,,percent of total billed charges,97% of total billed charges,1986,75,,,percent of total billed charges,75% of total billed charges,2542.08,96,,,percent of total billed charges,96% of total billed charges,112.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1986,75,,,percent of total billed charges,75% of total billed charges,1986,75,,,percent of total billed charges,75% of total billed charges,112.07,2568.56,
PF VAGINAL HYSTERECTOMY UTERUS > 250 GM,78001617P,CDM,975,RC,58290,HCPCS,Outpatient,,,5098,3823.5,,4690.16,92,,,percent of total billed charges,92% of total billed charges,133.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4741.14,93,,,percent of total billed charges,93% of total billed charges,4588.2,90,,,percent of total billed charges,90% of total billed charges,4588.2,90,,,percent of total billed charges,90% of total billed charges,4945.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,133.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4945.06,97,,,percent of total billed charges,97% of total billed charges,3823.5,75,,,percent of total billed charges,75% of total billed charges,4894.08,96,,,percent of total billed charges,96% of total billed charges,133.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3823.5,75,,,percent of total billed charges,75% of total billed charges,3823.5,75,,,percent of total billed charges,75% of total billed charges,133.2,4945.06,
PF VAG HYST > 250 GM RMVL TUBE and /OVARY,78001618P,CDM,975,RC,58291,HCPCS,Outpatient,,,5213,3909.75,,4795.96,92,,,percent of total billed charges,92% of total billed charges,144.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4848.09,93,,,percent of total billed charges,93% of total billed charges,4691.7,90,,,percent of total billed charges,90% of total billed charges,4691.7,90,,,percent of total billed charges,90% of total billed charges,5056.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,144.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5056.61,97,,,percent of total billed charges,97% of total billed charges,3909.75,75,,,percent of total billed charges,75% of total billed charges,5004.48,96,,,percent of total billed charges,96% of total billed charges,144.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3909.75,75,,,percent of total billed charges,75% of total billed charges,3909.75,75,,,percent of total billed charges,75% of total billed charges,144.25,5056.61,
PF INSERTION INTRAUTERINE DEVICE IUD,78001619P,CDM,975,RC,58300,HCPCS,Outpatient,,,170,127.5,,156.4,92,,,percent of total billed charges,92% of total billed charges,4.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.1,93,,,percent of total billed charges,93% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,164.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.9,97,,,percent of total billed charges,97% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,163.2,96,,,percent of total billed charges,96% of total billed charges,4.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.5,75,,,percent of total billed charges,75% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,4.44,164.9,
PF CHROMOTUBATION OVIDUCT W/MATERIALS,78001623P,CDM,975,RC,58350,HCPCS,Outpatient,,,257,192.75,,236.44,92,,,percent of total billed charges,92% of total billed charges,8.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,239.01,93,,,percent of total billed charges,93% of total billed charges,231.3,90,,,percent of total billed charges,90% of total billed charges,231.3,90,,,percent of total billed charges,90% of total billed charges,249.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249.29,97,,,percent of total billed charges,97% of total billed charges,192.75,75,,,percent of total billed charges,75% of total billed charges,246.72,96,,,percent of total billed charges,96% of total billed charges,8.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,192.75,75,,,percent of total billed charges,75% of total billed charges,192.75,75,,,percent of total billed charges,75% of total billed charges,8.2,249.29,
PF LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<,78001625P,CDM,975,RC,58550,HCPCS,Outpatient,,,5209,3906.75,,4792.28,92,,,percent of total billed charges,92% of total billed charges,99.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4844.37,93,,,percent of total billed charges,93% of total billed charges,4688.1,90,,,percent of total billed charges,90% of total billed charges,4688.1,90,,,percent of total billed charges,90% of total billed charges,5052.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,99.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5052.73,97,,,percent of total billed charges,97% of total billed charges,3906.75,75,,,percent of total billed charges,75% of total billed charges,5000.64,96,,,percent of total billed charges,96% of total billed charges,99.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3906.75,75,,,percent of total billed charges,75% of total billed charges,3906.75,75,,,percent of total billed charges,75% of total billed charges,99.52,5052.73,
PF LAPS W/VAG HYSTERECT 250 GM/ and RMVL TUBE and /OVARIES,78001628P,CDM,975,RC,58552,HCPCS,Outpatient,,,5214,3910.5,,4796.88,92,,,percent of total billed charges,92% of total billed charges,110.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4849.02,93,,,percent of total billed charges,93% of total billed charges,4692.6,90,,,percent of total billed charges,90% of total billed charges,4692.6,90,,,percent of total billed charges,90% of total billed charges,5057.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,110.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5057.58,97,,,percent of total billed charges,97% of total billed charges,3910.5,75,,,percent of total billed charges,75% of total billed charges,5005.44,96,,,percent of total billed charges,96% of total billed charges,110.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3910.5,75,,,percent of total billed charges,75% of total billed charges,3910.5,75,,,percent of total billed charges,75% of total billed charges,110.78,5057.58,
PF LAPAROSCOPY W/VAGINAL HYSTERECTOMY > 250 GRAMS,78001629P,CDM,975,RC,58553,HCPCS,Outpatient,,,4344,3258,,3996.48,92,,,percent of total billed charges,92% of total billed charges,131.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4039.92,93,,,percent of total billed charges,93% of total billed charges,3909.6,90,,,percent of total billed charges,90% of total billed charges,3909.6,90,,,percent of total billed charges,90% of total billed charges,4213.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,131.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4213.68,97,,,percent of total billed charges,97% of total billed charges,3258,75,,,percent of total billed charges,75% of total billed charges,4170.24,96,,,percent of total billed charges,96% of total billed charges,131.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3258,75,,,percent of total billed charges,75% of total billed charges,3258,75,,,percent of total billed charges,75% of total billed charges,131.02,4213.68,
PF LAPAROSCOPY VAGINAL HYSTERECT > 250 GM RMVL TUBE and /OVAR,78001631P,CDM,975,RC,58554,HCPCS,Outpatient,,,4344,3258,,3996.48,92,,,percent of total billed charges,92% of total billed charges,150.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4039.92,93,,,percent of total billed charges,93% of total billed charges,3909.6,90,,,percent of total billed charges,90% of total billed charges,3909.6,90,,,percent of total billed charges,90% of total billed charges,4213.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,150.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4213.68,97,,,percent of total billed charges,97% of total billed charges,3258,75,,,percent of total billed charges,75% of total billed charges,4170.24,96,,,percent of total billed charges,96% of total billed charges,150.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3258,75,,,percent of total billed charges,75% of total billed charges,3258,75,,,percent of total billed charges,75% of total billed charges,150.72,4213.68,
PF HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE,78001632P,CDM,975,RC,58555,HCPCS,Outpatient,,,1667,1250.25,,1533.64,92,,,percent of total billed charges,92% of total billed charges,17.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1550.31,93,,,percent of total billed charges,93% of total billed charges,1500.3,90,,,percent of total billed charges,90% of total billed charges,1500.3,90,,,percent of total billed charges,90% of total billed charges,1616.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1616.99,97,,,percent of total billed charges,97% of total billed charges,1250.25,75,,,percent of total billed charges,75% of total billed charges,1600.32,96,,,percent of total billed charges,96% of total billed charges,17.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1250.25,75,,,percent of total billed charges,75% of total billed charges,1250.25,75,,,percent of total billed charges,75% of total billed charges,17.15,1616.99,
PF HYSTEROSCOPY BX ENDOMETRIUM and /POLYPC W/WO D and C,78001633P,CDM,975,RC,58558,HCPCS,Outpatient,,,3053,2289.75,,2808.76,92,,,percent of total billed charges,92% of total billed charges,27.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2839.29,93,,,percent of total billed charges,93% of total billed charges,2747.7,90,,,percent of total billed charges,90% of total billed charges,2747.7,90,,,percent of total billed charges,90% of total billed charges,2961.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2961.41,97,,,percent of total billed charges,97% of total billed charges,2289.75,75,,,percent of total billed charges,75% of total billed charges,2930.88,96,,,percent of total billed charges,96% of total billed charges,27.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2289.75,75,,,percent of total billed charges,75% of total billed charges,2289.75,75,,,percent of total billed charges,75% of total billed charges,27.23,2961.41,
PF HYSTEROSCOPY REMOVAL LEIOMYOMATA,78001634P,CDM,975,RC,58561,HCPCS,Outpatient,,,3177,2382.75,,2922.84,92,,,percent of total billed charges,92% of total billed charges,42.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2954.61,93,,,percent of total billed charges,93% of total billed charges,2859.3,90,,,percent of total billed charges,90% of total billed charges,2859.3,90,,,percent of total billed charges,90% of total billed charges,3081.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,42.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3081.69,97,,,percent of total billed charges,97% of total billed charges,2382.75,75,,,percent of total billed charges,75% of total billed charges,3049.92,96,,,percent of total billed charges,96% of total billed charges,42.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2382.75,75,,,percent of total billed charges,75% of total billed charges,2382.75,75,,,percent of total billed charges,75% of total billed charges,42.97,3081.69,
PF HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY,78001635P,CDM,975,RC,58562,HCPCS,Outpatient,,,2360,1770,,2171.2,92,,,percent of total billed charges,92% of total billed charges,26.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2194.8,93,,,percent of total billed charges,93% of total billed charges,2124,90,,,percent of total billed charges,90% of total billed charges,2124,90,,,percent of total billed charges,90% of total billed charges,2289.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2289.2,97,,,percent of total billed charges,97% of total billed charges,1770,75,,,percent of total billed charges,75% of total billed charges,2265.6,96,,,percent of total billed charges,96% of total billed charges,26.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1770,75,,,percent of total billed charges,75% of total billed charges,1770,75,,,percent of total billed charges,75% of total billed charges,26.08,2289.2,
PF HYSTEROSCOPY ENDOMETRIAL ABLATION,78001636P,CDM,975,RC,58563,HCPCS,Outpatient,,,3177,2382.75,,2922.84,92,,,percent of total billed charges,92% of total billed charges,28.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2954.61,93,,,percent of total billed charges,93% of total billed charges,2859.3,90,,,percent of total billed charges,90% of total billed charges,2859.3,90,,,percent of total billed charges,90% of total billed charges,3081.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3081.69,97,,,percent of total billed charges,97% of total billed charges,2382.75,75,,,percent of total billed charges,75% of total billed charges,3049.92,96,,,percent of total billed charges,96% of total billed charges,28.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2382.75,75,,,percent of total billed charges,75% of total billed charges,2382.75,75,,,percent of total billed charges,75% of total billed charges,28.81,3081.69,
PF LAPAROSCOPY W TOTL HYSTERECTOMY UTERUS 250 GM/<,78001637P,CDM,975,RC,58570,HCPCS,Outpatient,,,4344,3258,,3996.48,92,,,percent of total billed charges,92% of total billed charges,88.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4039.92,93,,,percent of total billed charges,93% of total billed charges,3909.6,90,,,percent of total billed charges,90% of total billed charges,3909.6,90,,,percent of total billed charges,90% of total billed charges,4213.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,88.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4213.68,97,,,percent of total billed charges,97% of total billed charges,3258,75,,,percent of total billed charges,75% of total billed charges,4170.24,96,,,percent of total billed charges,96% of total billed charges,88.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3258,75,,,percent of total billed charges,75% of total billed charges,3258,75,,,percent of total billed charges,75% of total billed charges,88.81,4213.68,
PF LAPAROSCOPY TOTAL HYSTERECT 250 GM/< W/REMOVAL TUBE/OVARY,78001638P,CDM,975,RC,58571,HCPCS,Outpatient,,,5172,3879,,4758.24,92,,,percent of total billed charges,92% of total billed charges,100.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4809.96,93,,,percent of total billed charges,93% of total billed charges,4654.8,90,,,percent of total billed charges,90% of total billed charges,4654.8,90,,,percent of total billed charges,90% of total billed charges,5016.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,100.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5016.84,97,,,percent of total billed charges,97% of total billed charges,3879,75,,,percent of total billed charges,75% of total billed charges,4965.12,96,,,percent of total billed charges,96% of total billed charges,100.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3879,75,,,percent of total billed charges,75% of total billed charges,3879,75,,,percent of total billed charges,75% of total billed charges,100.48,5016.84,
PF LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM,78001639P,CDM,975,RC,58572,HCPCS,Outpatient,,,4344,3258,,3996.48,92,,,percent of total billed charges,92% of total billed charges,116.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4039.92,93,,,percent of total billed charges,93% of total billed charges,3909.6,90,,,percent of total billed charges,90% of total billed charges,3909.6,90,,,percent of total billed charges,90% of total billed charges,4213.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,116.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4213.68,97,,,percent of total billed charges,97% of total billed charges,3258,75,,,percent of total billed charges,75% of total billed charges,4170.24,96,,,percent of total billed charges,96% of total billed charges,116.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3258,75,,,percent of total billed charges,75% of total billed charges,3258,75,,,percent of total billed charges,75% of total billed charges,116.02,4213.68,
PF LAPAROSCOPY TOTAL HYSTERECTOMY >250 G W/TUBE/OVAR,78001640P,CDM,975,RC,58573,HCPCS,Outpatient,,,5172,3879,,4758.24,92,,,percent of total billed charges,92% of total billed charges,138.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4809.96,93,,,percent of total billed charges,93% of total billed charges,4654.8,90,,,percent of total billed charges,90% of total billed charges,4654.8,90,,,percent of total billed charges,90% of total billed charges,5016.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,138.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5016.84,97,,,percent of total billed charges,97% of total billed charges,3879,75,,,percent of total billed charges,75% of total billed charges,4965.12,96,,,percent of total billed charges,96% of total billed charges,138.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3879,75,,,percent of total billed charges,75% of total billed charges,3879,75,,,percent of total billed charges,75% of total billed charges,138.03,5016.84,
PF LIGATION/TRANSECTION FALLOPIAN TUBE ABDOMINAL/VAGINAL APP,78001641P,CDM,975,RC,58600,HCPCS,Outpatient,,,2567,1925.25,,2361.64,92,,,percent of total billed charges,92% of total billed charges,40.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2387.31,93,,,percent of total billed charges,93% of total billed charges,2310.3,90,,,percent of total billed charges,90% of total billed charges,2310.3,90,,,percent of total billed charges,90% of total billed charges,2489.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2489.99,97,,,percent of total billed charges,97% of total billed charges,1925.25,75,,,percent of total billed charges,75% of total billed charges,2464.32,96,,,percent of total billed charges,96% of total billed charges,40.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1925.25,75,,,percent of total billed charges,75% of total billed charges,1925.25,75,,,percent of total billed charges,75% of total billed charges,40.33,2489.99,
PF LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX,78001642P,CDM,975,RC,58605,HCPCS,Outpatient,,,903,677.25,,830.76,92,,,percent of total billed charges,92% of total billed charges,36.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,839.79,93,,,percent of total billed charges,93% of total billed charges,812.7,90,,,percent of total billed charges,90% of total billed charges,812.7,90,,,percent of total billed charges,90% of total billed charges,875.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,36.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,875.91,97,,,percent of total billed charges,97% of total billed charges,677.25,75,,,percent of total billed charges,75% of total billed charges,866.88,96,,,percent of total billed charges,96% of total billed charges,36.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,677.25,75,,,percent of total billed charges,75% of total billed charges,677.25,75,,,percent of total billed charges,75% of total billed charges,36.17,875.91,
PF LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SRG,78001643P,CDM,975,RC,58611,HCPCS,Outpatient,,,1138,853.5,,1046.96,92,,,percent of total billed charges,92% of total billed charges,9.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1058.34,93,,,percent of total billed charges,93% of total billed charges,1024.2,90,,,percent of total billed charges,90% of total billed charges,1024.2,90,,,percent of total billed charges,90% of total billed charges,1103.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1103.86,97,,,percent of total billed charges,97% of total billed charges,853.5,75,,,percent of total billed charges,75% of total billed charges,1092.48,96,,,percent of total billed charges,96% of total billed charges,9.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,853.5,75,,,percent of total billed charges,75% of total billed charges,853.5,75,,,percent of total billed charges,75% of total billed charges,9.1,1103.86,
PF OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR,78001645P,CDM,975,RC,58615,HCPCS,Outpatient,,,3053,2289.75,,2808.76,92,,,percent of total billed charges,92% of total billed charges,27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2839.29,93,,,percent of total billed charges,93% of total billed charges,2747.7,90,,,percent of total billed charges,90% of total billed charges,2747.7,90,,,percent of total billed charges,90% of total billed charges,2961.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2961.41,97,,,percent of total billed charges,97% of total billed charges,2289.75,75,,,percent of total billed charges,75% of total billed charges,2930.88,96,,,percent of total billed charges,96% of total billed charges,27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2289.75,75,,,percent of total billed charges,75% of total billed charges,2289.75,75,,,percent of total billed charges,75% of total billed charges,27,2961.41,
PF LAPAROSCOPY W/LYSIS OF ADHESIONS,78001646P,CDM,975,RC,58660,HCPCS,Outpatient,,,4140,3105,,3808.8,92,,,percent of total billed charges,92% of total billed charges,84.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3850.2,93,,,percent of total billed charges,93% of total billed charges,3726,90,,,percent of total billed charges,90% of total billed charges,3726,90,,,percent of total billed charges,90% of total billed charges,4015.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,84.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4015.8,97,,,percent of total billed charges,97% of total billed charges,3105,75,,,percent of total billed charges,75% of total billed charges,3974.4,96,,,percent of total billed charges,96% of total billed charges,84.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3105,75,,,percent of total billed charges,75% of total billed charges,3105,75,,,percent of total billed charges,75% of total billed charges,84.81,4015.8,
PF LAPAROSCOPY W/REMOVAL ADNEXAL STRUCTURES,78001647P,CDM,975,RC,58661,HCPCS,Outpatient,,,4334,3250.5,,3987.28,92,,,percent of total billed charges,92% of total billed charges,74.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4030.62,93,,,percent of total billed charges,93% of total billed charges,3900.6,90,,,percent of total billed charges,90% of total billed charges,3900.6,90,,,percent of total billed charges,90% of total billed charges,4203.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,74.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4203.98,97,,,percent of total billed charges,97% of total billed charges,3250.5,75,,,percent of total billed charges,75% of total billed charges,4160.64,96,,,percent of total billed charges,96% of total billed charges,74.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3250.5,75,,,percent of total billed charges,75% of total billed charges,3250.5,75,,,percent of total billed charges,75% of total billed charges,74.71,4203.98,
PF LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE,78001648P,CDM,975,RC,58662,HCPCS,Outpatient,,,1345,1008.75,,1237.4,92,,,percent of total billed charges,92% of total billed charges,81.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1250.85,93,,,percent of total billed charges,93% of total billed charges,1210.5,90,,,percent of total billed charges,90% of total billed charges,1210.5,90,,,percent of total billed charges,90% of total billed charges,1304.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,81.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1304.65,97,,,percent of total billed charges,97% of total billed charges,1008.75,75,,,percent of total billed charges,75% of total billed charges,1291.2,96,,,percent of total billed charges,96% of total billed charges,81.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1008.75,75,,,percent of total billed charges,75% of total billed charges,1008.75,75,,,percent of total billed charges,75% of total billed charges,81.46,1304.65,
PF LAPAROSCOPY FULGURATION OVIDUCTS,78001649P,CDM,975,RC,58670,HCPCS,Outpatient,,,2965,2223.75,,2727.8,92,,,percent of total billed charges,92% of total billed charges,40.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2757.45,93,,,percent of total billed charges,93% of total billed charges,2668.5,90,,,percent of total billed charges,90% of total billed charges,2668.5,90,,,percent of total billed charges,90% of total billed charges,2876.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2876.05,97,,,percent of total billed charges,97% of total billed charges,2223.75,75,,,percent of total billed charges,75% of total billed charges,2846.4,96,,,percent of total billed charges,96% of total billed charges,40.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2223.75,75,,,percent of total billed charges,75% of total billed charges,2223.75,75,,,percent of total billed charges,75% of total billed charges,40.35,2876.05,
PF LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS,78001650P,CDM,975,RC,58671,HCPCS,Outpatient,,,2839,2129.25,,2611.88,92,,,percent of total billed charges,92% of total billed charges,40.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2640.27,93,,,percent of total billed charges,93% of total billed charges,2555.1,90,,,percent of total billed charges,90% of total billed charges,2555.1,90,,,percent of total billed charges,90% of total billed charges,2753.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2753.83,97,,,percent of total billed charges,97% of total billed charges,2129.25,75,,,percent of total billed charges,75% of total billed charges,2725.44,96,,,percent of total billed charges,96% of total billed charges,40.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2129.25,75,,,percent of total billed charges,75% of total billed charges,2129.25,75,,,percent of total billed charges,75% of total billed charges,40.35,2753.83,
PF SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX,78001652P,CDM,975,RC,58700,HCPCS,Outpatient,,,3080,2310,,2833.6,92,,,percent of total billed charges,92% of total billed charges,93.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2864.4,93,,,percent of total billed charges,93% of total billed charges,2772,90,,,percent of total billed charges,90% of total billed charges,2772,90,,,percent of total billed charges,90% of total billed charges,2987.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,93.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2987.6,97,,,percent of total billed charges,97% of total billed charges,2310,75,,,percent of total billed charges,75% of total billed charges,2956.8,96,,,percent of total billed charges,96% of total billed charges,93.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2310,75,,,percent of total billed charges,75% of total billed charges,2310,75,,,percent of total billed charges,75% of total billed charges,93.21,2987.6,
PF SALPINGO-OOPHORECTOMY COMP OR PART UNIL OR BIL,78002226P,CDM,975,RC,58720,HCPCS,Outpatient,,,2927,2195.25,,2692.84,92,,,percent of total billed charges,92% of total billed charges,84.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2722.11,93,,,percent of total billed charges,93% of total billed charges,2634.3,90,,,percent of total billed charges,90% of total billed charges,2634.3,90,,,percent of total billed charges,90% of total billed charges,2839.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,84.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2839.19,97,,,percent of total billed charges,97% of total billed charges,2195.25,75,,,percent of total billed charges,75% of total billed charges,2809.92,96,,,percent of total billed charges,96% of total billed charges,84.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2195.25,75,,,percent of total billed charges,75% of total billed charges,2195.25,75,,,percent of total billed charges,75% of total billed charges,84.75,2839.19,
PF LYSIS OF ADHESIONS SALPINGOLYSIS OVARIOLYSIS,78001653P,CDM,975,RC,58740,HCPCS,Outpatient,,,2399,1799.25,,2207.08,92,,,percent of total billed charges,92% of total billed charges,105.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2231.07,93,,,percent of total billed charges,93% of total billed charges,2159.1,90,,,percent of total billed charges,90% of total billed charges,2159.1,90,,,percent of total billed charges,90% of total billed charges,2327.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,105.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2327.03,97,,,percent of total billed charges,97% of total billed charges,1799.25,75,,,percent of total billed charges,75% of total billed charges,2303.04,96,,,percent of total billed charges,96% of total billed charges,105.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1799.25,75,,,percent of total billed charges,75% of total billed charges,1799.25,75,,,percent of total billed charges,75% of total billed charges,105.91,2327.03,
PF OOPHORECTOMY PARTIAL/TOTAL UNI/BI,78001655P,CDM,975,RC,58940,HCPCS,Outpatient,,,1138,853.5,,1046.96,92,,,percent of total billed charges,92% of total billed charges,61.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1058.34,93,,,percent of total billed charges,93% of total billed charges,1024.2,90,,,percent of total billed charges,90% of total billed charges,1024.2,90,,,percent of total billed charges,90% of total billed charges,1103.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1103.86,97,,,percent of total billed charges,97% of total billed charges,853.5,75,,,percent of total billed charges,75% of total billed charges,1092.48,96,,,percent of total billed charges,96% of total billed charges,61.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,853.5,75,,,percent of total billed charges,75% of total billed charges,853.5,75,,,percent of total billed charges,75% of total billed charges,61.66,1103.86,
PF TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPROACH,78001662P,CDM,975,RC,59120,HCPCS,Outpatient,,,3920,2940,,3606.4,92,,,percent of total billed charges,92% of total billed charges,133.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3645.6,93,,,percent of total billed charges,93% of total billed charges,3528,90,,,percent of total billed charges,90% of total billed charges,3528,90,,,percent of total billed charges,90% of total billed charges,3802.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,133.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3802.4,97,,,percent of total billed charges,97% of total billed charges,2940,75,,,percent of total billed charges,75% of total billed charges,3763.2,96,,,percent of total billed charges,96% of total billed charges,133.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2940,75,,,percent of total billed charges,75% of total billed charges,2940,75,,,percent of total billed charges,75% of total billed charges,133.77,3802.4,
PF TX ECTOPIC PREGNANCY W/O SALPING and /OOPHORECTOMY,78001663P,CDM,975,RC,59121,HCPCS,Outpatient,,,3920,2940,,3606.4,92,,,percent of total billed charges,92% of total billed charges,134.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3645.6,93,,,percent of total billed charges,93% of total billed charges,3528,90,,,percent of total billed charges,90% of total billed charges,3528,90,,,percent of total billed charges,90% of total billed charges,3802.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,134.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3802.4,97,,,percent of total billed charges,97% of total billed charges,2940,75,,,percent of total billed charges,75% of total billed charges,3763.2,96,,,percent of total billed charges,96% of total billed charges,134.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2940,75,,,percent of total billed charges,75% of total billed charges,2940,75,,,percent of total billed charges,75% of total billed charges,134.33,3802.4,
PF TX ECTOPIC PREGNANCY CERVICAL W/EVACUATION,78001664P,CDM,975,RC,59140,HCPCS,Outpatient,,,792,594,,728.64,92,,,percent of total billed charges,92% of total billed charges,63.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,736.56,93,,,percent of total billed charges,93% of total billed charges,712.8,90,,,percent of total billed charges,90% of total billed charges,712.8,90,,,percent of total billed charges,90% of total billed charges,768.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,63.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,768.24,97,,,percent of total billed charges,97% of total billed charges,594,75,,,percent of total billed charges,75% of total billed charges,760.32,96,,,percent of total billed charges,96% of total billed charges,63.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594,75,,,percent of total billed charges,75% of total billed charges,594,75,,,percent of total billed charges,75% of total billed charges,63.72,768.24,
PF LAPAROSCOPIC TX ECTOPIC PREG W/O SALPING and /OOPHORECTOMY,78001665P,CDM,975,RC,59150,HCPCS,Outpatient,,,5647,4235.25,,5195.24,92,,,percent of total billed charges,92% of total billed charges,129.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5251.71,93,,,percent of total billed charges,93% of total billed charges,5082.3,90,,,percent of total billed charges,90% of total billed charges,5082.3,90,,,percent of total billed charges,90% of total billed charges,5477.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,129.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5477.59,97,,,percent of total billed charges,97% of total billed charges,4235.25,75,,,percent of total billed charges,75% of total billed charges,5421.12,96,,,percent of total billed charges,96% of total billed charges,129.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4235.25,75,,,percent of total billed charges,75% of total billed charges,4235.25,75,,,percent of total billed charges,75% of total billed charges,129.67,5477.59,
PF LAPAROSCOPIC TX ECTOPIC PREG W/SALPING and /OOPHORECTOMY,78001667P,CDM,975,RC,59151,HCPCS,Outpatient,,,5647,4235.25,,5195.24,92,,,percent of total billed charges,92% of total billed charges,127.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5251.71,93,,,percent of total billed charges,93% of total billed charges,5082.3,90,,,percent of total billed charges,90% of total billed charges,5082.3,90,,,percent of total billed charges,90% of total billed charges,5477.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,127.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5477.59,97,,,percent of total billed charges,97% of total billed charges,4235.25,75,,,percent of total billed charges,75% of total billed charges,5421.12,96,,,percent of total billed charges,96% of total billed charges,127.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4235.25,75,,,percent of total billed charges,75% of total billed charges,4235.25,75,,,percent of total billed charges,75% of total billed charges,127.71,5477.59,
PF EPISIOTOMY/VAG REPAIR BY OTHER THAN ATTENDING,78001669P,CDM,975,RC,59300,HCPCS,Outpatient,,,730,547.5,,671.6,92,,,percent of total billed charges,92% of total billed charges,25.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678.9,93,,,percent of total billed charges,93% of total billed charges,657,90,,,percent of total billed charges,90% of total billed charges,657,90,,,percent of total billed charges,90% of total billed charges,708.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,708.1,97,,,percent of total billed charges,97% of total billed charges,547.5,75,,,percent of total billed charges,75% of total billed charges,700.8,96,,,percent of total billed charges,96% of total billed charges,25.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,547.5,75,,,percent of total billed charges,75% of total billed charges,547.5,75,,,percent of total billed charges,75% of total billed charges,25.2,708.1,
PF VAGINAL DELIVERY ONLY,78001673P,CDM,975,RC,59409,HCPCS,Outpatient,,,3943,2957.25,,3627.56,92,,,percent of total billed charges,92% of total billed charges,133.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3666.99,93,,,percent of total billed charges,93% of total billed charges,3548.7,90,,,percent of total billed charges,90% of total billed charges,3548.7,90,,,percent of total billed charges,90% of total billed charges,3824.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,133.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3824.71,97,,,percent of total billed charges,97% of total billed charges,2957.25,75,,,percent of total billed charges,75% of total billed charges,3785.28,96,,,percent of total billed charges,96% of total billed charges,133.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2957.25,75,,,percent of total billed charges,75% of total billed charges,2957.25,75,,,percent of total billed charges,75% of total billed charges,133.73,3824.71,
PF EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS,78001676P,CDM,975,RC,59412,HCPCS,Outpatient,,,268,201,,246.56,92,,,percent of total billed charges,92% of total billed charges,17.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249.24,93,,,percent of total billed charges,93% of total billed charges,241.2,90,,,percent of total billed charges,90% of total billed charges,241.2,90,,,percent of total billed charges,90% of total billed charges,259.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,259.96,97,,,percent of total billed charges,97% of total billed charges,201,75,,,percent of total billed charges,75% of total billed charges,257.28,96,,,percent of total billed charges,96% of total billed charges,17.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201,75,,,percent of total billed charges,75% of total billed charges,201,75,,,percent of total billed charges,75% of total billed charges,17.67,259.96,
PF DELIVERY PLACENTA SEPARATE PROCEDURE,78001678P,CDM,975,RC,59414,HCPCS,Outpatient,,,359,269.25,,330.28,92,,,percent of total billed charges,92% of total billed charges,16.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333.87,93,,,percent of total billed charges,93% of total billed charges,323.1,90,,,percent of total billed charges,90% of total billed charges,323.1,90,,,percent of total billed charges,90% of total billed charges,348.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,348.23,97,,,percent of total billed charges,97% of total billed charges,269.25,75,,,percent of total billed charges,75% of total billed charges,344.64,96,,,percent of total billed charges,96% of total billed charges,16.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,269.25,75,,,percent of total billed charges,75% of total billed charges,269.25,75,,,percent of total billed charges,75% of total billed charges,16.43,348.23,
PF ANTEPARTUM CARE ONLY 4-6 VISITS,78001680P,CDM,975,RC,59425,HCPCS,Outpatient,,,829,621.75,,762.68,92,,,percent of total billed charges,92% of total billed charges,73.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,770.97,93,,,percent of total billed charges,93% of total billed charges,746.1,90,,,percent of total billed charges,90% of total billed charges,746.1,90,,,percent of total billed charges,90% of total billed charges,804.13,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,73.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,804.13,97,,,percent of total billed charges,97% of total billed charges,621.75,75,,,percent of total billed charges,75% of total billed charges,795.84,96,,,percent of total billed charges,96% of total billed charges,73.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,621.75,75,,,percent of total billed charges,75% of total billed charges,621.75,75,,,percent of total billed charges,75% of total billed charges,73.32,804.13,
PF ANTEPARTUM CARE ONLY 7/> VISITS,78001682P,CDM,975,RC,59426,HCPCS,Outpatient,,,1515,1136.25,,1393.8,92,,,percent of total billed charges,92% of total billed charges,135.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1408.95,93,,,percent of total billed charges,93% of total billed charges,1363.5,90,,,percent of total billed charges,90% of total billed charges,1363.5,90,,,percent of total billed charges,90% of total billed charges,1469.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,135.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1469.55,97,,,percent of total billed charges,97% of total billed charges,1136.25,75,,,percent of total billed charges,75% of total billed charges,1454.4,96,,,percent of total billed charges,96% of total billed charges,135.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1136.25,75,,,percent of total billed charges,75% of total billed charges,1136.25,75,,,percent of total billed charges,75% of total billed charges,135.51,1469.55,
PF CESAREAN DELIVERY ONLY,78001687P,CDM,975,RC,59514,HCPCS,Outpatient,,,7380,5535,,6789.6,92,,,percent of total billed charges,92% of total billed charges,161.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6863.4,93,,,percent of total billed charges,93% of total billed charges,6642,90,,,percent of total billed charges,90% of total billed charges,6642,90,,,percent of total billed charges,90% of total billed charges,7158.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,161.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7158.6,97,,,percent of total billed charges,97% of total billed charges,5535,75,,,percent of total billed charges,75% of total billed charges,7084.8,96,,,percent of total billed charges,96% of total billed charges,161.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5535,75,,,percent of total billed charges,75% of total billed charges,5535,75,,,percent of total billed charges,75% of total billed charges,161.04,7158.6,
PF HYSTERECTOMY AFTER CESAREAN DELIVERY,78001692P,CDM,975,RC,59525,HCPCS,Outpatient,,,2631,1973.25,,2420.52,92,,,percent of total billed charges,92% of total billed charges,87.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2446.83,93,,,percent of total billed charges,93% of total billed charges,2367.9,90,,,percent of total billed charges,90% of total billed charges,2367.9,90,,,percent of total billed charges,90% of total billed charges,2552.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,87.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2552.07,97,,,percent of total billed charges,97% of total billed charges,1973.25,75,,,percent of total billed charges,75% of total billed charges,2525.76,96,,,percent of total billed charges,96% of total billed charges,87.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1973.25,75,,,percent of total billed charges,75% of total billed charges,1973.25,75,,,percent of total billed charges,75% of total billed charges,87.71,2552.07,
PF ROUTINE OB CARE VAG DELIVERY  and  POSTPARTUM CARE VBAC,78001693P,CDM,975,RC,59610,HCPCS,Outpatient,,,4623,3467.25,,4253.16,92,,,percent of total billed charges,92% of total billed charges,410.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4299.39,93,,,percent of total billed charges,93% of total billed charges,4160.7,90,,,percent of total billed charges,90% of total billed charges,4160.7,90,,,percent of total billed charges,90% of total billed charges,4484.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,410.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4484.31,97,,,percent of total billed charges,97% of total billed charges,3467.25,75,,,percent of total billed charges,75% of total billed charges,4438.08,96,,,percent of total billed charges,96% of total billed charges,410.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3467.25,75,,,percent of total billed charges,75% of total billed charges,3467.25,75,,,percent of total billed charges,75% of total billed charges,410.97,4484.31,
PF VAGINAL DELIVERY AFTER CESAREAN DELIVERY,78001694P,CDM,975,RC,59612,HCPCS,Outpatient,,,3678,2758.5,,3383.76,92,,,percent of total billed charges,92% of total billed charges,164.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3420.54,93,,,percent of total billed charges,93% of total billed charges,3310.2,90,,,percent of total billed charges,90% of total billed charges,3310.2,90,,,percent of total billed charges,90% of total billed charges,3567.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,164.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3567.66,97,,,percent of total billed charges,97% of total billed charges,2758.5,75,,,percent of total billed charges,75% of total billed charges,3530.88,96,,,percent of total billed charges,96% of total billed charges,164.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2758.5,75,,,percent of total billed charges,75% of total billed charges,2758.5,75,,,percent of total billed charges,75% of total billed charges,164.82,3567.66,
PF TX MISSED ABORTION FIRST TRIMESTER SURGICAL,78001696P,CDM,975,RC,59820,HCPCS,Outpatient,,,1847,1385.25,,1699.24,92,,,percent of total billed charges,92% of total billed charges,53.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1717.71,93,,,percent of total billed charges,93% of total billed charges,1662.3,90,,,percent of total billed charges,90% of total billed charges,1662.3,90,,,percent of total billed charges,90% of total billed charges,1791.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,53.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1791.59,97,,,percent of total billed charges,97% of total billed charges,1385.25,75,,,percent of total billed charges,75% of total billed charges,1773.12,96,,,percent of total billed charges,96% of total billed charges,53.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1385.25,75,,,percent of total billed charges,75% of total billed charges,1385.25,75,,,percent of total billed charges,75% of total billed charges,53.43,1791.59,
PF MISSED ABORTION COMPLETE SECOND TRIMESTER,78001697P,CDM,975,RC,59821,HCPCS,Outpatient,,,2124,1593,,1954.08,92,,,percent of total billed charges,92% of total billed charges,55.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1975.32,93,,,percent of total billed charges,93% of total billed charges,1911.6,90,,,percent of total billed charges,90% of total billed charges,1911.6,90,,,percent of total billed charges,90% of total billed charges,2060.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,55.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2060.28,97,,,percent of total billed charges,97% of total billed charges,1593,75,,,percent of total billed charges,75% of total billed charges,2039.04,96,,,percent of total billed charges,96% of total billed charges,55.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1593,75,,,percent of total billed charges,75% of total billed charges,1593,75,,,percent of total billed charges,75% of total billed charges,55.56,2060.28,
PF INDUCED ABORTION DILATION AND CURETTAGE,78001698P,CDM,975,RC,59840,HCPCS,Outpatient,,,591,443.25,,543.72,92,,,percent of total billed charges,92% of total billed charges,33.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,549.63,93,,,percent of total billed charges,93% of total billed charges,531.9,90,,,percent of total billed charges,90% of total billed charges,531.9,90,,,percent of total billed charges,90% of total billed charges,573.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,573.27,97,,,percent of total billed charges,97% of total billed charges,443.25,75,,,percent of total billed charges,75% of total billed charges,567.36,96,,,percent of total billed charges,96% of total billed charges,33.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,443.25,75,,,percent of total billed charges,75% of total billed charges,443.25,75,,,percent of total billed charges,75% of total billed charges,33.01,573.27,
PF TOTAL THYROID LOBECTOMY UNI W/CONTRALAT SUB TOTAL LOBECTO,78001700P,CDM,975,RC,60225,HCPCS,Outpatient,,,5001,3750.75,,4600.92,92,,,percent of total billed charges,92% of total billed charges,109.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4650.93,93,,,percent of total billed charges,93% of total billed charges,4500.9,90,,,percent of total billed charges,90% of total billed charges,4500.9,90,,,percent of total billed charges,90% of total billed charges,4850.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4850.97,97,,,percent of total billed charges,97% of total billed charges,3750.75,75,,,percent of total billed charges,75% of total billed charges,4800.96,96,,,percent of total billed charges,96% of total billed charges,109.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3750.75,75,,,percent of total billed charges,75% of total billed charges,3750.75,75,,,percent of total billed charges,75% of total billed charges,109.57,4850.97,
PF EXCISION THYROGLOSSAL DUCT CYST/SINUS,78001701P,CDM,975,RC,60280,HCPCS,Outpatient,,,3488,2616,,3208.96,92,,,percent of total billed charges,92% of total billed charges,41.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3243.84,93,,,percent of total billed charges,93% of total billed charges,3139.2,90,,,percent of total billed charges,90% of total billed charges,3139.2,90,,,percent of total billed charges,90% of total billed charges,3383.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3383.36,97,,,percent of total billed charges,97% of total billed charges,2616,75,,,percent of total billed charges,75% of total billed charges,3348.48,96,,,percent of total billed charges,96% of total billed charges,41.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2616,75,,,percent of total billed charges,75% of total billed charges,2616,75,,,percent of total billed charges,75% of total billed charges,41.63,3383.36,
PF PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS,78001702P,CDM,975,RC,60500,HCPCS,Outpatient,,,5500,4125,,5060,92,,,percent of total billed charges,92% of total billed charges,126.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5115,93,,,percent of total billed charges,93% of total billed charges,4950,90,,,percent of total billed charges,90% of total billed charges,4950,90,,,percent of total billed charges,90% of total billed charges,5335,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,126.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5335,97,,,percent of total billed charges,97% of total billed charges,4125,75,,,percent of total billed charges,75% of total billed charges,5280,96,,,percent of total billed charges,96% of total billed charges,126.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4125,75,,,percent of total billed charges,75% of total billed charges,4125,75,,,percent of total billed charges,75% of total billed charges,126.13,5335,
PF SPINAL PUNCTURE LUMBAR DIAGNOSTIC,78001703P,CDM,975,RC,62270,HCPCS,Outpatient,,,931,698.25,,856.52,92,,,percent of total billed charges,92% of total billed charges,9.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,865.83,93,,,percent of total billed charges,93% of total billed charges,837.9,90,,,percent of total billed charges,90% of total billed charges,837.9,90,,,percent of total billed charges,90% of total billed charges,903.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,903.07,97,,,percent of total billed charges,97% of total billed charges,698.25,75,,,percent of total billed charges,75% of total billed charges,893.76,96,,,percent of total billed charges,96% of total billed charges,9.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,698.25,75,,,percent of total billed charges,75% of total billed charges,698.25,75,,,percent of total billed charges,75% of total billed charges,9.51,903.07,
PF INJECTION EPIDURAL BLOOD/CLOT PATCH,78001705P,CDM,975,RC,62273,HCPCS,Outpatient,,,894,670.5,,822.48,92,,,percent of total billed charges,92% of total billed charges,9.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,831.42,93,,,percent of total billed charges,93% of total billed charges,804.6,90,,,percent of total billed charges,90% of total billed charges,804.6,90,,,percent of total billed charges,90% of total billed charges,867.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,867.18,97,,,percent of total billed charges,97% of total billed charges,670.5,75,,,percent of total billed charges,75% of total billed charges,858.24,96,,,percent of total billed charges,96% of total billed charges,9.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,670.5,75,,,percent of total billed charges,75% of total billed charges,670.5,75,,,percent of total billed charges,75% of total billed charges,9.85,867.18,
PF INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR,78001707P,CDM,975,RC,62290,HCPCS,Outpatient,,,422,316.5,,388.24,92,,,percent of total billed charges,92% of total billed charges,12.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,392.46,93,,,percent of total billed charges,93% of total billed charges,379.8,90,,,percent of total billed charges,90% of total billed charges,379.8,90,,,percent of total billed charges,90% of total billed charges,409.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,409.34,97,,,percent of total billed charges,97% of total billed charges,316.5,75,,,percent of total billed charges,75% of total billed charges,405.12,96,,,percent of total billed charges,96% of total billed charges,12.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,316.5,75,,,percent of total billed charges,75% of total billed charges,316.5,75,,,percent of total billed charges,75% of total billed charges,12.65,409.34,
PF MYELOGRAPHY LUMBAR INJECTION CERVCAL WITH S  and  I,78002205P,CDM,975,RC,62302,HCPCS,Outpatient,,,314,235.5,,288.88,92,,,percent of total billed charges,92% of total billed charges,10.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.02,93,,,percent of total billed charges,93% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,304.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.58,97,,,percent of total billed charges,97% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,301.44,96,,,percent of total billed charges,96% of total billed charges,10.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,235.5,75,,,percent of total billed charges,75% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,10.01,304.58,
PF MYELOGRAPHY LUMBAR INJECT THORACIC WITH S  and  I,78002207P,CDM,975,RC,62303,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,9.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,9.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,9.74,305.55,
PF MYELOGRAPHY LUMBAR INJECT LUMBOSACRAL WI/S  and  I,78002209P,CDM,975,RC,62304,HCPCS,Outpatient,,,310,232.5,,285.2,92,,,percent of total billed charges,92% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.3,93,,,percent of total billed charges,93% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,300.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.7,97,,,percent of total billed charges,97% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,297.6,96,,,percent of total billed charges,96% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,232.5,75,,,percent of total billed charges,75% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,9.96,300.7,
PF MYELOGRAPHY VIA LUMBAR INJECTION S  and  I 2+ REGN,78002211P,CDM,975,RC,62305,HCPCS,Outpatient,,,323,242.25,,297.16,92,,,percent of total billed charges,92% of total billed charges,10.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.39,93,,,percent of total billed charges,93% of total billed charges,290.7,90,,,percent of total billed charges,90% of total billed charges,290.7,90,,,percent of total billed charges,90% of total billed charges,313.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,313.31,97,,,percent of total billed charges,97% of total billed charges,242.25,75,,,percent of total billed charges,75% of total billed charges,310.08,96,,,percent of total billed charges,96% of total billed charges,10.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,242.25,75,,,percent of total billed charges,75% of total billed charges,242.25,75,,,percent of total billed charges,75% of total billed charges,10.11,313.31,
PF INJECTION CERVICAL OR THORACIC,78001709P,CDM,975,RC,62320,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,10.21,255.11,
PF INJECTION CERVICAL OR THORACIC W/FLUOROSCOPY,78001711P,CDM,975,RC,62321,HCPCS,Outpatient,,,424,318,,390.08,92,,,percent of total billed charges,92% of total billed charges,8.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,394.32,93,,,percent of total billed charges,93% of total billed charges,381.6,90,,,percent of total billed charges,90% of total billed charges,381.6,90,,,percent of total billed charges,90% of total billed charges,411.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.28,97,,,percent of total billed charges,97% of total billed charges,318,75,,,percent of total billed charges,75% of total billed charges,407.04,96,,,percent of total billed charges,96% of total billed charges,8.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,318,75,,,percent of total billed charges,75% of total billed charges,318,75,,,percent of total billed charges,75% of total billed charges,8.84,411.28,
PF INJECTION ESI LUMBAR OR SACRAL W/O GUIDANCE,78001713P,CDM,975,RC,62322,HCPCS,Outpatient,,,213,159.75,,195.96,92,,,percent of total billed charges,92% of total billed charges,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,198.09,93,,,percent of total billed charges,93% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,206.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,206.61,97,,,percent of total billed charges,97% of total billed charges,159.75,75,,,percent of total billed charges,75% of total billed charges,204.48,96,,,percent of total billed charges,96% of total billed charges,7.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,159.75,75,,,percent of total billed charges,75% of total billed charges,159.75,75,,,percent of total billed charges,75% of total billed charges,7.33,206.61,
PF INJECTION ESI LUMBAR OR SACRAL W/FLUOROSCOPY,78001715P,CDM,975,RC,62323,HCPCS,Outpatient,,,262,196.5,,241.04,92,,,percent of total billed charges,92% of total billed charges,8.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,243.66,93,,,percent of total billed charges,93% of total billed charges,235.8,90,,,percent of total billed charges,90% of total billed charges,235.8,90,,,percent of total billed charges,90% of total billed charges,254.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,254.14,97,,,percent of total billed charges,97% of total billed charges,196.5,75,,,percent of total billed charges,75% of total billed charges,251.52,96,,,percent of total billed charges,96% of total billed charges,8.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,196.5,75,,,percent of total billed charges,75% of total billed charges,196.5,75,,,percent of total billed charges,75% of total billed charges,8.29,254.14,
PF DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT,78001717P,CDM,975,RC,62328,HCPCS,Outpatient,,,338,253.5,,310.96,92,,,percent of total billed charges,92% of total billed charges,7.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,314.34,93,,,percent of total billed charges,93% of total billed charges,304.2,90,,,percent of total billed charges,90% of total billed charges,304.2,90,,,percent of total billed charges,90% of total billed charges,327.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,327.86,97,,,percent of total billed charges,97% of total billed charges,253.5,75,,,percent of total billed charges,75% of total billed charges,324.48,96,,,percent of total billed charges,96% of total billed charges,7.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,253.5,75,,,percent of total billed charges,75% of total billed charges,253.5,75,,,percent of total billed charges,75% of total billed charges,7.51,327.86,
PF LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LMBR,78001719P,CDM,975,RC,63030,HCPCS,Outpatient,,,11502,8626.5,,10581.84,92,,,percent of total billed charges,92% of total billed charges,137.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,10696.86,93,,,percent of total billed charges,93% of total billed charges,10351.8,90,,,percent of total billed charges,90% of total billed charges,10351.8,90,,,percent of total billed charges,90% of total billed charges,11156.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,137.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,11156.94,97,,,percent of total billed charges,97% of total billed charges,8626.5,75,,,percent of total billed charges,75% of total billed charges,11041.92,96,,,percent of total billed charges,96% of total billed charges,137.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,8626.5,75,,,percent of total billed charges,75% of total billed charges,8626.5,75,,,percent of total billed charges,75% of total billed charges,137.87,11156.94,
PF INJECTION ANES TRIGEMINAL NRV ANY DIV/BRANCH,78001720P,CDM,975,RC,64400,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges,7.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.35,93,,,percent of total billed charges,93% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,189.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.15,97,,,percent of total billed charges,97% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,187.2,96,,,percent of total billed charges,96% of total billed charges,7.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.25,75,,,percent of total billed charges,75% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,7.48,189.15,
PF INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE,78001722P,CDM,975,RC,64405,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.3,93,,,percent of total billed charges,93% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,203.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.7,97,,,percent of total billed charges,97% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,201.6,96,,,percent of total billed charges,96% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,157.5,75,,,percent of total billed charges,75% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,7.79,203.7,
PF SINGLE NERVE BLOCK INJECTION ARM NERVE,78001724P,CDM,975,RC,64415,HCPCS,Outpatient,,,1033,774.75,,950.36,92,,,percent of total billed charges,92% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,960.69,93,,,percent of total billed charges,93% of total billed charges,929.7,90,,,percent of total billed charges,90% of total billed charges,929.7,90,,,percent of total billed charges,90% of total billed charges,1002.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1002.01,97,,,percent of total billed charges,97% of total billed charges,774.75,75,,,percent of total billed charges,75% of total billed charges,991.68,96,,,percent of total billed charges,96% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,774.75,75,,,percent of total billed charges,75% of total billed charges,774.75,75,,,percent of total billed charges,75% of total billed charges,5.9,1002.01,
PF INJECTION ANESTHETIC OR STEROID AXILLARY NERVE,78200007P,CDM,975,RC,64417,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges,5.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.15,93,,,percent of total billed charges,93% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,150.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.35,97,,,percent of total billed charges,97% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,148.8,96,,,percent of total billed charges,96% of total billed charges,5.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,75,,,percent of total billed charges,75% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,5.71,150.35,
PF INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE,78001726P,CDM,975,RC,64418,HCPCS,Outpatient,,,148,111,,136.16,92,,,percent of total billed charges,92% of total billed charges,5.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,137.64,93,,,percent of total billed charges,93% of total billed charges,133.2,90,,,percent of total billed charges,90% of total billed charges,133.2,90,,,percent of total billed charges,90% of total billed charges,143.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.56,97,,,percent of total billed charges,97% of total billed charges,111,75,,,percent of total billed charges,75% of total billed charges,142.08,96,,,percent of total billed charges,96% of total billed charges,5.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111,75,,,percent of total billed charges,75% of total billed charges,111,75,,,percent of total billed charges,75% of total billed charges,5.15,143.56,
PF INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE,78001728P,CDM,975,RC,64420,HCPCS,Outpatient,,,156,117,,143.52,92,,,percent of total billed charges,92% of total billed charges,4.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,145.08,93,,,percent of total billed charges,93% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,151.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,151.32,97,,,percent of total billed charges,97% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,149.76,96,,,percent of total billed charges,96% of total billed charges,4.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117,75,,,percent of total billed charges,75% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,4.7,151.32,
PF MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES,78001730P,CDM,975,RC,64421,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges,2.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.38,93,,,percent of total billed charges,93% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,64.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.02,97,,,percent of total billed charges,97% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,63.36,96,,,percent of total billed charges,96% of total billed charges,2.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.5,75,,,percent of total billed charges,75% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,2.21,64.02,
PF INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRV,78001732P,CDM,975,RC,64425,HCPCS,Outpatient,,,145,108.75,,133.4,92,,,percent of total billed charges,92% of total billed charges,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,134.85,93,,,percent of total billed charges,93% of total billed charges,130.5,90,,,percent of total billed charges,90% of total billed charges,130.5,90,,,percent of total billed charges,90% of total billed charges,140.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,140.65,97,,,percent of total billed charges,97% of total billed charges,108.75,75,,,percent of total billed charges,75% of total billed charges,139.2,96,,,percent of total billed charges,96% of total billed charges,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,108.75,75,,,percent of total billed charges,75% of total billed charges,108.75,75,,,percent of total billed charges,75% of total billed charges,4.58,140.65,
PF INJECTION ANESTHETIC AGENT PUDENDAL NERVE,78001734P,CDM,975,RC,64430,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges,5.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.99,93,,,percent of total billed charges,93% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,138.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.71,97,,,percent of total billed charges,97% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,137.28,96,,,percent of total billed charges,96% of total billed charges,5.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.25,75,,,percent of total billed charges,75% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,5.13,138.71,
PF INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE,78001736P,CDM,975,RC,64445,HCPCS,Outpatient,,,141,105.75,,129.72,92,,,percent of total billed charges,92% of total billed charges,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.13,93,,,percent of total billed charges,93% of total billed charges,126.9,90,,,percent of total billed charges,90% of total billed charges,126.9,90,,,percent of total billed charges,90% of total billed charges,136.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,136.77,97,,,percent of total billed charges,97% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges,135.36,96,,,percent of total billed charges,96% of total billed charges,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,105.75,75,,,percent of total billed charges,75% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges,6.26,136.77,
PF INJECTION(S) ANESTH AGENT/STEROID FEMORAL NERVE,78002257P,CDM,975,RC,64447,HCPCS,Outpatient,,,134,100.5,,123.28,92,,,percent of total billed charges,92% of total billed charges,5.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,124.62,93,,,percent of total billed charges,93% of total billed charges,120.6,90,,,percent of total billed charges,90% of total billed charges,120.6,90,,,percent of total billed charges,90% of total billed charges,129.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,129.98,97,,,percent of total billed charges,97% of total billed charges,100.5,75,,,percent of total billed charges,75% of total billed charges,128.64,96,,,percent of total billed charges,96% of total billed charges,5.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.5,75,,,percent of total billed charges,75% of total billed charges,100.5,75,,,percent of total billed charges,75% of total billed charges,5.14,129.98,
PF INJECTION ANESTHETIC AGENT/STEROID FEMORAL NERVE,78002841P,CDM,975,RC,64448,HCPCS,Outpatient,,,196,147,,180.32,92,,,percent of total billed charges,92% of total billed charges,6.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,182.28,93,,,percent of total billed charges,93% of total billed charges,176.4,90,,,percent of total billed charges,90% of total billed charges,176.4,90,,,percent of total billed charges,90% of total billed charges,190.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,190.12,97,,,percent of total billed charges,97% of total billed charges,147,75,,,percent of total billed charges,75% of total billed charges,188.16,96,,,percent of total billed charges,96% of total billed charges,6.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147,75,,,percent of total billed charges,75% of total billed charges,147,75,,,percent of total billed charges,75% of total billed charges,6.25,190.12,
PF INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,78001738P,CDM,975,RC,64450,HCPCS,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156.24,93,,,percent of total billed charges,93% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,162.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.96,97,,,percent of total billed charges,97% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,161.28,96,,,percent of total billed charges,96% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126,75,,,percent of total billed charges,75% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,3.88,162.96,
PF INJECTION AA and /STRD NERVES NRVTG SI JOINT W/IMG,78001740P,CDM,975,RC,64451,HCPCS,Outpatient,,,292,219,,268.64,92,,,percent of total billed charges,92% of total billed charges,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,271.56,93,,,percent of total billed charges,93% of total billed charges,262.8,90,,,percent of total billed charges,90% of total billed charges,262.8,90,,,percent of total billed charges,90% of total billed charges,283.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,283.24,97,,,percent of total billed charges,97% of total billed charges,219,75,,,percent of total billed charges,75% of total billed charges,280.32,96,,,percent of total billed charges,96% of total billed charges,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219,75,,,percent of total billed charges,75% of total billed charges,219,75,,,percent of total billed charges,75% of total billed charges,6.59,283.24,
PF INJECTION AA and /STRD GENICULAR NRV BRANCHES W/IMG,78001742P,CDM,975,RC,64454,HCPCS,Outpatient,,,310,232.5,,285.2,92,,,percent of total billed charges,92% of total billed charges,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.3,93,,,percent of total billed charges,93% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,300.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.7,97,,,percent of total billed charges,97% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,297.6,96,,,percent of total billed charges,96% of total billed charges,6.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,232.5,75,,,percent of total billed charges,75% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,6.62,300.7,
PF INJECTION(S) ANESTH AGENT/STEROID FOOT NERVE,78002259P,CDM,975,RC,64455,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.98,93,,,percent of total billed charges,93% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,83.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.42,97,,,percent of total billed charges,97% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,82.56,96,,,percent of total billed charges,96% of total billed charges,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.5,75,,,percent of total billed charges,75% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,2.77,83.42,
PF PVB THORACIC SINGLE INJECTION SITE W/IMG GUIDE,78001744P,CDM,975,RC,64461,HCPCS,Outpatient,,,1012,759,,931.04,92,,,percent of total billed charges,92% of total billed charges,7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,941.16,93,,,percent of total billed charges,93% of total billed charges,910.8,90,,,percent of total billed charges,90% of total billed charges,910.8,90,,,percent of total billed charges,90% of total billed charges,981.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,981.64,97,,,percent of total billed charges,97% of total billed charges,759,75,,,percent of total billed charges,75% of total billed charges,971.52,96,,,percent of total billed charges,96% of total billed charges,7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,759,75,,,percent of total billed charges,75% of total billed charges,759,75,,,percent of total billed charges,75% of total billed charges,7,981.64,
PF PVB THORACIC SECOND  and  ADDL INJ SITE W/IMG GUIDANCE,78001746P,CDM,975,RC,64462,HCPCS,Outpatient,,,843,632.25,,775.56,92,,,percent of total billed charges,92% of total billed charges,4.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,783.99,93,,,percent of total billed charges,93% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,758.7,90,,,percent of total billed charges,90% of total billed charges,817.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,817.71,97,,,percent of total billed charges,97% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,809.28,96,,,percent of total billed charges,96% of total billed charges,4.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,632.25,75,,,percent of total billed charges,75% of total billed charges,632.25,75,,,percent of total billed charges,75% of total billed charges,4.09,817.71,
PF INJECTION(S) ANESTH AGENT CERV/THOR SINGLE W/GD,78002261P,CDM,975,RC,64479,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges,10.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.9,93,,,percent of total billed charges,93% of total billed charges,297,90,,,percent of total billed charges,90% of total billed charges,297,90,,,percent of total billed charges,90% of total billed charges,320.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,320.1,97,,,percent of total billed charges,97% of total billed charges,247.5,75,,,percent of total billed charges,75% of total billed charges,316.8,96,,,percent of total billed charges,96% of total billed charges,10.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,247.5,75,,,percent of total billed charges,75% of total billed charges,247.5,75,,,percent of total billed charges,75% of total billed charges,10.17,320.1,
PF INJECTION(S) ANESTH AGENT CERV/THOR  W/GD ADD'L,78002263P,CDM,975,RC,64480,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.15,93,,,percent of total billed charges,93% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,150.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.35,97,,,percent of total billed charges,97% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,148.8,96,,,percent of total billed charges,96% of total billed charges,5.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,75,,,percent of total billed charges,75% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,5.07,150.35,
PF INJECTION ANES and /STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL,78001748P,CDM,975,RC,64483,HCPCS,Outpatient,,,293,219.75,,269.56,92,,,percent of total billed charges,92% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,272.49,93,,,percent of total billed charges,93% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,284.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.21,97,,,percent of total billed charges,97% of total billed charges,219.75,75,,,percent of total billed charges,75% of total billed charges,281.28,96,,,percent of total billed charges,96% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.75,75,,,percent of total billed charges,75% of total billed charges,219.75,75,,,percent of total billed charges,75% of total billed charges,8.7,284.21,
PF INJECTION ANES and /STRD W/IMG TFRML EDRL LMBR/SAC EA LV,78001750P,CDM,975,RC,64484,HCPCS,Outpatient,,,136,102,,125.12,92,,,percent of total billed charges,92% of total billed charges,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126.48,93,,,percent of total billed charges,93% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,131.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.92,97,,,percent of total billed charges,97% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,130.56,96,,,percent of total billed charges,96% of total billed charges,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102,75,,,percent of total billed charges,75% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,4.47,131.92,
PF INJECTION ANES and /STRD W/IMG TFRML EDRL LMBR/SAC EA LV,78001750P,CDM,975,RC,64484,HCPCS,Outpatient,,,136,102,,125.12,92,,,percent of total billed charges,92% of total billed charges,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126.48,93,,,percent of total billed charges,93% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,131.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.92,97,,,percent of total billed charges,97% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,130.56,96,,,percent of total billed charges,96% of total billed charges,4.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102,75,,,percent of total billed charges,75% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,4.47,131.92,
PF TRANSVERSUS ABDIMINIS PLANE BLOCK W/GUIDANCE,78001752P,CDM,975,RC,64486,HCPCS,Outpatient,,,146,109.5,,134.32,92,,,percent of total billed charges,92% of total billed charges,4.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.78,93,,,percent of total billed charges,93% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,141.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.62,97,,,percent of total billed charges,97% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,140.16,96,,,percent of total billed charges,96% of total billed charges,4.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,109.5,75,,,percent of total billed charges,75% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,4.86,141.62,
PF TAP BLOCK BILATERAL BY INJECTION(S),78001754P,CDM,975,RC,64488,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges,5.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.33,93,,,percent of total billed charges,93% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,175.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.57,97,,,percent of total billed charges,97% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,173.76,96,,,percent of total billed charges,96% of total billed charges,5.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.75,75,,,percent of total billed charges,75% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,5.86,175.57,
PF INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL,78001756P,CDM,975,RC,64490,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,386.88,93,,,percent of total billed charges,93% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,403.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.52,97,,,percent of total billed charges,97% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,399.36,96,,,percent of total billed charges,96% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312,75,,,percent of total billed charges,75% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,8.5,403.52,
PF INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 2ND LVL,78001758P,CDM,975,RC,64491,HCPCS,Outpatient,,,191,143.25,,175.72,92,,,percent of total billed charges,92% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.63,93,,,percent of total billed charges,93% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,185.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.27,97,,,percent of total billed charges,97% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,183.36,96,,,percent of total billed charges,96% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.25,75,,,percent of total billed charges,75% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,5.28,185.27,
PF INJECTION DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL,78001760P,CDM,975,RC,64492,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.56,93,,,percent of total billed charges,93% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,186.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.24,97,,,percent of total billed charges,97% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,184.32,96,,,percent of total billed charges,96% of total billed charges,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144,75,,,percent of total billed charges,75% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,5.32,186.24,
PF INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL,78001762P,CDM,975,RC,64493,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,7.18,343.38,
PF INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LVL,78001764P,CDM,975,RC,64494,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.55,93,,,percent of total billed charges,93% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,130.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.95,97,,,percent of total billed charges,97% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,129.6,96,,,percent of total billed charges,96% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.25,75,,,percent of total billed charges,75% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,4.45,130.95,
PF INJECTION DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL,78001766P,CDM,975,RC,64495,HCPCS,Outpatient,,,137,102.75,,126.04,92,,,percent of total billed charges,92% of total billed charges,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.41,93,,,percent of total billed charges,93% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,132.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.89,97,,,percent of total billed charges,97% of total billed charges,102.75,75,,,percent of total billed charges,75% of total billed charges,131.52,96,,,percent of total billed charges,96% of total billed charges,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102.75,75,,,percent of total billed charges,75% of total billed charges,102.75,75,,,percent of total billed charges,75% of total billed charges,4.48,132.89,
PF INJECTION ANES AGENT SPHENOPALATINE GANGLION,78001768P,CDM,975,RC,64505,HCPCS,Outpatient,,,580,435,,533.6,92,,,percent of total billed charges,92% of total billed charges,13.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,539.4,93,,,percent of total billed charges,93% of total billed charges,522,90,,,percent of total billed charges,90% of total billed charges,522,90,,,percent of total billed charges,90% of total billed charges,562.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,562.6,97,,,percent of total billed charges,97% of total billed charges,435,75,,,percent of total billed charges,75% of total billed charges,556.8,96,,,percent of total billed charges,96% of total billed charges,13.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,435,75,,,percent of total billed charges,75% of total billed charges,435,75,,,percent of total billed charges,75% of total billed charges,13.69,562.6,
PF INJECTION ANESTH AGENT STELLATE GANGLION CERV SYMPATHETC,78002802P,CDM,975,RC,64510,HCPCS,Outpatient,,,379,284.25,,348.68,92,,,percent of total billed charges,92% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.47,93,,,percent of total billed charges,93% of total billed charges,341.1,90,,,percent of total billed charges,90% of total billed charges,341.1,90,,,percent of total billed charges,90% of total billed charges,367.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.63,97,,,percent of total billed charges,97% of total billed charges,284.25,75,,,percent of total billed charges,75% of total billed charges,363.84,96,,,percent of total billed charges,96% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.25,75,,,percent of total billed charges,75% of total billed charges,284.25,75,,,percent of total billed charges,75% of total billed charges,5.9,367.63,
PF INJECTION ANES LUMBAR/THORACIC PARAVERTBRL SYMPATHETIC,78001770P,CDM,975,RC,64520,HCPCS,Outpatient,,,606,454.5,,557.52,92,,,percent of total billed charges,92% of total billed charges,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,563.58,93,,,percent of total billed charges,93% of total billed charges,545.4,90,,,percent of total billed charges,90% of total billed charges,545.4,90,,,percent of total billed charges,90% of total billed charges,587.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,587.82,97,,,percent of total billed charges,97% of total billed charges,454.5,75,,,percent of total billed charges,75% of total billed charges,581.76,96,,,percent of total billed charges,96% of total billed charges,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,454.5,75,,,percent of total billed charges,75% of total billed charges,454.5,75,,,percent of total billed charges,75% of total billed charges,6.45,587.82,
PF DESTRUCTION NEUROLYTIC AGENT INTERCOSTAL NERVE,78001772P,CDM,975,RC,64620,HCPCS,Outpatient,,,468,351,,430.56,92,,,percent of total billed charges,92% of total billed charges,15.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,435.24,93,,,percent of total billed charges,93% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,453.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,453.96,97,,,percent of total billed charges,97% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,449.28,96,,,percent of total billed charges,96% of total billed charges,15.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,351,75,,,percent of total billed charges,75% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,15.35,453.96,
PF DESTRUCTION NEUROLYTIC AGENT GENICULAR NRVE W/IMG,78001774P,CDM,975,RC,64624,HCPCS,Outpatient,,,579,434.25,,532.68,92,,,percent of total billed charges,92% of total billed charges,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,538.47,93,,,percent of total billed charges,93% of total billed charges,521.1,90,,,percent of total billed charges,90% of total billed charges,521.1,90,,,percent of total billed charges,90% of total billed charges,561.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,561.63,97,,,percent of total billed charges,97% of total billed charges,434.25,75,,,percent of total billed charges,75% of total billed charges,555.84,96,,,percent of total billed charges,96% of total billed charges,11.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,434.25,75,,,percent of total billed charges,75% of total billed charges,434.25,75,,,percent of total billed charges,75% of total billed charges,11.26,561.63,
PF DESTRUCTION NEUROLYTIC AGENT PARVERTEB FCT SNGL CRVCL/THO,78002825P,CDM,975,RC,64633,HCPCS,Outpatient,,,1301,975.75,,1196.92,92,,,percent of total billed charges,92% of total billed charges,15.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1209.93,93,,,percent of total billed charges,93% of total billed charges,1170.9,90,,,percent of total billed charges,90% of total billed charges,1170.9,90,,,percent of total billed charges,90% of total billed charges,1261.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1261.97,97,,,percent of total billed charges,97% of total billed charges,975.75,75,,,percent of total billed charges,75% of total billed charges,1248.96,96,,,percent of total billed charges,96% of total billed charges,15.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,975.75,75,,,percent of total billed charges,75% of total billed charges,975.75,75,,,percent of total billed charges,75% of total billed charges,15.29,1261.97,
PF DESTRUCTION NEUROLYTIC AGENT PARVERTEB FCT ADDL CRVCL/THO,78002826P,CDM,975,RC,64634,HCPCS,Outpatient,,,920,690,,846.4,92,,,percent of total billed charges,92% of total billed charges,5.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,855.6,93,,,percent of total billed charges,93% of total billed charges,828,90,,,percent of total billed charges,90% of total billed charges,828,90,,,percent of total billed charges,90% of total billed charges,892.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,892.4,97,,,percent of total billed charges,97% of total billed charges,690,75,,,percent of total billed charges,75% of total billed charges,883.2,96,,,percent of total billed charges,96% of total billed charges,5.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,690,75,,,percent of total billed charges,75% of total billed charges,690,75,,,percent of total billed charges,75% of total billed charges,5.82,892.4,
PF DESTRUCT NEUROLYTIC AGENT PARVERTEB FCT SNGL LMBR/SACRL,78001780P,CDM,975,RC,64635,HCPCS,Outpatient,,,506,379.5,,465.52,92,,,percent of total billed charges,92% of total billed charges,15.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,470.58,93,,,percent of total billed charges,93% of total billed charges,455.4,90,,,percent of total billed charges,90% of total billed charges,455.4,90,,,percent of total billed charges,90% of total billed charges,490.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,490.82,97,,,percent of total billed charges,97% of total billed charges,379.5,75,,,percent of total billed charges,75% of total billed charges,485.76,96,,,percent of total billed charges,96% of total billed charges,15.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,379.5,75,,,percent of total billed charges,75% of total billed charges,379.5,75,,,percent of total billed charges,75% of total billed charges,15.3,490.82,
PF DESTRUCTION NEUROLYTIC AGENT PARVERTEB FCT ADDL LUMBAR/SA,78001784P,CDM,975,RC,64636,HCPCS,Outpatient,,,156,117,,143.52,92,,,percent of total billed charges,92% of total billed charges,4.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,145.08,93,,,percent of total billed charges,93% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,151.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,151.32,97,,,percent of total billed charges,97% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,149.76,96,,,percent of total billed charges,96% of total billed charges,4.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117,75,,,percent of total billed charges,75% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,4.99,151.32,
PF DESTRUCTION NEUROLYTIC AGENT OTHER PERIPHERAL NERVE,78001786P,CDM,975,RC,64640,HCPCS,Outpatient,,,313,234.75,,287.96,92,,,percent of total billed charges,92% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,291.09,93,,,percent of total billed charges,93% of total billed charges,281.7,90,,,percent of total billed charges,90% of total billed charges,281.7,90,,,percent of total billed charges,90% of total billed charges,303.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,303.61,97,,,percent of total billed charges,97% of total billed charges,234.75,75,,,percent of total billed charges,75% of total billed charges,300.48,96,,,percent of total billed charges,96% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,234.75,75,,,percent of total billed charges,75% of total billed charges,234.75,75,,,percent of total billed charges,75% of total billed charges,9.79,303.61,
PF NEUROPLASTY /TRANSPOSITION ULNAR NERVE ELBOW,78001788P,CDM,975,RC,64718,HCPCS,Outpatient,,,4282,3211.5,,3939.44,92,,,percent of total billed charges,92% of total billed charges,61.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3982.26,93,,,percent of total billed charges,93% of total billed charges,3853.8,90,,,percent of total billed charges,90% of total billed charges,3853.8,90,,,percent of total billed charges,90% of total billed charges,4153.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,61.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4153.54,97,,,percent of total billed charges,97% of total billed charges,3211.5,75,,,percent of total billed charges,75% of total billed charges,4110.72,96,,,percent of total billed charges,96% of total billed charges,61.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3211.5,75,,,percent of total billed charges,75% of total billed charges,3211.5,75,,,percent of total billed charges,75% of total billed charges,61.34,4153.54,
PF NEUROPLASTY  and /TRANSPOSITION ULNAR NERVE WRIST,78001789P,CDM,975,RC,64719,HCPCS,Outpatient,,,4282,3211.5,,3939.44,92,,,percent of total billed charges,92% of total billed charges,40.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3982.26,93,,,percent of total billed charges,93% of total billed charges,3853.8,90,,,percent of total billed charges,90% of total billed charges,3853.8,90,,,percent of total billed charges,90% of total billed charges,4153.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4153.54,97,,,percent of total billed charges,97% of total billed charges,3211.5,75,,,percent of total billed charges,75% of total billed charges,4110.72,96,,,percent of total billed charges,96% of total billed charges,40.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3211.5,75,,,percent of total billed charges,75% of total billed charges,3211.5,75,,,percent of total billed charges,75% of total billed charges,40.65,4153.54,
PF NEUROPLASTY  and /TRANSPOS MEDIAN NRV CARPAL TUNNE,78001790P,CDM,975,RC,64721,HCPCS,Outpatient,,,4282,3211.5,,3939.44,92,,,percent of total billed charges,92% of total billed charges,42.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3982.26,93,,,percent of total billed charges,93% of total billed charges,3853.8,90,,,percent of total billed charges,90% of total billed charges,3853.8,90,,,percent of total billed charges,90% of total billed charges,4153.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,42.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4153.54,97,,,percent of total billed charges,97% of total billed charges,3211.5,75,,,percent of total billed charges,75% of total billed charges,4110.72,96,,,percent of total billed charges,96% of total billed charges,42.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3211.5,75,,,percent of total billed charges,75% of total billed charges,3211.5,75,,,percent of total billed charges,75% of total billed charges,42.79,4153.54,
PF DECOMPRESSION UNSPECIFIED NERVE,78001791P,CDM,975,RC,64722,HCPCS,Outpatient,,,4282,3211.5,,3939.44,92,,,percent of total billed charges,92% of total billed charges,41.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3982.26,93,,,percent of total billed charges,93% of total billed charges,3853.8,90,,,percent of total billed charges,90% of total billed charges,3853.8,90,,,percent of total billed charges,90% of total billed charges,4153.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,41.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4153.54,97,,,percent of total billed charges,97% of total billed charges,3211.5,75,,,percent of total billed charges,75% of total billed charges,4110.72,96,,,percent of total billed charges,96% of total billed charges,41.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3211.5,75,,,percent of total billed charges,75% of total billed charges,3211.5,75,,,percent of total billed charges,75% of total billed charges,41.76,4153.54,
PF SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE,78001792P,CDM,975,RC,64831,HCPCS,Outpatient,,,8191,6143.25,,7535.72,92,,,percent of total billed charges,92% of total billed charges,70.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7617.63,93,,,percent of total billed charges,93% of total billed charges,7371.9,90,,,percent of total billed charges,90% of total billed charges,7371.9,90,,,percent of total billed charges,90% of total billed charges,7945.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,70.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7945.27,97,,,percent of total billed charges,97% of total billed charges,6143.25,75,,,percent of total billed charges,75% of total billed charges,7863.36,96,,,percent of total billed charges,96% of total billed charges,70.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6143.25,75,,,percent of total billed charges,75% of total billed charges,6143.25,75,,,percent of total billed charges,75% of total billed charges,70.62,7945.27,
PF SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE,78001793P,CDM,975,RC,64834,HCPCS,Outpatient,,,8191,6143.25,,7535.72,92,,,percent of total billed charges,92% of total billed charges,76.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7617.63,93,,,percent of total billed charges,93% of total billed charges,7371.9,90,,,percent of total billed charges,90% of total billed charges,7371.9,90,,,percent of total billed charges,90% of total billed charges,7945.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,76.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7945.27,97,,,percent of total billed charges,97% of total billed charges,6143.25,75,,,percent of total billed charges,75% of total billed charges,7863.36,96,,,percent of total billed charges,96% of total billed charges,76.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6143.25,75,,,percent of total billed charges,75% of total billed charges,6143.25,75,,,percent of total billed charges,75% of total billed charges,76.09,7945.27,
PF SUTURE 1 NERVE MEDIAN MOTOR THENAR,78001794P,CDM,975,RC,64835,HCPCS,Outpatient,,,8191,6143.25,,7535.72,92,,,percent of total billed charges,92% of total billed charges,93.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7617.63,93,,,percent of total billed charges,93% of total billed charges,7371.9,90,,,percent of total billed charges,90% of total billed charges,7371.9,90,,,percent of total billed charges,90% of total billed charges,7945.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,93.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,7945.27,97,,,percent of total billed charges,97% of total billed charges,6143.25,75,,,percent of total billed charges,75% of total billed charges,7863.36,96,,,percent of total billed charges,96% of total billed charges,93.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6143.25,75,,,percent of total billed charges,75% of total billed charges,6143.25,75,,,percent of total billed charges,75% of total billed charges,93.8,7945.27,
PF ERECTOR SPINAE BLOCK,78001795P,CDM,975,RC,64999,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,678,876.88,
PF REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL,78001797P,CDM,975,RC,65205,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges,1.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,105.09,93,,,percent of total billed charges,93% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,109.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,109.61,97,,,percent of total billed charges,97% of total billed charges,84.75,75,,,percent of total billed charges,75% of total billed charges,108.48,96,,,percent of total billed charges,96% of total billed charges,1.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.75,75,,,percent of total billed charges,75% of total billed charges,84.75,75,,,percent of total billed charges,75% of total billed charges,1.8,109.61,
PF RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERF,78001799P,CDM,975,RC,65210,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges,2.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.99,93,,,percent of total billed charges,93% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,138.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.71,97,,,percent of total billed charges,97% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,137.28,96,,,percent of total billed charges,96% of total billed charges,2.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.25,75,,,percent of total billed charges,75% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,2.03,138.71,
PF RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP,78001801P,CDM,975,RC,65220,HCPCS,Outpatient,,,163,122.25,,149.96,92,,,percent of total billed charges,92% of total billed charges,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,151.59,93,,,percent of total billed charges,93% of total billed charges,146.7,90,,,percent of total billed charges,90% of total billed charges,146.7,90,,,percent of total billed charges,90% of total billed charges,158.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.11,97,,,percent of total billed charges,97% of total billed charges,122.25,75,,,percent of total billed charges,75% of total billed charges,156.48,96,,,percent of total billed charges,96% of total billed charges,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,122.25,75,,,percent of total billed charges,75% of total billed charges,122.25,75,,,percent of total billed charges,75% of total billed charges,3.86,158.11,
PF REMOVAL FB EXTERNAL EYE CORNEAL W/SLIT LAMP,78001803P,CDM,975,RC,65222,HCPCS,Outpatient,,,201,150.75,,184.92,92,,,percent of total billed charges,92% of total billed charges,3.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.93,93,,,percent of total billed charges,93% of total billed charges,180.9,90,,,percent of total billed charges,90% of total billed charges,180.9,90,,,percent of total billed charges,90% of total billed charges,194.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194.97,97,,,percent of total billed charges,97% of total billed charges,150.75,75,,,percent of total billed charges,75% of total billed charges,192.96,96,,,percent of total billed charges,96% of total billed charges,3.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.75,75,,,percent of total billed charges,75% of total billed charges,150.75,75,,,percent of total billed charges,75% of total billed charges,3.07,194.97,
PF RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION,78001805P,CDM,975,RC,65435,HCPCS,Outpatient,,,272,204,,250.24,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,252.96,93,,,percent of total billed charges,93% of total billed charges,244.8,90,,,percent of total billed charges,90% of total billed charges,244.8,90,,,percent of total billed charges,90% of total billed charges,263.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,263.84,97,,,percent of total billed charges,97% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges,261.12,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204,75,,,percent of total billed charges,75% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges,4.28,263.84,
PF BLEPHAROTOMY DRAINAGE ABSCESS EYELID,78001807P,CDM,975,RC,67700,HCPCS,Outpatient,,,726,544.5,,667.92,92,,,percent of total billed charges,92% of total billed charges,6.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,675.18,93,,,percent of total billed charges,93% of total billed charges,653.4,90,,,percent of total billed charges,90% of total billed charges,653.4,90,,,percent of total billed charges,90% of total billed charges,704.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,704.22,97,,,percent of total billed charges,97% of total billed charges,544.5,75,,,percent of total billed charges,75% of total billed charges,696.96,96,,,percent of total billed charges,96% of total billed charges,6.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,544.5,75,,,percent of total billed charges,75% of total billed charges,544.5,75,,,percent of total billed charges,75% of total billed charges,6.98,704.22,
PF INCISIONAL BIOPSY EYELID SKIN  and  LID MARGIN,78001809P,CDM,975,RC,67810,HCPCS,Outpatient,,,281,210.75,,258.52,92,,,percent of total billed charges,92% of total billed charges,5.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,261.33,93,,,percent of total billed charges,93% of total billed charges,252.9,90,,,percent of total billed charges,90% of total billed charges,252.9,90,,,percent of total billed charges,90% of total billed charges,272.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,272.57,97,,,percent of total billed charges,97% of total billed charges,210.75,75,,,percent of total billed charges,75% of total billed charges,269.76,96,,,percent of total billed charges,96% of total billed charges,5.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,210.75,75,,,percent of total billed charges,75% of total billed charges,210.75,75,,,percent of total billed charges,75% of total billed charges,5.3,272.57,
PF EXCISION LESION OF EYELID,78002863P,CDM,960,RC,67840,HCPCS,Outpatient,,,567,425.25,,521.64,92,,,percent of total billed charges,92% of total billed charges,9.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,527.31,93,,,percent of total billed charges,93% of total billed charges,510.3,90,,,percent of total billed charges,90% of total billed charges,510.3,90,,,percent of total billed charges,90% of total billed charges,549.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,549.99,97,,,percent of total billed charges,97% of total billed charges,425.25,75,,,percent of total billed charges,75% of total billed charges,544.32,96,,,percent of total billed charges,96% of total billed charges,9.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,425.25,75,,,percent of total billed charges,75% of total billed charges,425.25,75,,,percent of total billed charges,75% of total billed charges,9.98,549.99,
PF REMOVAL EMBEDDED FOREIGN BODY EYELID,78001811P,CDM,975,RC,67938,HCPCS,Outpatient,,,452,339,,415.84,92,,,percent of total billed charges,92% of total billed charges,6.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,420.36,93,,,percent of total billed charges,93% of total billed charges,406.8,90,,,percent of total billed charges,90% of total billed charges,406.8,90,,,percent of total billed charges,90% of total billed charges,438.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,438.44,97,,,percent of total billed charges,97% of total billed charges,339,75,,,percent of total billed charges,75% of total billed charges,433.92,96,,,percent of total billed charges,96% of total billed charges,6.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,339,75,,,percent of total billed charges,75% of total billed charges,339,75,,,percent of total billed charges,75% of total billed charges,6.48,438.44,
PF DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS,78001813P,CDM,975,RC,69020,HCPCS,Outpatient,,,385,288.75,,354.2,92,,,percent of total billed charges,92% of total billed charges,10.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,358.05,93,,,percent of total billed charges,93% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,373.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,373.45,97,,,percent of total billed charges,97% of total billed charges,288.75,75,,,percent of total billed charges,75% of total billed charges,369.6,96,,,percent of total billed charges,96% of total billed charges,10.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.75,75,,,percent of total billed charges,75% of total billed charges,288.75,75,,,percent of total billed charges,75% of total billed charges,10.98,373.45,
PF EXCISION EXTERNAL EAR COMPLETE AMPUTATION,78001815P,CDM,975,RC,69120,HCPCS,Outpatient,,,1054,790.5,,969.68,92,,,percent of total billed charges,92% of total billed charges,29.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,980.22,93,,,percent of total billed charges,93% of total billed charges,948.6,90,,,percent of total billed charges,90% of total billed charges,948.6,90,,,percent of total billed charges,90% of total billed charges,1022.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1022.38,97,,,percent of total billed charges,97% of total billed charges,790.5,75,,,percent of total billed charges,75% of total billed charges,1011.84,96,,,percent of total billed charges,96% of total billed charges,29.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,790.5,75,,,percent of total billed charges,75% of total billed charges,790.5,75,,,percent of total billed charges,75% of total billed charges,29.21,1022.38,
PF REMOVAL FB EXTERNAL AUDITORY CANAL W/O ANES,78001817P,CDM,975,RC,69200,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges,4.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.05,93,,,percent of total billed charges,93% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,179.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.45,97,,,percent of total billed charges,97% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,177.6,96,,,percent of total billed charges,96% of total billed charges,4.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,4.62,179.45,
PF REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,78001820P,CDM,975,RC,69210,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,3.29,84.39,
PF PSYCH DIAG EVAL W/MED SRVCS,78002426P,CDM,960,RC,90792,HCPCS,Outpatient,,,563,422.25,,517.96,92,,,percent of total billed charges,92% of total billed charges,10.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,523.59,93,,,percent of total billed charges,93% of total billed charges,506.7,90,,,percent of total billed charges,90% of total billed charges,506.7,90,,,percent of total billed charges,90% of total billed charges,546.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546.11,97,,,percent of total billed charges,97% of total billed charges,422.25,75,,,percent of total billed charges,75% of total billed charges,540.48,96,,,percent of total billed charges,96% of total billed charges,10.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,422.25,75,,,percent of total billed charges,75% of total billed charges,422.25,75,,,percent of total billed charges,75% of total billed charges,10.46,546.11,
PF CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL,68500005P,CDM,975,RC,92960,HCPCS,Outpatient,,,428,321,,393.76,92,,,percent of total billed charges,92% of total billed charges,7.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,398.04,93,,,percent of total billed charges,93% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,385.2,90,,,percent of total billed charges,90% of total billed charges,415.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,415.16,97,,,percent of total billed charges,97% of total billed charges,321,75,,,percent of total billed charges,75% of total billed charges,410.88,96,,,percent of total billed charges,96% of total billed charges,7.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321,75,,,percent of total billed charges,75% of total billed charges,321,75,,,percent of total billed charges,75% of total billed charges,7.73,415.16,
PF EXTERNAL ECG RECORDING UP TO 48 HRS REVIEW  INTERP,74000027P,CDM,985,RC,93227,HCPCS,Outpatient,,,47,35.25,,43.24,92,,,percent of total billed charges,92% of total billed charges,0.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.71,93,,,percent of total billed charges,93% of total billed charges,42.3,90,,,percent of total billed charges,90% of total billed charges,42.3,90,,,percent of total billed charges,90% of total billed charges,45.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,45.59,97,,,percent of total billed charges,97% of total billed charges,35.25,75,,,percent of total billed charges,75% of total billed charges,45.12,96,,,percent of total billed charges,96% of total billed charges,0.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,35.25,75,,,percent of total billed charges,75% of total billed charges,35.25,75,,,percent of total billed charges,75% of total billed charges,0.89,45.59,
PF INSERT  and  PLACE FLOW DIRECTED CATHETER,78002231P,CDM,960,RC,93503,HCPCS,Outpatient,,,232,174,,213.44,92,,,percent of total billed charges,92% of total billed charges,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,215.76,93,,,percent of total billed charges,93% of total billed charges,208.8,90,,,percent of total billed charges,90% of total billed charges,208.8,90,,,percent of total billed charges,90% of total billed charges,225.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,225.04,97,,,percent of total billed charges,97% of total billed charges,174,75,,,percent of total billed charges,75% of total billed charges,222.72,96,,,percent of total billed charges,96% of total billed charges,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,174,75,,,percent of total billed charges,75% of total billed charges,174,75,,,percent of total billed charges,75% of total billed charges,7.84,225.04,
PF INJECTION SUBQ OR IM,66100025P,CDM,960,RC,96372,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,32.55,93,,,percent of total billed charges,93% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,33.95,97,,,percent of total billed charges,97% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,33.6,96,,,percent of total billed charges,96% of total billed charges,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,0.77,33.95,
PF DERMATOLOGICAL SERVICE OR PROCEDURE PHOTOTHERAPY,78002862P,CDM,960,RC,96999,HCPCS,Outpatient,,,74,55.5,,68.08,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,68.82,93,,,percent of total billed charges,93% of total billed charges,66.6,90,,,percent of total billed charges,90% of total billed charges,66.6,90,,,percent of total billed charges,90% of total billed charges,71.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,71.78,97,,,percent of total billed charges,97% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges,71.04,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,55.5,75,,,percent of total billed charges,75% of total billed charges,55.5,75,,,percent of total billed charges,75% of total billed charges,55.5,71.78,
PF DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM,78001864P,CDM,975,RC,97598,HCPCS,Outpatient,,,316,237,,290.72,92,,,percent of total billed charges,92% of total billed charges,2.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,293.88,93,,,percent of total billed charges,93% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,306.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.52,97,,,percent of total billed charges,97% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,303.36,96,,,percent of total billed charges,96% of total billed charges,2.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237,75,,,percent of total billed charges,75% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,2.47,306.52,
PF NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQCM,78001867P,CDM,960,RC,97605,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.38,93,,,percent of total billed charges,93% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,64.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.02,97,,,percent of total billed charges,97% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,63.36,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.5,75,,,percent of total billed charges,75% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,1.1,64.02,
PF NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM,78001869P,CDM,960,RC,97606,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.96,93,,,percent of total billed charges,93% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,69.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.84,97,,,percent of total billed charges,97% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,69.12,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54,75,,,percent of total billed charges,75% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,1.18,69.84,
PF ANOGENITAL CHILD/SUSPECT TRAUMA W IMAGING,68500023P,CDM,960,RC,99170,HCPCS,Outpatient,,,558,418.5,,513.36,92,,,percent of total billed charges,92% of total billed charges,6.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,518.94,93,,,percent of total billed charges,93% of total billed charges,502.2,90,,,percent of total billed charges,90% of total billed charges,502.2,90,,,percent of total billed charges,90% of total billed charges,541.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,541.26,97,,,percent of total billed charges,97% of total billed charges,418.5,75,,,percent of total billed charges,75% of total billed charges,535.68,96,,,percent of total billed charges,96% of total billed charges,6.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,418.5,75,,,percent of total billed charges,75% of total billed charges,418.5,75,,,percent of total billed charges,75% of total billed charges,6.14,541.26,
PF ATTEND  and  SUPERVE HYPERBARIC OXYGEN THERAPY EA,78001890P,CDM,960,RC,99183,HCPCS,Outpatient,,,282,211.5,,259.44,92,,,percent of total billed charges,92% of total billed charges,10.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,262.26,93,,,percent of total billed charges,93% of total billed charges,253.8,90,,,percent of total billed charges,90% of total billed charges,253.8,90,,,percent of total billed charges,90% of total billed charges,273.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,273.54,97,,,percent of total billed charges,97% of total billed charges,211.5,75,,,percent of total billed charges,75% of total billed charges,270.72,96,,,percent of total billed charges,96% of total billed charges,10.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,211.5,75,,,percent of total billed charges,75% of total billed charges,211.5,75,,,percent of total billed charges,75% of total billed charges,10.67,273.54,
PF ER VISIT LEVEL 2 EXPANDED PROBLEM FOCUSED,68500033P,CDM,981,RC,99282,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,4.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,4.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,4.14,107.67,
PF COLORECTAL CANCER SCREEN FLEXIBLE SIGMOIDOSCOPY,66100001P,CDM,975,RC,,,Outpatient,,,2896,2172,,2664.32,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,2693.28,93,,,percent of total billed charges,93% of total billed charges,2606.4,90,,,percent of total billed charges,90% of total billed charges,2606.4,90,,,percent of total billed charges,90% of total billed charges,2809.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2809.12,97,,,percent of total billed charges,97% of total billed charges,2172,75,,,percent of total billed charges,75% of total billed charges,2780.16,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,2172,75,,,percent of total billed charges,75% of total billed charges,2172,75,,,percent of total billed charges,75% of total billed charges,2172,2809.12,
PF COLORECTAL CANCER SCEENING HIGH RISK INDIVIDUAL,78002828P,CDM,975,RC,,,Outpatient,,,887,665.25,,816.04,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,824.91,93,,,percent of total billed charges,93% of total billed charges,798.3,90,,,percent of total billed charges,90% of total billed charges,798.3,90,,,percent of total billed charges,90% of total billed charges,860.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,860.39,97,,,percent of total billed charges,97% of total billed charges,665.25,75,,,percent of total billed charges,75% of total billed charges,851.52,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,665.25,75,,,percent of total billed charges,75% of total billed charges,665.25,75,,,percent of total billed charges,75% of total billed charges,665.25,860.39,
PF COLON CANCER SCREENING NOT HIGH RISK,78002228P,CDM,983,RC,,,Outpatient,,,485,363.75,,446.2,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,451.05,93,,,percent of total billed charges,93% of total billed charges,436.5,90,,,percent of total billed charges,90% of total billed charges,436.5,90,,,percent of total billed charges,90% of total billed charges,470.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,470.45,97,,,percent of total billed charges,97% of total billed charges,363.75,75,,,percent of total billed charges,75% of total billed charges,465.6,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,363.75,75,,,percent of total billed charges,75% of total billed charges,363.75,75,,,percent of total billed charges,75% of total billed charges,363.75,470.45,
IP FOLLOW-UP CONSULT 15 MIN,78002798P,CDM,988,RC,,,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,325.5,93,,,percent of total billed charges,93% of total billed charges,315,90,,,percent of total billed charges,90% of total billed charges,315,90,,,percent of total billed charges,90% of total billed charges,339.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,339.5,97,,,percent of total billed charges,97% of total billed charges,262.5,75,,,percent of total billed charges,75% of total billed charges,336,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,262.5,75,,,percent of total billed charges,75% of total billed charges,262.5,75,,,percent of total billed charges,75% of total billed charges,262.5,339.5,
PF TELEHEALTH CONSULT 30 MIN,68500060P,CDM,988,RC,,,Outpatient,,,550,412.5,,506,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,511.5,93,,,percent of total billed charges,93% of total billed charges,495,90,,,percent of total billed charges,90% of total billed charges,495,90,,,percent of total billed charges,90% of total billed charges,533.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,533.5,97,,,percent of total billed charges,97% of total billed charges,412.5,75,,,percent of total billed charges,75% of total billed charges,528,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,412.5,75,,,percent of total billed charges,75% of total billed charges,412.5,75,,,percent of total billed charges,75% of total billed charges,412.5,533.5,
PF GRAFTING OF AUTOLOGOUS SOFT TISSUE,78002830P,CDM,975,RC,15769,HCPCS,Outpatient,,,1204,903,,1107.68,92,,,percent of total billed charges,92% of total billed charges,50.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1119.72,93,,,percent of total billed charges,93% of total billed charges,1083.6,90,,,percent of total billed charges,90% of total billed charges,1083.6,90,,,percent of total billed charges,90% of total billed charges,1167.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,50.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1167.88,97,,,percent of total billed charges,97% of total billed charges,903,75,,,percent of total billed charges,75% of total billed charges,1155.84,96,,,percent of total billed charges,96% of total billed charges,50.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,903,75,,,percent of total billed charges,75% of total billed charges,903,75,,,percent of total billed charges,75% of total billed charges,50.85,1167.88,
PF-FINE NEEDLE ASPIRATION BX W/US GDN EA ADD'L,78002853P,CDM,972,RC,10006,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.6,93,,,percent of total billed charges,93% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,116.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.4,97,,,percent of total billed charges,97% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,115.2,96,,,percent of total billed charges,96% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90,75,,,percent of total billed charges,75% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,4.42,116.4,
PF BIOPSY MUSCLE PERCUTANEOUS NEEDLE,78000336P,CDM,972,RC,20206,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges,4.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,325.5,93,,,percent of total billed charges,93% of total billed charges,315,90,,,percent of total billed charges,90% of total billed charges,315,90,,,percent of total billed charges,90% of total billed charges,339.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,339.5,97,,,percent of total billed charges,97% of total billed charges,262.5,75,,,percent of total billed charges,75% of total billed charges,336,96,,,percent of total billed charges,96% of total billed charges,4.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,262.5,75,,,percent of total billed charges,75% of total billed charges,262.5,75,,,percent of total billed charges,75% of total billed charges,4.66,339.5,
PF CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,78001274P,CDM,972,RC,32408,HCPCS,Outpatient,,,2192,1644,,2016.64,92,,,percent of total billed charges,92% of total billed charges,13.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2038.56,93,,,percent of total billed charges,93% of total billed charges,1972.8,90,,,percent of total billed charges,90% of total billed charges,1972.8,90,,,percent of total billed charges,90% of total billed charges,2126.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2126.24,97,,,percent of total billed charges,97% of total billed charges,1644,75,,,percent of total billed charges,75% of total billed charges,2104.32,96,,,percent of total billed charges,96% of total billed charges,13.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1644,75,,,percent of total billed charges,75% of total billed charges,1644,75,,,percent of total billed charges,75% of total billed charges,13.81,2126.24,
PF US TRANSVAGINAL ADD-ON,72600020P,CDM,971,RC,76817,HCPCS,Outpatient,,,253,189.75,,232.76,92,,,percent of total billed charges,92% of total billed charges,2.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,235.29,93,,,percent of total billed charges,93% of total billed charges,227.7,90,,,percent of total billed charges,90% of total billed charges,227.7,90,,,percent of total billed charges,90% of total billed charges,245.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.41,97,,,percent of total billed charges,97% of total billed charges,189.75,75,,,percent of total billed charges,75% of total billed charges,242.88,96,,,percent of total billed charges,96% of total billed charges,2.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.75,75,,,percent of total billed charges,75% of total billed charges,189.75,75,,,percent of total billed charges,75% of total billed charges,2.25,245.41,
PF US TRANSVAGINAL NON-OB,72600024P,CDM,972,RC,76830,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.11,93,,,percent of total billed charges,93% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,317.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,317.19,97,,,percent of total billed charges,97% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,313.92,96,,,percent of total billed charges,96% of total billed charges,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.25,75,,,percent of total billed charges,75% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,3.54,317.19,
PF XR DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL,71800495P,CDM,972,RC,77080,HCPCS,Outpatient,,,109,81.75,,100.28,92,,,percent of total billed charges,92% of total billed charges,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.37,93,,,percent of total billed charges,93% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,105.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,105.73,97,,,percent of total billed charges,97% of total billed charges,81.75,75,,,percent of total billed charges,75% of total billed charges,104.64,96,,,percent of total billed charges,96% of total billed charges,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.75,75,,,percent of total billed charges,75% of total billed charges,81.75,75,,,percent of total billed charges,75% of total billed charges,1.29,105.73,
PF CT ABDOMEN  and  PELVIS W/O CONTRST 1/> BODY RE,72300054P,CDM,972,RC,74178,HCPCS,Outpatient,,,978,733.5,,899.76,92,,,percent of total billed charges,92% of total billed charges,9.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,909.54,93,,,percent of total billed charges,93% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,948.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,948.66,97,,,percent of total billed charges,97% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,938.88,96,,,percent of total billed charges,96% of total billed charges,9.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,733.5,75,,,percent of total billed charges,75% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,9.63,948.66,
PF CT ABDOMEN  and  PELVIS W/CONTRAST MATERIAL,72300053P,CDM,972,RC,74177,HCPCS,Outpatient,,,873,654.75,,803.16,92,,,percent of total billed charges,92% of total billed charges,8.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,811.89,93,,,percent of total billed charges,93% of total billed charges,785.7,90,,,percent of total billed charges,90% of total billed charges,785.7,90,,,percent of total billed charges,90% of total billed charges,846.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,846.81,97,,,percent of total billed charges,97% of total billed charges,654.75,75,,,percent of total billed charges,75% of total billed charges,838.08,96,,,percent of total billed charges,96% of total billed charges,8.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,654.75,75,,,percent of total billed charges,75% of total billed charges,654.75,75,,,percent of total billed charges,75% of total billed charges,8.35,846.81,
PF CT ABDOMEN  and  PELVIS W/O CONTRAST MATERIAL,72300052P,CDM,972,RC,74176,HCPCS,Outpatient,,,559,419.25,,514.28,92,,,percent of total billed charges,92% of total billed charges,4.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,519.87,93,,,percent of total billed charges,93% of total billed charges,503.1,90,,,percent of total billed charges,90% of total billed charges,503.1,90,,,percent of total billed charges,90% of total billed charges,542.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,542.23,97,,,percent of total billed charges,97% of total billed charges,419.25,75,,,percent of total billed charges,75% of total billed charges,536.64,96,,,percent of total billed charges,96% of total billed charges,4.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,419.25,75,,,percent of total billed charges,75% of total billed charges,419.25,75,,,percent of total billed charges,75% of total billed charges,4.21,542.23,
PF CT ABDOMEN W/O  and  W/CONTRAST MATERIAL,72300050P,CDM,972,RC,74170,HCPCS,Outpatient,,,753,564.75,,692.76,92,,,percent of total billed charges,92% of total billed charges,7.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,700.29,93,,,percent of total billed charges,93% of total billed charges,677.7,90,,,percent of total billed charges,90% of total billed charges,677.7,90,,,percent of total billed charges,90% of total billed charges,730.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,730.41,97,,,percent of total billed charges,97% of total billed charges,564.75,75,,,percent of total billed charges,75% of total billed charges,722.88,96,,,percent of total billed charges,96% of total billed charges,7.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564.75,75,,,percent of total billed charges,75% of total billed charges,564.75,75,,,percent of total billed charges,75% of total billed charges,7.57,730.41,
PF CT ABDOMEN W/CONTRAST MATERIAL,72300049P,CDM,972,RC,74160,HCPCS,Outpatient,,,673,504.75,,619.16,92,,,percent of total billed charges,92% of total billed charges,6.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,625.89,93,,,percent of total billed charges,93% of total billed charges,605.7,90,,,percent of total billed charges,90% of total billed charges,605.7,90,,,percent of total billed charges,90% of total billed charges,652.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,652.81,97,,,percent of total billed charges,97% of total billed charges,504.75,75,,,percent of total billed charges,75% of total billed charges,646.08,96,,,percent of total billed charges,96% of total billed charges,6.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,504.75,75,,,percent of total billed charges,75% of total billed charges,504.75,75,,,percent of total billed charges,75% of total billed charges,6.74,652.81,
PF CT ABDOMEN W/O CONTRAST MATERIAL,72300048P,CDM,972,RC,74150,HCPCS,Outpatient,,,433,324.75,,398.36,92,,,percent of total billed charges,92% of total billed charges,3.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,402.69,93,,,percent of total billed charges,93% of total billed charges,389.7,90,,,percent of total billed charges,90% of total billed charges,389.7,90,,,percent of total billed charges,90% of total billed charges,420.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,420.01,97,,,percent of total billed charges,97% of total billed charges,324.75,75,,,percent of total billed charges,75% of total billed charges,415.68,96,,,percent of total billed charges,96% of total billed charges,3.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,324.75,75,,,percent of total billed charges,75% of total billed charges,324.75,75,,,percent of total billed charges,75% of total billed charges,3.18,420.01,
PF CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,72300051P,CDM,972,RC,74175,HCPCS,Outpatient,,,869,651.75,,799.48,92,,,percent of total billed charges,92% of total billed charges,8.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,808.17,93,,,percent of total billed charges,93% of total billed charges,782.1,90,,,percent of total billed charges,90% of total billed charges,782.1,90,,,percent of total billed charges,90% of total billed charges,842.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.93,97,,,percent of total billed charges,97% of total billed charges,651.75,75,,,percent of total billed charges,75% of total billed charges,834.24,96,,,percent of total billed charges,96% of total billed charges,8.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,651.75,75,,,percent of total billed charges,75% of total billed charges,651.75,75,,,percent of total billed charges,75% of total billed charges,8.71,842.93,
PF CTA ABDL AORTA and BI ILIOFEM W/CONTRAST and POSTP,72300055P,CDM,972,RC,75635,HCPCS,Outpatient,,,1156,867,,1063.52,92,,,percent of total billed charges,92% of total billed charges,12.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1075.08,93,,,percent of total billed charges,93% of total billed charges,1040.4,90,,,percent of total billed charges,90% of total billed charges,1040.4,90,,,percent of total billed charges,90% of total billed charges,1121.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1121.32,97,,,percent of total billed charges,97% of total billed charges,867,75,,,percent of total billed charges,75% of total billed charges,1109.76,96,,,percent of total billed charges,96% of total billed charges,12.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,867,75,,,percent of total billed charges,75% of total billed charges,867,75,,,percent of total billed charges,75% of total billed charges,12.07,1121.32,
PF CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,72300013P,CDM,972,RC,70496,HCPCS,Outpatient,,,778,583.5,,715.76,92,,,percent of total billed charges,92% of total billed charges,7.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,723.54,93,,,percent of total billed charges,93% of total billed charges,700.2,90,,,percent of total billed charges,90% of total billed charges,700.2,90,,,percent of total billed charges,90% of total billed charges,754.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,754.66,97,,,percent of total billed charges,97% of total billed charges,583.5,75,,,percent of total billed charges,75% of total billed charges,746.88,96,,,percent of total billed charges,96% of total billed charges,7.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,583.5,75,,,percent of total billed charges,75% of total billed charges,583.5,75,,,percent of total billed charges,75% of total billed charges,7.76,754.66,
PF CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,72300019P,CDM,972,RC,71275,HCPCS,Outpatient,,,794,595.5,,730.48,92,,,percent of total billed charges,92% of total billed charges,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,738.42,93,,,percent of total billed charges,93% of total billed charges,714.6,90,,,percent of total billed charges,90% of total billed charges,714.6,90,,,percent of total billed charges,90% of total billed charges,770.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,770.18,97,,,percent of total billed charges,97% of total billed charges,595.5,75,,,percent of total billed charges,75% of total billed charges,762.24,96,,,percent of total billed charges,96% of total billed charges,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,595.5,75,,,percent of total billed charges,75% of total billed charges,595.5,75,,,percent of total billed charges,75% of total billed charges,7.84,770.18,
PF CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,72300019P,CDM,972,RC,71275,HCPCS,Outpatient,,,794,595.5,,730.48,92,,,percent of total billed charges,92% of total billed charges,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,738.42,93,,,percent of total billed charges,93% of total billed charges,714.6,90,,,percent of total billed charges,90% of total billed charges,714.6,90,,,percent of total billed charges,90% of total billed charges,770.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,770.18,97,,,percent of total billed charges,97% of total billed charges,595.5,75,,,percent of total billed charges,75% of total billed charges,762.24,96,,,percent of total billed charges,96% of total billed charges,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,595.5,75,,,percent of total billed charges,75% of total billed charges,595.5,75,,,percent of total billed charges,75% of total billed charges,7.84,770.18,
PF CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,72300019P,CDM,972,RC,71275,HCPCS,Outpatient,,,794,595.5,,730.48,92,,,percent of total billed charges,92% of total billed charges,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,738.42,93,,,percent of total billed charges,93% of total billed charges,714.6,90,,,percent of total billed charges,90% of total billed charges,714.6,90,,,percent of total billed charges,90% of total billed charges,770.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,770.18,97,,,percent of total billed charges,97% of total billed charges,595.5,75,,,percent of total billed charges,75% of total billed charges,762.24,96,,,percent of total billed charges,96% of total billed charges,7.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,595.5,75,,,percent of total billed charges,75% of total billed charges,595.5,75,,,percent of total billed charges,75% of total billed charges,7.84,770.18,
PF CT ANGIOGRAPHY LOWER EXTREMITY BILATERAL,72300047P,CDM,972,RC,73706,HCPCS,Outpatient,,,917,687.75,,843.64,92,,,percent of total billed charges,92% of total billed charges,9.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,852.81,93,,,percent of total billed charges,93% of total billed charges,825.3,90,,,percent of total billed charges,90% of total billed charges,825.3,90,,,percent of total billed charges,90% of total billed charges,889.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,889.49,97,,,percent of total billed charges,97% of total billed charges,687.75,75,,,percent of total billed charges,75% of total billed charges,880.32,96,,,percent of total billed charges,96% of total billed charges,9.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,687.75,75,,,percent of total billed charges,75% of total billed charges,687.75,75,,,percent of total billed charges,75% of total billed charges,9.48,889.49,
PF CT ANGIOGRAPHY LOWER EXTREMITY LT,72300046P,CDM,972,RC,73706,HCPCS,Outpatient,,,917,687.75,,843.64,92,,,percent of total billed charges,92% of total billed charges,9.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,852.81,93,,,percent of total billed charges,93% of total billed charges,825.3,90,,,percent of total billed charges,90% of total billed charges,825.3,90,,,percent of total billed charges,90% of total billed charges,889.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,889.49,97,,,percent of total billed charges,97% of total billed charges,687.75,75,,,percent of total billed charges,75% of total billed charges,880.32,96,,,percent of total billed charges,96% of total billed charges,9.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,687.75,75,,,percent of total billed charges,75% of total billed charges,687.75,75,,,percent of total billed charges,75% of total billed charges,9.48,889.49,
PF CT ANGIOGRAPHY LOWER EXTREMITY RT,72300046P,CDM,972,RC,73706,HCPCS,Outpatient,,,917,687.75,,843.64,92,,,percent of total billed charges,92% of total billed charges,9.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,852.81,93,,,percent of total billed charges,93% of total billed charges,825.3,90,,,percent of total billed charges,90% of total billed charges,825.3,90,,,percent of total billed charges,90% of total billed charges,889.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,889.49,97,,,percent of total billed charges,97% of total billed charges,687.75,75,,,percent of total billed charges,75% of total billed charges,880.32,96,,,percent of total billed charges,96% of total billed charges,9.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,687.75,75,,,percent of total billed charges,75% of total billed charges,687.75,75,,,percent of total billed charges,75% of total billed charges,9.48,889.49,
PF CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,72300014P,CDM,972,RC,70498,HCPCS,Outpatient,,,777,582.75,,714.84,92,,,percent of total billed charges,92% of total billed charges,7.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,722.61,93,,,percent of total billed charges,93% of total billed charges,699.3,90,,,percent of total billed charges,90% of total billed charges,699.3,90,,,percent of total billed charges,90% of total billed charges,753.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,753.69,97,,,percent of total billed charges,97% of total billed charges,582.75,75,,,percent of total billed charges,75% of total billed charges,745.92,96,,,percent of total billed charges,96% of total billed charges,7.75,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,582.75,75,,,percent of total billed charges,75% of total billed charges,582.75,75,,,percent of total billed charges,75% of total billed charges,7.75,753.69,
PF CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,72300051P,CDM,972,RC,74175,HCPCS,Outpatient,,,869,651.75,,799.48,92,,,percent of total billed charges,92% of total billed charges,8.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,808.17,93,,,percent of total billed charges,93% of total billed charges,782.1,90,,,percent of total billed charges,90% of total billed charges,782.1,90,,,percent of total billed charges,90% of total billed charges,842.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.93,97,,,percent of total billed charges,97% of total billed charges,651.75,75,,,percent of total billed charges,75% of total billed charges,834.24,96,,,percent of total billed charges,96% of total billed charges,8.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,651.75,75,,,percent of total billed charges,75% of total billed charges,651.75,75,,,percent of total billed charges,75% of total billed charges,8.71,842.93,
PF CT ANGIOGRAPHY UPPER EXTREMITY BIL,72300038P,CDM,972,RC,73206,HCPCS,Outpatient,,,846,634.5,,778.32,92,,,percent of total billed charges,92% of total billed charges,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,786.78,93,,,percent of total billed charges,93% of total billed charges,761.4,90,,,percent of total billed charges,90% of total billed charges,761.4,90,,,percent of total billed charges,90% of total billed charges,820.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,820.62,97,,,percent of total billed charges,97% of total billed charges,634.5,75,,,percent of total billed charges,75% of total billed charges,812.16,96,,,percent of total billed charges,96% of total billed charges,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,634.5,75,,,percent of total billed charges,75% of total billed charges,634.5,75,,,percent of total billed charges,75% of total billed charges,8.44,820.62,
PF CT ANGIOGRAPHY UPPER EXTREMITY LT,72300038P,CDM,972,RC,73206,HCPCS,Outpatient,,,846,634.5,,778.32,92,,,percent of total billed charges,92% of total billed charges,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,786.78,93,,,percent of total billed charges,93% of total billed charges,761.4,90,,,percent of total billed charges,90% of total billed charges,761.4,90,,,percent of total billed charges,90% of total billed charges,820.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,820.62,97,,,percent of total billed charges,97% of total billed charges,634.5,75,,,percent of total billed charges,75% of total billed charges,812.16,96,,,percent of total billed charges,96% of total billed charges,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,634.5,75,,,percent of total billed charges,75% of total billed charges,634.5,75,,,percent of total billed charges,75% of total billed charges,8.44,820.62,
PF CT ANGIOGRAPHY UPPER EXTREMITY RT,72300038P,CDM,972,RC,73206,HCPCS,Outpatient,,,846,634.5,,778.32,92,,,percent of total billed charges,92% of total billed charges,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,786.78,93,,,percent of total billed charges,93% of total billed charges,761.4,90,,,percent of total billed charges,90% of total billed charges,761.4,90,,,percent of total billed charges,90% of total billed charges,820.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,820.62,97,,,percent of total billed charges,97% of total billed charges,634.5,75,,,percent of total billed charges,75% of total billed charges,812.16,96,,,percent of total billed charges,96% of total billed charges,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,634.5,75,,,percent of total billed charges,75% of total billed charges,634.5,75,,,percent of total billed charges,75% of total billed charges,8.44,820.62,
PF CT ANKLE LOWER EXTREMITY W/O  and  W/CONTRAST BIL,72300045P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT LOWER EXTREMITY W/O  and  W/CONTRAST LT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT LOWER EXTREMITY W/O  and  W/CONTRAST RT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT ANKLE LOWER EXTREMITY W/CONTRAST  BIL,72300043P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT LOWER EXTREMITY W/CONTRAST MATERIAL LT,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT LOWER EXTREMITY W/CONTRAST MATERIAL RT,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT ANKLE LOWER EXTREMITY W/O CONTRAST BIL,72300041P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT LOWER EXTREMITY W/O CONTRAST MATERIAL LT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT LOWER EXTREMITY W/O CONTRAST MATERIAL RT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF BIOPSY ABDOMINAL OR RETROPERITONEAL MASS,78002203P,CDM,972,RC,77012,HCPCS,Outpatient,,,427,320.25,,392.84,92,,,percent of total billed charges,92% of total billed charges,2.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,397.11,93,,,percent of total billed charges,93% of total billed charges,384.3,90,,,percent of total billed charges,90% of total billed charges,384.3,90,,,percent of total billed charges,90% of total billed charges,414.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,414.19,97,,,percent of total billed charges,97% of total billed charges,320.25,75,,,percent of total billed charges,75% of total billed charges,409.92,96,,,percent of total billed charges,96% of total billed charges,2.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,320.25,75,,,percent of total billed charges,75% of total billed charges,320.25,75,,,percent of total billed charges,75% of total billed charges,2.71,414.19,
PF CT BRAIN/HEAD STROKE PROTOCOL,72300001P,CDM,972,RC,70450,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.11,93,,,percent of total billed charges,93% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,317.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,317.19,97,,,percent of total billed charges,97% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,313.92,96,,,percent of total billed charges,96% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.25,75,,,percent of total billed charges,75% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,2.65,317.19,
PF CT HEAD/BRAIN W/O  and  W/CONTRAST MATERIAL,72300003P,CDM,972,RC,70470,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges,4.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.11,93,,,percent of total billed charges,93% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,317.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,317.19,97,,,percent of total billed charges,97% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,313.92,96,,,percent of total billed charges,96% of total billed charges,4.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.25,75,,,percent of total billed charges,75% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,4.63,317.19,
PF CT HEAD/BRAIN W/CONTRAST MATERIAL,72300002P,CDM,972,RC,70460,HCPCS,Outpatient,,,490,367.5,,450.8,92,,,percent of total billed charges,92% of total billed charges,3.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.7,93,,,percent of total billed charges,93% of total billed charges,441,90,,,percent of total billed charges,90% of total billed charges,441,90,,,percent of total billed charges,90% of total billed charges,475.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,475.3,97,,,percent of total billed charges,97% of total billed charges,367.5,75,,,percent of total billed charges,75% of total billed charges,470.4,96,,,percent of total billed charges,96% of total billed charges,3.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.5,75,,,percent of total billed charges,75% of total billed charges,367.5,75,,,percent of total billed charges,75% of total billed charges,3.69,475.3,
PF CT HEAD/BRAIN W/O CONTRAST MATERIAL,72300001P,CDM,972,RC,70450,HCPCS,Outpatient,,,417,312.75,,383.64,92,,,percent of total billed charges,92% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,387.81,93,,,percent of total billed charges,93% of total billed charges,375.3,90,,,percent of total billed charges,90% of total billed charges,375.3,90,,,percent of total billed charges,90% of total billed charges,404.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,404.49,97,,,percent of total billed charges,97% of total billed charges,312.75,75,,,percent of total billed charges,75% of total billed charges,400.32,96,,,percent of total billed charges,96% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312.75,75,,,percent of total billed charges,75% of total billed charges,312.75,75,,,percent of total billed charges,75% of total billed charges,2.65,404.49,
PF CT THORAX W/O  and  W/CONTRAST MATERIAL,72300017P,CDM,972,RC,71270,HCPCS,Outpatient,,,557,417.75,,512.44,92,,,percent of total billed charges,92% of total billed charges,5.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,518.01,93,,,percent of total billed charges,93% of total billed charges,501.3,90,,,percent of total billed charges,90% of total billed charges,501.3,90,,,percent of total billed charges,90% of total billed charges,540.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,540.29,97,,,percent of total billed charges,97% of total billed charges,417.75,75,,,percent of total billed charges,75% of total billed charges,534.72,96,,,percent of total billed charges,96% of total billed charges,5.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,417.75,75,,,percent of total billed charges,75% of total billed charges,417.75,75,,,percent of total billed charges,75% of total billed charges,5.48,540.29,
PF CT THORAX W/CONTRAST MATERIAL,72300016P,CDM,972,RC,71260,HCPCS,Outpatient,,,469,351.75,,431.48,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,436.17,93,,,percent of total billed charges,93% of total billed charges,422.1,90,,,percent of total billed charges,90% of total billed charges,422.1,90,,,percent of total billed charges,90% of total billed charges,454.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,454.93,97,,,percent of total billed charges,97% of total billed charges,351.75,75,,,percent of total billed charges,75% of total billed charges,450.24,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,351.75,75,,,percent of total billed charges,75% of total billed charges,351.75,75,,,percent of total billed charges,75% of total billed charges,4.57,454.93,
PF CT THORAX W/O CONTRAST MATERIAL,72300015P,CDM,972,RC,71250,HCPCS,Outpatient,,,418,313.5,,384.56,92,,,percent of total billed charges,92% of total billed charges,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388.74,93,,,percent of total billed charges,93% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,405.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,405.46,97,,,percent of total billed charges,97% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,401.28,96,,,percent of total billed charges,96% of total billed charges,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,313.5,75,,,percent of total billed charges,75% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,3.23,405.46,
PF CT THORAX W/O  and  W/CONTRAST MATERIAL,72300017P,CDM,972,RC,71270,HCPCS,Outpatient,,,557,417.75,,512.44,92,,,percent of total billed charges,92% of total billed charges,5.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,518.01,93,,,percent of total billed charges,93% of total billed charges,501.3,90,,,percent of total billed charges,90% of total billed charges,501.3,90,,,percent of total billed charges,90% of total billed charges,540.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,540.29,97,,,percent of total billed charges,97% of total billed charges,417.75,75,,,percent of total billed charges,75% of total billed charges,534.72,96,,,percent of total billed charges,96% of total billed charges,5.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,417.75,75,,,percent of total billed charges,75% of total billed charges,417.75,75,,,percent of total billed charges,75% of total billed charges,5.48,540.29,
PF CT THORAX W/CONTRAST MATERIAL,72300016P,CDM,972,RC,71260,HCPCS,Outpatient,,,469,351.75,,431.48,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,436.17,93,,,percent of total billed charges,93% of total billed charges,422.1,90,,,percent of total billed charges,90% of total billed charges,422.1,90,,,percent of total billed charges,90% of total billed charges,454.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,454.93,97,,,percent of total billed charges,97% of total billed charges,351.75,75,,,percent of total billed charges,75% of total billed charges,450.24,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,351.75,75,,,percent of total billed charges,75% of total billed charges,351.75,75,,,percent of total billed charges,75% of total billed charges,4.57,454.93,
PF CT THORAX W/O CONTRAST MATERIAL,72300015P,CDM,972,RC,71250,HCPCS,Outpatient,,,418,313.5,,384.56,92,,,percent of total billed charges,92% of total billed charges,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388.74,93,,,percent of total billed charges,93% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,405.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,405.46,97,,,percent of total billed charges,97% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,401.28,96,,,percent of total billed charges,96% of total billed charges,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,313.5,75,,,percent of total billed charges,75% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,3.23,405.46,
PF CT CLAVICLE UPPER EXTREMITY W/O  and  W/CONTRAST BIL,72300037P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT UPPER EXTREMITY W/O  and  W/CONTRAST LT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT UPPER EXTREMITY W/O  and  W/CONTRAST RT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT CLAVICLE UPPER EXTREMITY W/CONTRAST MATERIAL BIL,72300035P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT UPPER EXTREMITY W/CONTRAST MATERIAL LT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT UPPER EXTREMITY W/CONTRAST MATERIAL RT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT CLAVICLE UPPER EXTREMITY W/O CONTRAST MATERIAL BIL,72300033P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT CLAVICLE UPPER EXTREMITY W/O CONTRAST LT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT CLAVICLE UPPER EXTREMITY W/O CONTRAST RT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF XR GUIDANCE PERQ DRAINAGE W/PLACEMT CATH RS and I,72300056P,CDM,972,RC,75989,HCPCS,Outpatient,,,435,326.25,,400.2,92,,,percent of total billed charges,92% of total billed charges,2.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,404.55,93,,,percent of total billed charges,93% of total billed charges,391.5,90,,,percent of total billed charges,90% of total billed charges,391.5,90,,,percent of total billed charges,90% of total billed charges,421.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,421.95,97,,,percent of total billed charges,97% of total billed charges,326.25,75,,,percent of total billed charges,75% of total billed charges,417.6,96,,,percent of total billed charges,96% of total billed charges,2.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,326.25,75,,,percent of total billed charges,75% of total billed charges,326.25,75,,,percent of total billed charges,75% of total billed charges,2.24,421.95,
PF CT ELBOW UPPER EXTREMITY W/O  and  W/CONTRAST BIL,72300037P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT ELBOW UPPER EXTREMITY W/O  and  W/CONT LT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT ELBOW UPPER EXTREMITY W/O  and  W/CONT RT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT ELBOW UPPER EXTREMITY W/CONTRAST MATERIAL BIL,72300035P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT ELBOW UPPER EXTREMITY W/CONTRAST LT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT ELBOW UPPER EXTREMITY W/CONTRAST RT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT ELBOW UPPER EXTREMITY W/O CONTRAST MATERIAL BIL,72300033P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT ELBOW UPPER EXTREMITY W/O CONTRAST LT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT ELBOW UPPER EXTREMITY W/O CONTRAST RT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT LOWER EXTREMITY W/O  and  W/CONTRAST MATRL BIL,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT FEMUR LOWER EXTREMITY W/O  and  W/CONTRAST LT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT FEMUR LOWER EXTREMITY W/O  and  W/CONTRAST RT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT FEMUR LOWER EXTREMITY W/CONTRAST BIL,72300043P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT FEMUR LOWER EXTREMITY W/CONTRAST LT,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT FEMUR LOWER EXTREMITY W/CONTRAST RT,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT FEMUR LOWER EXTREMITY W/O CONTRAST BIL,72300041P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT FEMUR LOWER EXTREMITY W/O CONTRAST LT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT FEMUR LOWER EXTREMITY W/O CONTRAST RT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT FOOT LOWER EXTREMITY W/O  and  W/CONTRAST BIL,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT FOOT LOWER EXTREMITY W/O  and  W/CONTRAST LT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT FOOT LOWER EXTREMITY W/O  and  W/CONTRAST RT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT FOOT LOWER EXTREMITY W/CONTRAST BIL,72300043P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT FOOT LOWER EXTREMITY W/CONTRAST LT,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT FOOT LOWER EXTREMITY W/CONTRAST RT,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT FOOT LOWER EXTREMITY W/O CONTRAST BIL,72300041P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT FOOT LOWER EXTREMITY W/O CONTRAST LT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT FOOT LOWER EXTREMITY W/O CONTRAST RT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT FOREARM UPPER EXTREMITY W/O  and  W/CONTRAST BIL,72300037P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT FOREARM UPPER EXTREMITY W/O  and  W/CONTRAST LT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT FOREARM UPPER EXTREMITY W/O  and  W/CONTRAST RT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT FOREARM UPPER EXTREMITY W/CONTRAST BIL,72300035P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT FOREARM UPPER EXTREMITY W/O CONTRAST LT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT FOREARM UPPER EXTREMITY W/O CONTRAST RT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT FOREARM UPPER EXTREMITY W/O CONTRAST BIL,72300033P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT FOREARM UPPER EXTREMITY W/O CONTRAST LT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT FOREARM UPPER EXTREMITY W/O CONTRAST RT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT GUIDANCE NEEDLE PLACEMENT,72300059P,CDM,972,RC,77012,HCPCS,Outpatient,,,427,320.25,,392.84,92,,,percent of total billed charges,92% of total billed charges,2.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,397.11,93,,,percent of total billed charges,93% of total billed charges,384.3,90,,,percent of total billed charges,90% of total billed charges,384.3,90,,,percent of total billed charges,90% of total billed charges,414.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,414.19,97,,,percent of total billed charges,97% of total billed charges,320.25,75,,,percent of total billed charges,75% of total billed charges,409.92,96,,,percent of total billed charges,96% of total billed charges,2.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,320.25,75,,,percent of total billed charges,75% of total billed charges,320.25,75,,,percent of total billed charges,75% of total billed charges,2.71,414.19,
PF CT HAND UPPER EXTREMITY W/O  and  W/CONT BIL,72300037P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT HAND UPPER EXTREMITY W/O  and  W/CONT LT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT HAND UPPER EXTREMITY W/O  and  W/CONT RT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT HAND UPPER EXTREMITY W/CONTRAST BIL,72300035P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT HAND UPPER EXTREMITY W/CONTRAST LT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT HAND UPPER EXTREMITY W/CONTRAST RT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT HAND UPPER EXTREMITY W/O CONTRAST BIL,72300033P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT HAND UPPER EXTREMITY W/O CONTRAST LT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT HAND UPPER EXTREMITY W/O CONTRAST RT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT HIP LOWER EXTREMITY W/O  and  W/CONTRAST BIL,72300045P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT HIP LOWER EXTREMITY W/O  and  W/CONTRAST LT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT HIP LOWER EXTREMITY W/O  and  W/CONTRAST RT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT HIP LOWER EXTREMITY W/CONTRAST BIL,72300043P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT HIP LOWER EXTREMITY W/CONTRAST LT,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT HIP LOWER EXTREMITY W/CONTRAST RT,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT HIP LOWER EXTREMITY W/O CONTRAST BIL,72300041P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT HIP LOWER EXTREMITY W/O CONTRAST LT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT HIP LOWER EXTREMITY W/O CONTRAST RT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT HUMERUS UPPER EXTREMITY W/O  and  W/CONT BIL,72300037P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT HUMERUS UPPER EXTREMITY W/O  and  W/CONT LT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT HUMERUS UPPER EXTREMITY W/O  and  W/CONT RT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT HUMERUS UPPER EXTREMITY W/CONTRAST BIL,72300035P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT HUMERUS UPPER EXTREMITY W/CONTRAST LT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT HUMERUS UPPER EXTREMITY W/CONTRAST RT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT HUMERUS UPPER EXTREMITY W/O CONTRAST BIL,72300033P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT HUMERUS UPPER EXTREMITY W/O CONTRAST LT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT HUMERUS UPPER EXTREMITY W/O CONTRAST RT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT KNEE LOWER EXTREMITY W/O  and  W/CONTRAST BIL,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT KNEE LOWER EXTREMITY W/O  and  W/CONTRAST LT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT KNEE LOWER EXTREMITY W/O  and  W/CONTRAST RT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT KNEE LOWER EXTREMITY W/CONTRAST BIL,72300043P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT KNEE LOWER EXTREMITY W/CONTRAST LT,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT KNEE LOWER EXTREMITY W/CONTRAST RT,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT KNEE LOWER EXTREMITY W/O CONTRAST BIL,72300041P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT KNEE LOWER EXTREMITY W/O CONTRAST LT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT KNEE LOWER EXTREMITY W/O CONTRAST RT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT LIMITED/LOCALIZED FOLLOW UP STUDY,72300058P,CDM,972,RC,76380,HCPCS,Outpatient,,,372,279,,342.24,92,,,percent of total billed charges,92% of total billed charges,3.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.96,93,,,percent of total billed charges,93% of total billed charges,334.8,90,,,percent of total billed charges,90% of total billed charges,334.8,90,,,percent of total billed charges,90% of total billed charges,360.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,360.84,97,,,percent of total billed charges,97% of total billed charges,279,75,,,percent of total billed charges,75% of total billed charges,357.12,96,,,percent of total billed charges,96% of total billed charges,3.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,279,75,,,percent of total billed charges,75% of total billed charges,279,75,,,percent of total billed charges,75% of total billed charges,3.35,360.84,
PF CT THORAX LOW DOSE LUNG CANCER SCREEN W/O CONT,72300018P,CDM,972,RC,71271,HCPCS,Outpatient,,,385,288.75,,354.2,92,,,percent of total billed charges,92% of total billed charges,3.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,358.05,93,,,percent of total billed charges,93% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,373.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,373.45,97,,,percent of total billed charges,97% of total billed charges,288.75,75,,,percent of total billed charges,75% of total billed charges,369.6,96,,,percent of total billed charges,96% of total billed charges,3.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.75,75,,,percent of total billed charges,75% of total billed charges,288.75,75,,,percent of total billed charges,75% of total billed charges,3.66,373.45,
PF CT MAXILLOFACIAL W/O  and  W/CONTRAST MATERIAL,72300009P,CDM,972,RC,70488,HCPCS,Outpatient,,,522,391.5,,480.24,92,,,percent of total billed charges,92% of total billed charges,5.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485.46,93,,,percent of total billed charges,93% of total billed charges,469.8,90,,,percent of total billed charges,90% of total billed charges,469.8,90,,,percent of total billed charges,90% of total billed charges,506.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,506.34,97,,,percent of total billed charges,97% of total billed charges,391.5,75,,,percent of total billed charges,75% of total billed charges,501.12,96,,,percent of total billed charges,96% of total billed charges,5.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,391.5,75,,,percent of total billed charges,75% of total billed charges,391.5,75,,,percent of total billed charges,75% of total billed charges,5.02,506.34,
PF CT MAXILLOFACIAL W/CONTRAST MATERIAL,72300008P,CDM,972,RC,70487,HCPCS,Outpatient,,,473,354.75,,435.16,92,,,percent of total billed charges,92% of total billed charges,4.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,439.89,93,,,percent of total billed charges,93% of total billed charges,425.7,90,,,percent of total billed charges,90% of total billed charges,425.7,90,,,percent of total billed charges,90% of total billed charges,458.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,458.81,97,,,percent of total billed charges,97% of total billed charges,354.75,75,,,percent of total billed charges,75% of total billed charges,454.08,96,,,percent of total billed charges,96% of total billed charges,4.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,354.75,75,,,percent of total billed charges,75% of total billed charges,354.75,75,,,percent of total billed charges,75% of total billed charges,4.11,458.81,
PF CT MAXILLOFACIAL W/O CONTRAST MATERIAL,72300007P,CDM,972,RC,70486,HCPCS,Outpatient,,,411,308.25,,378.12,92,,,percent of total billed charges,92% of total billed charges,3.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,382.23,93,,,percent of total billed charges,93% of total billed charges,369.9,90,,,percent of total billed charges,90% of total billed charges,369.9,90,,,percent of total billed charges,90% of total billed charges,398.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,398.67,97,,,percent of total billed charges,97% of total billed charges,308.25,75,,,percent of total billed charges,75% of total billed charges,394.56,96,,,percent of total billed charges,96% of total billed charges,3.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,308.25,75,,,percent of total billed charges,75% of total billed charges,308.25,75,,,percent of total billed charges,75% of total billed charges,3.42,398.67,
PF CT SOFT TISSUE NECK W/O  and  W/CONTRAST MATERIAL,72300012P,CDM,972,RC,70492,HCPCS,Outpatient,,,627,470.25,,576.84,92,,,percent of total billed charges,92% of total billed charges,5.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,583.11,93,,,percent of total billed charges,93% of total billed charges,564.3,90,,,percent of total billed charges,90% of total billed charges,564.3,90,,,percent of total billed charges,90% of total billed charges,608.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,608.19,97,,,percent of total billed charges,97% of total billed charges,470.25,75,,,percent of total billed charges,75% of total billed charges,601.92,96,,,percent of total billed charges,96% of total billed charges,5.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,470.25,75,,,percent of total billed charges,75% of total billed charges,470.25,75,,,percent of total billed charges,75% of total billed charges,5.76,608.19,
PF CT SOFT TISSUE NECK W/CONTRAST MATERIAL,72300011P,CDM,972,RC,70491,HCPCS,Outpatient,,,521,390.75,,479.32,92,,,percent of total billed charges,92% of total billed charges,4.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,484.53,93,,,percent of total billed charges,93% of total billed charges,468.9,90,,,percent of total billed charges,90% of total billed charges,468.9,90,,,percent of total billed charges,90% of total billed charges,505.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,505.37,97,,,percent of total billed charges,97% of total billed charges,390.75,75,,,percent of total billed charges,75% of total billed charges,500.16,96,,,percent of total billed charges,96% of total billed charges,4.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,390.75,75,,,percent of total billed charges,75% of total billed charges,390.75,75,,,percent of total billed charges,75% of total billed charges,4.83,505.37,
PF CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,72300010P,CDM,972,RC,70490,HCPCS,Outpatient,,,467,350.25,,429.64,92,,,percent of total billed charges,92% of total billed charges,3.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,434.31,93,,,percent of total billed charges,93% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,452.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,452.99,97,,,percent of total billed charges,97% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,448.32,96,,,percent of total billed charges,96% of total billed charges,3.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,350.25,75,,,percent of total billed charges,75% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,3.5,452.99,
PF CT ORBIT SELLA/POST FOSSA/EAR W/O  and  W/CONTRAST,72300006P,CDM,972,RC,70482,HCPCS,Outpatient,,,599,449.25,,551.08,92,,,percent of total billed charges,92% of total billed charges,5.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,557.07,93,,,percent of total billed charges,93% of total billed charges,539.1,90,,,percent of total billed charges,90% of total billed charges,539.1,90,,,percent of total billed charges,90% of total billed charges,581.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,581.03,97,,,percent of total billed charges,97% of total billed charges,449.25,75,,,percent of total billed charges,75% of total billed charges,575.04,96,,,percent of total billed charges,96% of total billed charges,5.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,449.25,75,,,percent of total billed charges,75% of total billed charges,449.25,75,,,percent of total billed charges,75% of total billed charges,5.96,581.03,
PF CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,72300005P,CDM,972,RC,70481,HCPCS,Outpatient,,,510,382.5,,469.2,92,,,percent of total billed charges,92% of total billed charges,5.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,474.3,93,,,percent of total billed charges,93% of total billed charges,459,90,,,percent of total billed charges,90% of total billed charges,459,90,,,percent of total billed charges,90% of total billed charges,494.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,494.7,97,,,percent of total billed charges,97% of total billed charges,382.5,75,,,percent of total billed charges,75% of total billed charges,489.6,96,,,percent of total billed charges,96% of total billed charges,5.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,382.5,75,,,percent of total billed charges,75% of total billed charges,382.5,75,,,percent of total billed charges,75% of total billed charges,5.11,494.7,
PF CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST,72300004P,CDM,972,RC,70480,HCPCS,Outpatient,,,460,345,,423.2,92,,,percent of total billed charges,92% of total billed charges,4.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,427.8,93,,,percent of total billed charges,93% of total billed charges,414,90,,,percent of total billed charges,90% of total billed charges,414,90,,,percent of total billed charges,90% of total billed charges,446.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,446.2,97,,,percent of total billed charges,97% of total billed charges,345,75,,,percent of total billed charges,75% of total billed charges,441.6,96,,,percent of total billed charges,96% of total billed charges,4.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345,75,,,percent of total billed charges,75% of total billed charges,345,75,,,percent of total billed charges,75% of total billed charges,4.08,446.2,
PF CT PELVIS W/O  and  W/CONTRAST MATERIAL,72300031P,CDM,972,RC,72194,HCPCS,Outpatient,,,727,545.25,,668.84,92,,,percent of total billed charges,92% of total billed charges,7.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,676.11,93,,,percent of total billed charges,93% of total billed charges,654.3,90,,,percent of total billed charges,90% of total billed charges,654.3,90,,,percent of total billed charges,90% of total billed charges,705.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,705.19,97,,,percent of total billed charges,97% of total billed charges,545.25,75,,,percent of total billed charges,75% of total billed charges,697.92,96,,,percent of total billed charges,96% of total billed charges,7.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,545.25,75,,,percent of total billed charges,75% of total billed charges,545.25,75,,,percent of total billed charges,75% of total billed charges,7.53,705.19,
PF CT PELVIS W/CONTRAST MATERIAL,72300030P,CDM,972,RC,72193,HCPCS,Outpatient,,,660,495,,607.2,92,,,percent of total billed charges,92% of total billed charges,6.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,613.8,93,,,percent of total billed charges,93% of total billed charges,594,90,,,percent of total billed charges,90% of total billed charges,594,90,,,percent of total billed charges,90% of total billed charges,640.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,640.2,97,,,percent of total billed charges,97% of total billed charges,495,75,,,percent of total billed charges,75% of total billed charges,633.6,96,,,percent of total billed charges,96% of total billed charges,6.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,495,75,,,percent of total billed charges,75% of total billed charges,495,75,,,percent of total billed charges,75% of total billed charges,6.78,640.2,
PF CT PELVIS W/O CONTRAST MATERIAL,72300029P,CDM,972,RC,72192,HCPCS,Outpatient,,,670,502.5,,616.4,92,,,percent of total billed charges,92% of total billed charges,3.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,623.1,93,,,percent of total billed charges,93% of total billed charges,603,90,,,percent of total billed charges,90% of total billed charges,603,90,,,percent of total billed charges,90% of total billed charges,649.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,649.9,97,,,percent of total billed charges,97% of total billed charges,502.5,75,,,percent of total billed charges,75% of total billed charges,643.2,96,,,percent of total billed charges,96% of total billed charges,3.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,502.5,75,,,percent of total billed charges,75% of total billed charges,502.5,75,,,percent of total billed charges,75% of total billed charges,3.22,649.9,
PF CT SCAPULA UPPER EXTREMITY W/O  and  W/CONT BIL,72300037P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT SCAPULA UPPER EXTREMITY W/O  and  W/CONT LT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT SCAPULA UPPER EXTREMITY W/O  and  W/CONT RT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT SCAPULA UPPER EXTREMITY W/CONTRAST BIL,72300035P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT SCAPULA UPPER EXTREMITY W/CONTRAST LT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT SCAPULA UPPER EXTREMITY W/CONTRAST RT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT SCAPULA UPPER EXTREMITY W/O CONTRAST BIL,72300033P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT SCAPULA UPPER EXTREMITY W/O CONTRAST LT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT SCAPULA UPPER EXTREMITY W/O CONTRAST RT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT SHOULDER UPPER EXTREMITY W/O  and  W/CONT BIL,72300037P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT SHOULDER UPPER EXTREMITY W/O  and  W/CONT LT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT SHOULDER W/ + W/O CONTRAST RIGHT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT SHOULDER UPPER EXTREMITY W/CONTRAST BIL,72300035P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT SHOULDER UPPER EXTREMITY W/CONTRAST LT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT SHOULDER UPPER EXTREMITY W/CONTRAST RT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT SHOULDER UPPER EXTREMITY W/O CONTRAST BIL,72300033P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT SHOULDER UPPER EXTREMITY W/O CONTRAST LT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT SHOULDER UPPER EXTREMITY W/O CONTRAST RT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT CERVICAL SPINE W/O  and W/CONTRAST MATERIAL,72300022P,CDM,972,RC,72127,HCPCS,Outpatient,,,462,346.5,,425.04,92,,,percent of total billed charges,92% of total billed charges,5.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,429.66,93,,,percent of total billed charges,93% of total billed charges,415.8,90,,,percent of total billed charges,90% of total billed charges,415.8,90,,,percent of total billed charges,90% of total billed charges,448.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,448.14,97,,,percent of total billed charges,97% of total billed charges,346.5,75,,,percent of total billed charges,75% of total billed charges,443.52,96,,,percent of total billed charges,96% of total billed charges,5.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,346.5,75,,,percent of total billed charges,75% of total billed charges,346.5,75,,,percent of total billed charges,75% of total billed charges,5.49,448.14,
PF CT CERVICAL SPINE W/CONTRAST MATERIAL,72300021P,CDM,972,RC,72126,HCPCS,Outpatient,,,476,357,,437.92,92,,,percent of total billed charges,92% of total billed charges,4.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,442.68,93,,,percent of total billed charges,93% of total billed charges,428.4,90,,,percent of total billed charges,90% of total billed charges,428.4,90,,,percent of total billed charges,90% of total billed charges,461.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,461.72,97,,,percent of total billed charges,97% of total billed charges,357,75,,,percent of total billed charges,75% of total billed charges,456.96,96,,,percent of total billed charges,96% of total billed charges,4.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,357,75,,,percent of total billed charges,75% of total billed charges,357,75,,,percent of total billed charges,75% of total billed charges,4.54,461.72,
PF CT CERVICAL SPINE W/O CONTRAST MATERIAL,72300020P,CDM,972,RC,72125,HCPCS,Outpatient,,,421,315.75,,387.32,92,,,percent of total billed charges,92% of total billed charges,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,391.53,93,,,percent of total billed charges,93% of total billed charges,378.9,90,,,percent of total billed charges,90% of total billed charges,378.9,90,,,percent of total billed charges,90% of total billed charges,408.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,408.37,97,,,percent of total billed charges,97% of total billed charges,315.75,75,,,percent of total billed charges,75% of total billed charges,404.16,96,,,percent of total billed charges,96% of total billed charges,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,315.75,75,,,percent of total billed charges,75% of total billed charges,315.75,75,,,percent of total billed charges,75% of total billed charges,3.26,408.37,
PF CT LUMBAR SPINE W/O  and  W/CONTRAST MATERIAL,72300028P,CDM,972,RC,72133,HCPCS,Outpatient,,,559,419.25,,514.28,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,519.87,93,,,percent of total billed charges,93% of total billed charges,503.1,90,,,percent of total billed charges,90% of total billed charges,503.1,90,,,percent of total billed charges,90% of total billed charges,542.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,542.23,97,,,percent of total billed charges,97% of total billed charges,419.25,75,,,percent of total billed charges,75% of total billed charges,536.64,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,419.25,75,,,percent of total billed charges,75% of total billed charges,419.25,75,,,percent of total billed charges,75% of total billed charges,5.5,542.23,
PF CT LUMBAR SPINE W/CONTRAST MATERIAL,72300027P,CDM,972,RC,72132,HCPCS,Outpatient,,,476,357,,437.92,92,,,percent of total billed charges,92% of total billed charges,4.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,442.68,93,,,percent of total billed charges,93% of total billed charges,428.4,90,,,percent of total billed charges,90% of total billed charges,428.4,90,,,percent of total billed charges,90% of total billed charges,461.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,461.72,97,,,percent of total billed charges,97% of total billed charges,357,75,,,percent of total billed charges,75% of total billed charges,456.96,96,,,percent of total billed charges,96% of total billed charges,4.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,357,75,,,percent of total billed charges,75% of total billed charges,357,75,,,percent of total billed charges,75% of total billed charges,4.56,461.72,
PF CT LUMBAR SPINE W/O CONTRAST MATERIAL,72300026P,CDM,972,RC,72131,HCPCS,Outpatient,,,415,311.25,,381.8,92,,,percent of total billed charges,92% of total billed charges,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,385.95,93,,,percent of total billed charges,93% of total billed charges,373.5,90,,,percent of total billed charges,90% of total billed charges,373.5,90,,,percent of total billed charges,90% of total billed charges,402.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,402.55,97,,,percent of total billed charges,97% of total billed charges,311.25,75,,,percent of total billed charges,75% of total billed charges,398.4,96,,,percent of total billed charges,96% of total billed charges,3.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,311.25,75,,,percent of total billed charges,75% of total billed charges,311.25,75,,,percent of total billed charges,75% of total billed charges,3.23,402.55,
PF CT THORACIC SPINE W/O  and  W/CONTRAST MATERIAL,72300025P,CDM,972,RC,72130,HCPCS,Outpatient,,,562,421.5,,517.04,92,,,percent of total billed charges,92% of total billed charges,5.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,522.66,93,,,percent of total billed charges,93% of total billed charges,505.8,90,,,percent of total billed charges,90% of total billed charges,505.8,90,,,percent of total billed charges,90% of total billed charges,545.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,545.14,97,,,percent of total billed charges,97% of total billed charges,421.5,75,,,percent of total billed charges,75% of total billed charges,539.52,96,,,percent of total billed charges,96% of total billed charges,5.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,421.5,75,,,percent of total billed charges,75% of total billed charges,421.5,75,,,percent of total billed charges,75% of total billed charges,5.52,545.14,
PF CT THORACIC SPINE W/CONTRAST MATERIAL,72300024P,CDM,972,RC,72129,HCPCS,Outpatient,,,479,359.25,,440.68,92,,,percent of total billed charges,92% of total billed charges,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,445.47,93,,,percent of total billed charges,93% of total billed charges,431.1,90,,,percent of total billed charges,90% of total billed charges,431.1,90,,,percent of total billed charges,90% of total billed charges,464.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,464.63,97,,,percent of total billed charges,97% of total billed charges,359.25,75,,,percent of total billed charges,75% of total billed charges,459.84,96,,,percent of total billed charges,96% of total billed charges,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,359.25,75,,,percent of total billed charges,75% of total billed charges,359.25,75,,,percent of total billed charges,75% of total billed charges,4.58,464.63,
PF CT THORACIC SPINE W/O CONTRAST MATERIAL,72300023P,CDM,972,RC,72128,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges,3.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,386.88,93,,,percent of total billed charges,93% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,403.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.52,97,,,percent of total billed charges,97% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,399.36,96,,,percent of total billed charges,96% of total billed charges,3.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312,75,,,percent of total billed charges,75% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,3.25,403.52,
PF CT SPINE THORACIC/LUMBAR W/ +W/O CONT: REPORT,72300025P,CDM,972,RC,72130,HCPCS,Outpatient,,,562,421.5,,517.04,92,,,percent of total billed charges,92% of total billed charges,5.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,522.66,93,,,percent of total billed charges,93% of total billed charges,505.8,90,,,percent of total billed charges,90% of total billed charges,505.8,90,,,percent of total billed charges,90% of total billed charges,545.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,545.14,97,,,percent of total billed charges,97% of total billed charges,421.5,75,,,percent of total billed charges,75% of total billed charges,539.52,96,,,percent of total billed charges,96% of total billed charges,5.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,421.5,75,,,percent of total billed charges,75% of total billed charges,421.5,75,,,percent of total billed charges,75% of total billed charges,5.52,545.14,
PF CT SPINE THORACIC/LUMBAR W/ CONT: REPORT,72300024P,CDM,972,RC,72129,HCPCS,Outpatient,,,479,359.25,,440.68,92,,,percent of total billed charges,92% of total billed charges,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,445.47,93,,,percent of total billed charges,93% of total billed charges,431.1,90,,,percent of total billed charges,90% of total billed charges,431.1,90,,,percent of total billed charges,90% of total billed charges,464.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,464.63,97,,,percent of total billed charges,97% of total billed charges,359.25,75,,,percent of total billed charges,75% of total billed charges,459.84,96,,,percent of total billed charges,96% of total billed charges,4.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,359.25,75,,,percent of total billed charges,75% of total billed charges,359.25,75,,,percent of total billed charges,75% of total billed charges,4.58,464.63,
PF CT SPINE THORACIC/LUMBAR W/O CONT: REPORT,72300023P,CDM,972,RC,72128,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges,3.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,386.88,93,,,percent of total billed charges,93% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,403.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.52,97,,,percent of total billed charges,97% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,399.36,96,,,percent of total billed charges,96% of total billed charges,3.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312,75,,,percent of total billed charges,75% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,3.25,403.52,
PF CT TIBIA/FIBULA W/ + W/O CONTRAST LEFT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT TIBIA/FIBULA W/ + W/O CONTRAST RIGHT,72300044P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT TIBIA/FIBULA W/ + W/O CONTRAST BILATERAL,72300045P,CDM,972,RC,73702,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,5.5,534.47,
PF CT TIBIA/FIBULA W/ CONTRAST BILATERAL,72300043P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT TIBIA/FIBULA W/ + W/O CONTRAST LEFT,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT TIBIA/FIBULA LOWER EXTREMITY W/CONTRAST MATERIAL,72300042P,CDM,972,RC,73701,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,4.57,455.9,
PF CT TIBIA/FIBULA LOWER EXTREMITY W/O CONTRAST MATERIAL BIL,72300041P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT TIBIA/FIBULA LOWER EXTREMITY W/O CONTRAST LEFT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT TIBIA/FIBULA W/O CONTRAST RIGHT,72300040P,CDM,972,RC,73700,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,3.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,3.24,383.15,
PF CT WRIST W/ + W/O CONTRAST BILATERAL,72300037P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT WRIST UPPER EXTREMITY W/O  and  W/CONT LT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT WRIST UPPER EXTREMITY W/O  and  W/CONT RT,72300036P,CDM,972,RC,73202,HCPCS,Outpatient,,,715,536.25,,657.8,92,,,percent of total billed charges,92% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,664.95,93,,,percent of total billed charges,93% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,643.5,90,,,percent of total billed charges,90% of total billed charges,693.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,693.55,97,,,percent of total billed charges,97% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,686.4,96,,,percent of total billed charges,96% of total billed charges,7.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,536.25,75,,,percent of total billed charges,75% of total billed charges,536.25,75,,,percent of total billed charges,75% of total billed charges,7.4,693.55,
PF CT WRIST W/ CONTRAST BILATERAL,72300035P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT WRIST UPPER EXTREMITY W/CONTRAST LT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT WRIST UPPER EXTREMITY W/CONTRAST RT,72300034P,CDM,972,RC,73201,HCPCS,Outpatient,,,571,428.25,,525.32,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,531.03,93,,,percent of total billed charges,93% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,513.9,90,,,percent of total billed charges,90% of total billed charges,553.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,553.87,97,,,percent of total billed charges,97% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,548.16,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.25,75,,,percent of total billed charges,75% of total billed charges,428.25,75,,,percent of total billed charges,75% of total billed charges,5.78,553.87,
PF CT WRIST W/O CONTRAST BILATERAL,72300033P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT WRIST UPPER EXTREMITY W/O CONTRAST LT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF CT WRIST UPPER EXTREMITY W/O CONTRAST RT,72300032P,CDM,972,RC,73200,HCPCS,Outpatient,,,461,345.75,,424.12,92,,,percent of total billed charges,92% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.73,93,,,percent of total billed charges,93% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,414.9,90,,,percent of total billed charges,90% of total billed charges,447.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,447.17,97,,,percent of total billed charges,97% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,442.56,96,,,percent of total billed charges,96% of total billed charges,4.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,345.75,75,,,percent of total billed charges,75% of total billed charges,345.75,75,,,percent of total billed charges,75% of total billed charges,4.37,447.17,
PF MG BREAST TISSUE SPECIMEN,71800424P,CDM,972,RC,76098,HCPCS,Outpatient,,,73,54.75,,67.16,92,,,percent of total billed charges,92% of total billed charges,1.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,67.89,93,,,percent of total billed charges,93% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,70.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.81,97,,,percent of total billed charges,97% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges,70.08,96,,,percent of total billed charges,96% of total billed charges,1.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54.75,75,,,percent of total billed charges,75% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges,1.23,70.81,
PF MG MAMMO DIAGNOSTIC BILATERAL,71800476P,CDM,972,RC,77066,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.35,93,,,percent of total billed charges,93% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,189.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.15,97,,,percent of total billed charges,97% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,187.2,96,,,percent of total billed charges,96% of total billed charges,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.25,75,,,percent of total billed charges,75% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,4.41,189.15,
PF MG MAMMO DIAGNOSTIC BILATERAL W/TOMO,71800476P,CDM,972,RC,77066,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.35,93,,,percent of total billed charges,93% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,189.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.15,97,,,percent of total billed charges,97% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,187.2,96,,,percent of total billed charges,96% of total billed charges,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.25,75,,,percent of total billed charges,75% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,4.41,189.15,
PF MG MAMMO DIAGNOSTIC LEFT,71800474P,CDM,972,RC,77065,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.99,93,,,percent of total billed charges,93% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,138.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.71,97,,,percent of total billed charges,97% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,137.28,96,,,percent of total billed charges,96% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.25,75,,,percent of total billed charges,75% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,3.28,138.71,
PF MG MAMMO DIAGNOSTIC LEFT W/TOMO,71800474P,CDM,972,RC,77065,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.99,93,,,percent of total billed charges,93% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,138.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.71,97,,,percent of total billed charges,97% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,137.28,96,,,percent of total billed charges,96% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.25,75,,,percent of total billed charges,75% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,3.28,138.71,
PF MG MAMMO DIAGNOSTIC RIGHT,71800474P,CDM,972,RC,77065,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.99,93,,,percent of total billed charges,93% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,138.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.71,97,,,percent of total billed charges,97% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,137.28,96,,,percent of total billed charges,96% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.25,75,,,percent of total billed charges,75% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,3.28,138.71,
PF MG MAMMO DIAGNOSTIC RIGHT W/TOMO,71800474P,CDM,972,RC,77065,HCPCS,Outpatient,,,143,107.25,,131.56,92,,,percent of total billed charges,92% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.99,93,,,percent of total billed charges,93% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,128.7,90,,,percent of total billed charges,90% of total billed charges,138.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.71,97,,,percent of total billed charges,97% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,137.28,96,,,percent of total billed charges,96% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.25,75,,,percent of total billed charges,75% of total billed charges,107.25,75,,,percent of total billed charges,75% of total billed charges,3.28,138.71,
PF MG MAMMO DIGITAL SCREENING BILATERAL,71800478P,CDM,972,RC,77067,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,140.43,93,,,percent of total billed charges,93% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,146.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.47,97,,,percent of total billed charges,97% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,144.96,96,,,percent of total billed charges,96% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,113.25,75,,,percent of total billed charges,75% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,3.46,146.47,
PF MG MAMMO DIGITAL SCREENING LEFT,71800482P,CDM,972,RC,77067,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,3.46,73.72,
PF MG MAMMO DIGITAL SCREENING RIGHT,71800482P,CDM,972,RC,77067,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,3.46,73.72,
PF MG MAMMO IMPLANT DIAGNOSTIC BILATERAL W/TOMO,71800476P,CDM,972,RC,77066,HCPCS,Outpatient,,,228,171,,209.76,92,,,percent of total billed charges,92% of total billed charges,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,212.04,93,,,percent of total billed charges,93% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,221.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,221.16,97,,,percent of total billed charges,97% of total billed charges,171,75,,,percent of total billed charges,75% of total billed charges,218.88,96,,,percent of total billed charges,96% of total billed charges,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,171,75,,,percent of total billed charges,75% of total billed charges,171,75,,,percent of total billed charges,75% of total billed charges,4.41,221.16,
PF MG IMPLANT MAMMO DIAGNOSTIC LEFT W/TOMO,71800474P,CDM,972,RC,77065,HCPCS,Outpatient,,,175,131.25,,161,92,,,percent of total billed charges,92% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.75,93,,,percent of total billed charges,93% of total billed charges,157.5,90,,,percent of total billed charges,90% of total billed charges,157.5,90,,,percent of total billed charges,90% of total billed charges,169.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,169.75,97,,,percent of total billed charges,97% of total billed charges,131.25,75,,,percent of total billed charges,75% of total billed charges,168,96,,,percent of total billed charges,96% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.25,75,,,percent of total billed charges,75% of total billed charges,131.25,75,,,percent of total billed charges,75% of total billed charges,3.28,169.75,
PF MG IMPLANT MAMMO DIAGNOSTIC RIGHT W/TOMO,71800474P,CDM,972,RC,77065,HCPCS,Outpatient,,,175,131.25,,161,92,,,percent of total billed charges,92% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.75,93,,,percent of total billed charges,93% of total billed charges,157.5,90,,,percent of total billed charges,90% of total billed charges,157.5,90,,,percent of total billed charges,90% of total billed charges,169.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,169.75,97,,,percent of total billed charges,97% of total billed charges,131.25,75,,,percent of total billed charges,75% of total billed charges,168,96,,,percent of total billed charges,96% of total billed charges,3.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.25,75,,,percent of total billed charges,75% of total billed charges,131.25,75,,,percent of total billed charges,75% of total billed charges,3.28,169.75,
PF MG MAMMO IMPLANT SCREENING BILATERAL W/TOMO,71800478P,CDM,972,RC,77067,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.05,93,,,percent of total billed charges,93% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,179.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.45,97,,,percent of total billed charges,97% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,177.6,96,,,percent of total billed charges,96% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,3.46,179.45,
PF MG MAMMO IMPLANT SCREENING LEFT W/TOMO,71800482P,CDM,972,RC,77067,HCPCS,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,128.34,93,,,percent of total billed charges,93% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,133.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,133.86,97,,,percent of total billed charges,97% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges,132.48,96,,,percent of total billed charges,96% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.5,75,,,percent of total billed charges,75% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges,3.46,133.86,
PF MG MAMMO IMPLANT SCREENING RIGHT W/TOMO,71800482P,CDM,972,RC,77067,HCPCS,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,128.34,93,,,percent of total billed charges,93% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,133.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,133.86,97,,,percent of total billed charges,97% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges,132.48,96,,,percent of total billed charges,96% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.5,75,,,percent of total billed charges,75% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges,3.46,133.86,
PF MG MAMMO SCREENING BILATERAL W/TOMO,71800478P,CDM,972,RC,77067,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,140.43,93,,,percent of total billed charges,93% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,146.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.47,97,,,percent of total billed charges,97% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,144.96,96,,,percent of total billed charges,96% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,113.25,75,,,percent of total billed charges,75% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,3.46,146.47,
PF MG MAMMO SCREENING LEFT W/TOMO,71800482P,CDM,972,RC,77067,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,3.46,73.72,
PF MG MAMMO SCREENING RIGHT W/TOMO,71800482P,CDM,972,RC,77067,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,3.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,3.46,73.72,
MRA Abdomen w/ + w/o Contrast,72900072P,CDM,972,RC,74185,HCPCS,Outpatient,,,970,727.5,,892.4,92,,,percent of total billed charges,92% of total billed charges,10.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,902.1,93,,,percent of total billed charges,93% of total billed charges,873,90,,,percent of total billed charges,90% of total billed charges,873,90,,,percent of total billed charges,90% of total billed charges,940.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,940.9,97,,,percent of total billed charges,97% of total billed charges,727.5,75,,,percent of total billed charges,75% of total billed charges,931.2,96,,,percent of total billed charges,96% of total billed charges,10.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,727.5,75,,,percent of total billed charges,75% of total billed charges,727.5,75,,,percent of total billed charges,75% of total billed charges,10.16,940.9,
PF MRA ABDOMEN W/ CONTRAST,72900070P,CDM,972,RC,74185,HCPCS,Outpatient,,,868,651,,798.56,92,,,percent of total billed charges,92% of total billed charges,10.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,807.24,93,,,percent of total billed charges,93% of total billed charges,781.2,90,,,percent of total billed charges,90% of total billed charges,781.2,90,,,percent of total billed charges,90% of total billed charges,841.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,841.96,97,,,percent of total billed charges,97% of total billed charges,651,75,,,percent of total billed charges,75% of total billed charges,833.28,96,,,percent of total billed charges,96% of total billed charges,10.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,651,75,,,percent of total billed charges,75% of total billed charges,651,75,,,percent of total billed charges,75% of total billed charges,10.16,841.96,
PF MRA ABDOMEN W/O CONTRAST,72900071P,CDM,972,RC,74185,HCPCS,Outpatient,,,557,417.75,,512.44,92,,,percent of total billed charges,92% of total billed charges,10.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,518.01,93,,,percent of total billed charges,93% of total billed charges,501.3,90,,,percent of total billed charges,90% of total billed charges,501.3,90,,,percent of total billed charges,90% of total billed charges,540.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,540.29,97,,,percent of total billed charges,97% of total billed charges,417.75,75,,,percent of total billed charges,75% of total billed charges,534.72,96,,,percent of total billed charges,96% of total billed charges,10.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,417.75,75,,,percent of total billed charges,75% of total billed charges,417.75,75,,,percent of total billed charges,75% of total billed charges,10.16,540.29,
PF MRA BRAIN/HEAD W/ + W/O CONTRAST,72900006P,CDM,972,RC,70546,HCPCS,Outpatient,,,109,81.75,,100.28,92,,,percent of total billed charges,92% of total billed charges,10.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.37,93,,,percent of total billed charges,93% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,98.1,90,,,percent of total billed charges,90% of total billed charges,105.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,105.73,97,,,percent of total billed charges,97% of total billed charges,81.75,75,,,percent of total billed charges,75% of total billed charges,104.64,96,,,percent of total billed charges,96% of total billed charges,10.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.75,75,,,percent of total billed charges,75% of total billed charges,81.75,75,,,percent of total billed charges,75% of total billed charges,10.4,105.73,
PF MRA BRAIN/HEAD W/ CONTRAST,72900005P,CDM,972,RC,70545,HCPCS,Outpatient,,,937,702.75,,862.04,92,,,percent of total billed charges,92% of total billed charges,6.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,871.41,93,,,percent of total billed charges,93% of total billed charges,843.3,90,,,percent of total billed charges,90% of total billed charges,843.3,90,,,percent of total billed charges,90% of total billed charges,908.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,908.89,97,,,percent of total billed charges,97% of total billed charges,702.75,75,,,percent of total billed charges,75% of total billed charges,899.52,96,,,percent of total billed charges,96% of total billed charges,6.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,702.75,75,,,percent of total billed charges,75% of total billed charges,702.75,75,,,percent of total billed charges,75% of total billed charges,6.94,908.89,
PF MRA BRAIN/HEAD W/O CONTRAST,72900004P,CDM,972,RC,70544,HCPCS,Outpatient,,,710,532.5,,653.2,92,,,percent of total billed charges,92% of total billed charges,6.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,660.3,93,,,percent of total billed charges,93% of total billed charges,639,90,,,percent of total billed charges,90% of total billed charges,639,90,,,percent of total billed charges,90% of total billed charges,688.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,688.7,97,,,percent of total billed charges,97% of total billed charges,532.5,75,,,percent of total billed charges,75% of total billed charges,681.6,96,,,percent of total billed charges,96% of total billed charges,6.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,532.5,75,,,percent of total billed charges,75% of total billed charges,532.5,75,,,percent of total billed charges,75% of total billed charges,6.53,688.7,
PF MRA CHEST W/ + W/O CONTRAST,72900018P,CDM,972,RC,71555,HCPCS,Outpatient,,,956,717,,879.52,92,,,percent of total billed charges,92% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,889.08,93,,,percent of total billed charges,93% of total billed charges,860.4,90,,,percent of total billed charges,90% of total billed charges,860.4,90,,,percent of total billed charges,90% of total billed charges,927.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,927.32,97,,,percent of total billed charges,97% of total billed charges,717,75,,,percent of total billed charges,75% of total billed charges,917.76,96,,,percent of total billed charges,96% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717,75,,,percent of total billed charges,75% of total billed charges,717,75,,,percent of total billed charges,75% of total billed charges,10.04,927.32,
PF MRA CHEST W/ CONTRAST,72900016P,CDM,972,RC,71555,HCPCS,Outpatient,,,956,717,,879.52,92,,,percent of total billed charges,92% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,889.08,93,,,percent of total billed charges,93% of total billed charges,860.4,90,,,percent of total billed charges,90% of total billed charges,860.4,90,,,percent of total billed charges,90% of total billed charges,927.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,927.32,97,,,percent of total billed charges,97% of total billed charges,717,75,,,percent of total billed charges,75% of total billed charges,917.76,96,,,percent of total billed charges,96% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717,75,,,percent of total billed charges,75% of total billed charges,717,75,,,percent of total billed charges,75% of total billed charges,10.04,927.32,
PF MRA CHEST W/O CONTRAST,72900017P,CDM,972,RC,71555,HCPCS,Outpatient,,,956,717,,879.52,92,,,percent of total billed charges,92% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,889.08,93,,,percent of total billed charges,93% of total billed charges,860.4,90,,,percent of total billed charges,90% of total billed charges,860.4,90,,,percent of total billed charges,90% of total billed charges,927.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,927.32,97,,,percent of total billed charges,97% of total billed charges,717,75,,,percent of total billed charges,75% of total billed charges,917.76,96,,,percent of total billed charges,96% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717,75,,,percent of total billed charges,75% of total billed charges,717,75,,,percent of total billed charges,75% of total billed charges,10.04,927.32,
PF MRA LOWER EXTREMITY W/ + W/O CNT LEFT,72900065P,CDM,972,RC,73725,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.1,949.63,
PF MRA LOWER EXTREMITY W/ + W/O CNT RIGHT,72900065P,CDM,972,RC,73725,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.1,949.63,
PF MRA LOWER EXTREMITY W/ CONTRAST RIGHT,72900061P,CDM,972,RC,73725,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.1,949.63,
PF MRA LOWER EXTREMITY W/ CONTRAST LEFT,72900061P,CDM,972,RC,73725,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.1,949.63,
PF MRA LOWER EXTREMITY W/ CONTRAST BILAT,72900062P,CDM,972,RC,73725,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.1,949.63,
PF MRA LOWER EXTREMITY W/O CONTRAST RIGHT,72900063P,CDM,972,RC,73725,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.1,949.63,
PF MRA LOWER EXTREMITY W/O CONTRAST LEFT,72900063P,CDM,972,RC,73725,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.1,949.63,
PF MRA LOWER EXTREMITY W/O CONTRAST BILAT,72900064P,CDM,972,RC,73725,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.1,949.63,
PF MRA NECK W/O  and W/CONTRAST MATERIAL,72900009P,CDM,972,RC,70549,HCPCS,Outpatient,,,982,736.5,,903.44,92,,,percent of total billed charges,92% of total billed charges,10.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,913.26,93,,,percent of total billed charges,93% of total billed charges,883.8,90,,,percent of total billed charges,90% of total billed charges,883.8,90,,,percent of total billed charges,90% of total billed charges,952.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,952.54,97,,,percent of total billed charges,97% of total billed charges,736.5,75,,,percent of total billed charges,75% of total billed charges,942.72,96,,,percent of total billed charges,96% of total billed charges,10.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,736.5,75,,,percent of total billed charges,75% of total billed charges,736.5,75,,,percent of total billed charges,75% of total billed charges,10.45,952.54,
PF MRA NECK W/ CONTRAST,72900008P,CDM,972,RC,70548,HCPCS,Outpatient,,,699,524.25,,643.08,92,,,percent of total billed charges,92% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,650.07,93,,,percent of total billed charges,93% of total billed charges,629.1,90,,,percent of total billed charges,90% of total billed charges,629.1,90,,,percent of total billed charges,90% of total billed charges,678.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678.03,97,,,percent of total billed charges,97% of total billed charges,524.25,75,,,percent of total billed charges,75% of total billed charges,671.04,96,,,percent of total billed charges,96% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,524.25,75,,,percent of total billed charges,75% of total billed charges,524.25,75,,,percent of total billed charges,75% of total billed charges,7.12,678.03,
PF MRA NECK W/O CONTRAST,72900007P,CDM,972,RC,70547,HCPCS,Outpatient,,,614,460.5,,564.88,92,,,percent of total billed charges,92% of total billed charges,6.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,571.02,93,,,percent of total billed charges,93% of total billed charges,552.6,90,,,percent of total billed charges,90% of total billed charges,552.6,90,,,percent of total billed charges,90% of total billed charges,595.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,595.58,97,,,percent of total billed charges,97% of total billed charges,460.5,75,,,percent of total billed charges,75% of total billed charges,589.44,96,,,percent of total billed charges,96% of total billed charges,6.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,460.5,75,,,percent of total billed charges,75% of total billed charges,460.5,75,,,percent of total billed charges,75% of total billed charges,6.54,595.58,
PF MRA PELVIS W/ + W/O CONTRAST,72900033P,CDM,972,RC,72198,HCPCS,Outpatient,,,960,720,,883.2,92,,,percent of total billed charges,92% of total billed charges,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,892.8,93,,,percent of total billed charges,93% of total billed charges,864,90,,,percent of total billed charges,90% of total billed charges,864,90,,,percent of total billed charges,90% of total billed charges,931.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,931.2,97,,,percent of total billed charges,97% of total billed charges,720,75,,,percent of total billed charges,75% of total billed charges,921.6,96,,,percent of total billed charges,96% of total billed charges,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,720,75,,,percent of total billed charges,75% of total billed charges,720,75,,,percent of total billed charges,75% of total billed charges,10.21,931.2,
PF MRA PELVIS W/ CONTRAST,72900031P,CDM,972,RC,72198,HCPCS,Outpatient,,,960,720,,883.2,92,,,percent of total billed charges,92% of total billed charges,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,892.8,93,,,percent of total billed charges,93% of total billed charges,864,90,,,percent of total billed charges,90% of total billed charges,864,90,,,percent of total billed charges,90% of total billed charges,931.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,931.2,97,,,percent of total billed charges,97% of total billed charges,720,75,,,percent of total billed charges,75% of total billed charges,921.6,96,,,percent of total billed charges,96% of total billed charges,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,720,75,,,percent of total billed charges,75% of total billed charges,720,75,,,percent of total billed charges,75% of total billed charges,10.21,931.2,
PF MRA PELVIS W/O CONTRAST,72900032P,CDM,972,RC,72198,HCPCS,Outpatient,,,960,720,,883.2,92,,,percent of total billed charges,92% of total billed charges,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,892.8,93,,,percent of total billed charges,93% of total billed charges,864,90,,,percent of total billed charges,90% of total billed charges,864,90,,,percent of total billed charges,90% of total billed charges,931.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,931.2,97,,,percent of total billed charges,97% of total billed charges,720,75,,,percent of total billed charges,75% of total billed charges,921.6,96,,,percent of total billed charges,96% of total billed charges,10.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,720,75,,,percent of total billed charges,75% of total billed charges,720,75,,,percent of total billed charges,75% of total billed charges,10.21,931.2,
PF MRA UPPER EXTREMITY W/ + W/O CNT LEFT,72900046P,CDM,972,RC,73225,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.44,949.63,
PF MRA UPPER EXTREMITY W/ + W/O CNT RIGHT,72900046P,CDM,972,RC,73225,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.44,949.63,
PF MRA UPPER EXTREMITY W/ + W/O CNT BILAT,72900046P,CDM,972,RC,73225,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.44,949.63,
PF MRA UPPER EXTREMITY W/ CONTRAST LEFT,72900047P,CDM,972,RC,73225,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.44,949.63,
PF MRA UPPER EXTREMITY W/ CONTRAST RIGHT,72900047P,CDM,972,RC,73225,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.44,949.63,
PF MRA UPPER EXTREMITY W/ CONTRAST BILAT,72900047P,CDM,972,RC,73225,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.44,949.63,
PF MRA UPPER EXTREMITY WO  and  W CONTRAST LT,72900048P,CDM,972,RC,73225,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.44,949.63,
PF MRA UPPER EXTREMITY WO  and  W CONTRAST RT,72900048P,CDM,972,RC,73225,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.44,949.63,
PF MRA UPPER EXTREMITY WO  and  W CONTRAST BIL,72900048P,CDM,972,RC,73225,HCPCS,Outpatient,,,979,734.25,,900.68,92,,,percent of total billed charges,92% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,910.47,93,,,percent of total billed charges,93% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,881.1,90,,,percent of total billed charges,90% of total billed charges,949.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,949.63,97,,,percent of total billed charges,97% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,939.84,96,,,percent of total billed charges,96% of total billed charges,10.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,734.25,75,,,percent of total billed charges,75% of total billed charges,734.25,75,,,percent of total billed charges,75% of total billed charges,10.44,949.63,
PF MRI ABDOMEN W/O  and  W/CONTRAST MATERIAL,72900069P,CDM,972,RC,74183,HCPCS,Outpatient,,,970,727.5,,892.4,92,,,percent of total billed charges,92% of total billed charges,9.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,902.1,93,,,percent of total billed charges,93% of total billed charges,873,90,,,percent of total billed charges,90% of total billed charges,873,90,,,percent of total billed charges,90% of total billed charges,940.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,940.9,97,,,percent of total billed charges,97% of total billed charges,727.5,75,,,percent of total billed charges,75% of total billed charges,931.2,96,,,percent of total billed charges,96% of total billed charges,9.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,727.5,75,,,percent of total billed charges,75% of total billed charges,727.5,75,,,percent of total billed charges,75% of total billed charges,9.27,940.9,
PF MRI ABDOMEN W/CONTRAST MATERIAL,72900068P,CDM,972,RC,74182,HCPCS,Outpatient,,,868,651,,798.56,92,,,percent of total billed charges,92% of total billed charges,8.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,807.24,93,,,percent of total billed charges,93% of total billed charges,781.2,90,,,percent of total billed charges,90% of total billed charges,781.2,90,,,percent of total billed charges,90% of total billed charges,841.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,841.96,97,,,percent of total billed charges,97% of total billed charges,651,75,,,percent of total billed charges,75% of total billed charges,833.28,96,,,percent of total billed charges,96% of total billed charges,8.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,651,75,,,percent of total billed charges,75% of total billed charges,651,75,,,percent of total billed charges,75% of total billed charges,8.76,841.96,
PF MRI ABDOMEN W/O CONTRAST MATERIAL,72900067P,CDM,972,RC,74181,HCPCS,Outpatient,,,557,417.75,,512.44,92,,,percent of total billed charges,92% of total billed charges,5.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,518.01,93,,,percent of total billed charges,93% of total billed charges,501.3,90,,,percent of total billed charges,90% of total billed charges,501.3,90,,,percent of total billed charges,90% of total billed charges,540.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,540.29,97,,,percent of total billed charges,97% of total billed charges,417.75,75,,,percent of total billed charges,75% of total billed charges,534.72,96,,,percent of total billed charges,96% of total billed charges,5.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,417.75,75,,,percent of total billed charges,75% of total billed charges,417.75,75,,,percent of total billed charges,75% of total billed charges,5.13,540.29,
PF MRI ANKLE W/ + W/O CONTRAST BILATERAL,72900060P,CDM,972,RC,73723,HCPCS,Outpatient,,,1115,836.25,,1025.8,92,,,percent of total billed charges,92% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1036.95,93,,,percent of total billed charges,93% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1081.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1081.55,97,,,percent of total billed charges,97% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,1070.4,96,,,percent of total billed charges,96% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,836.25,75,,,percent of total billed charges,75% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,11.03,1081.55,
PF MRI ANKLE W/ + W/O CONTRAST LEFT,72900059P,CDM,972,RC,73723,HCPCS,Outpatient,,,1115,836.25,,1025.8,92,,,percent of total billed charges,92% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1036.95,93,,,percent of total billed charges,93% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1081.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1081.55,97,,,percent of total billed charges,97% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,1070.4,96,,,percent of total billed charges,96% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,836.25,75,,,percent of total billed charges,75% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,11.03,1081.55,
PF MRI ANKLE W/ + W/O CONTRAST RIGHT,72900059P,CDM,972,RC,73723,HCPCS,Outpatient,,,1115,836.25,,1025.8,92,,,percent of total billed charges,92% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1036.95,93,,,percent of total billed charges,93% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1081.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1081.55,97,,,percent of total billed charges,97% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,1070.4,96,,,percent of total billed charges,96% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,836.25,75,,,percent of total billed charges,75% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,11.03,1081.55,
PF MRI ANKLE W/ CONTRAST BILATERAL,72900058P,CDM,972,RC,73722,HCPCS,Outpatient,,,906,679.5,,833.52,92,,,percent of total billed charges,92% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.58,93,,,percent of total billed charges,93% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,878.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,878.82,97,,,percent of total billed charges,97% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,869.76,96,,,percent of total billed charges,96% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,679.5,75,,,percent of total billed charges,75% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,9.32,878.82,
PF MRI ANKLE W/ CONTRAST LEFT,72900057P,CDM,972,RC,73722,HCPCS,Outpatient,,,906,679.5,,833.52,92,,,percent of total billed charges,92% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.58,93,,,percent of total billed charges,93% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,878.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,878.82,97,,,percent of total billed charges,97% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,869.76,96,,,percent of total billed charges,96% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,679.5,75,,,percent of total billed charges,75% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,9.32,878.82,
PF MRI ANKLE W/ CONTRAST RIGHT,72900057P,CDM,972,RC,73722,HCPCS,Outpatient,,,906,679.5,,833.52,92,,,percent of total billed charges,92% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.58,93,,,percent of total billed charges,93% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,878.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,878.82,97,,,percent of total billed charges,97% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,869.76,96,,,percent of total billed charges,96% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,679.5,75,,,percent of total billed charges,75% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,9.32,878.82,
PF MRI ANKLE W/O CONTRAST BILATERAL,72900056P,CDM,972,RC,73721,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.53,556.78,
PF MRI ANKLE W/O CONTRAST LEFT,72900055P,CDM,972,RC,73721,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.53,556.78,
PF MRI ANKLE W/O CONTRAST RIGHT,72900055P,CDM,972,RC,73721,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.53,556.78,
PF MRI BRACHIAL PLEXUS W/ + W/O CONTRAST,72900045P,CDM,972,RC,73223,HCPCS,Outpatient,,,1119,839.25,,1029.48,92,,,percent of total billed charges,92% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.67,93,,,percent of total billed charges,93% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1085.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1085.43,97,,,percent of total billed charges,97% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,1074.24,96,,,percent of total billed charges,96% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,839.25,75,,,percent of total billed charges,75% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,11.07,1085.43,
PF MRI BRACHIAL PLEXUS W/ CONTRAST,72900042P,CDM,972,RC,73222,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,9.3,876.88,
PF MRI BRACHIAL PLEXUS W/O CONTRAST,72900040P,CDM,972,RC,73221,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.55,556.78,
PF MRI BRAIN W/ + W/O CONTRAST,72900012P,CDM,972,RC,70553,HCPCS,Outpatient,,,907,680.25,,834.44,92,,,percent of total billed charges,92% of total billed charges,8.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,843.51,93,,,percent of total billed charges,93% of total billed charges,816.3,90,,,percent of total billed charges,90% of total billed charges,816.3,90,,,percent of total billed charges,90% of total billed charges,879.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,879.79,97,,,percent of total billed charges,97% of total billed charges,680.25,75,,,percent of total billed charges,75% of total billed charges,870.72,96,,,percent of total billed charges,96% of total billed charges,8.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,680.25,75,,,percent of total billed charges,75% of total billed charges,680.25,75,,,percent of total billed charges,75% of total billed charges,8.42,879.79,
PF MRI BRAIN STEM W/CONTRAST MATERIAL,71800057P,CDM,972,RC,70552,HCPCS,Outpatient,,,769,576.75,,707.48,92,,,percent of total billed charges,92% of total billed charges,7.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.17,93,,,percent of total billed charges,93% of total billed charges,692.1,90,,,percent of total billed charges,90% of total billed charges,692.1,90,,,percent of total billed charges,90% of total billed charges,745.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,745.93,97,,,percent of total billed charges,97% of total billed charges,576.75,75,,,percent of total billed charges,75% of total billed charges,738.24,96,,,percent of total billed charges,96% of total billed charges,7.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,576.75,75,,,percent of total billed charges,75% of total billed charges,576.75,75,,,percent of total billed charges,75% of total billed charges,7.53,745.93,
PF MRI BRAIN W/O CONTRAST,72900010P,CDM,972,RC,70551,HCPCS,Outpatient,,,555,416.25,,510.6,92,,,percent of total billed charges,92% of total billed charges,5.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,516.15,93,,,percent of total billed charges,93% of total billed charges,499.5,90,,,percent of total billed charges,90% of total billed charges,499.5,90,,,percent of total billed charges,90% of total billed charges,538.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,538.35,97,,,percent of total billed charges,97% of total billed charges,416.25,75,,,percent of total billed charges,75% of total billed charges,532.8,96,,,percent of total billed charges,96% of total billed charges,5.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,416.25,75,,,percent of total billed charges,75% of total billed charges,416.25,75,,,percent of total billed charges,75% of total billed charges,5.11,538.35,
PF MRI CHEST W/ + W/O CONTRAST,72900015P,CDM,972,RC,71552,HCPCS,Outpatient,,,1365,1023.75,,1255.8,92,,,percent of total billed charges,92% of total billed charges,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1269.45,93,,,percent of total billed charges,93% of total billed charges,1228.5,90,,,percent of total billed charges,90% of total billed charges,1228.5,90,,,percent of total billed charges,90% of total billed charges,1324.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1324.05,97,,,percent of total billed charges,97% of total billed charges,1023.75,75,,,percent of total billed charges,75% of total billed charges,1310.4,96,,,percent of total billed charges,96% of total billed charges,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1023.75,75,,,percent of total billed charges,75% of total billed charges,1023.75,75,,,percent of total billed charges,75% of total billed charges,14.17,1324.05,
PF MRI CHEST W/CONTRAST MATERIAL,72900014P,CDM,972,RC,71551,HCPCS,Outpatient,,,1081,810.75,,994.52,92,,,percent of total billed charges,92% of total billed charges,11.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1005.33,93,,,percent of total billed charges,93% of total billed charges,972.9,90,,,percent of total billed charges,90% of total billed charges,972.9,90,,,percent of total billed charges,90% of total billed charges,1048.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1048.57,97,,,percent of total billed charges,97% of total billed charges,810.75,75,,,percent of total billed charges,75% of total billed charges,1037.76,96,,,percent of total billed charges,96% of total billed charges,11.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,810.75,75,,,percent of total billed charges,75% of total billed charges,810.75,75,,,percent of total billed charges,75% of total billed charges,11.28,1048.57,
PF MRI CHEST W/O CONTRAST MATERIAL,72900013P,CDM,972,RC,71550,HCPCS,Outpatient,,,978,733.5,,899.76,92,,,percent of total billed charges,92% of total billed charges,10.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,909.54,93,,,percent of total billed charges,93% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,948.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,948.66,97,,,percent of total billed charges,97% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,938.88,96,,,percent of total billed charges,96% of total billed charges,10.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,733.5,75,,,percent of total billed charges,75% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,10.45,948.66,
PF MRI ELBOW W/ + W/O CONTRAST BILATERAL,72900045P,CDM,972,RC,73223,HCPCS,Outpatient,,,1119,839.25,,1029.48,92,,,percent of total billed charges,92% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.67,93,,,percent of total billed charges,93% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1085.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1085.43,97,,,percent of total billed charges,97% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,1074.24,96,,,percent of total billed charges,96% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,839.25,75,,,percent of total billed charges,75% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,11.07,1085.43,
PF MRI ELBOW W/ + W/O CONTRAST LEFT,72900044P,CDM,972,RC,73223,HCPCS,Outpatient,,,1119,839.25,,1029.48,92,,,percent of total billed charges,92% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.67,93,,,percent of total billed charges,93% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1085.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1085.43,97,,,percent of total billed charges,97% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,1074.24,96,,,percent of total billed charges,96% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,839.25,75,,,percent of total billed charges,75% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,11.07,1085.43,
PF MRI ELBOW W/ + W/O CONTRAST RIGHT,72900044P,CDM,972,RC,73223,HCPCS,Outpatient,,,1119,839.25,,1029.48,92,,,percent of total billed charges,92% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.67,93,,,percent of total billed charges,93% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1085.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1085.43,97,,,percent of total billed charges,97% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,1074.24,96,,,percent of total billed charges,96% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,839.25,75,,,percent of total billed charges,75% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,11.07,1085.43,
PF MRI ELBOW W/ CONTRAST BILATERAL,72900043P,CDM,972,RC,73222,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,9.3,876.88,
PF MRI ELBOW W/ CONTRAST LEFT,72900042P,CDM,972,RC,73222,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,9.3,876.88,
PF MRI ELBOW W/ CONTRAST RIGHT,72900042P,CDM,972,RC,73222,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,9.3,876.88,
PF MRI ELBOW W/O CONTRAST BILATERAL,72900041P,CDM,972,RC,73221,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.55,556.78,
PF MRI ELBOW W/O CONTRAST LEFT,72900040P,CDM,972,RC,73221,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.55,556.78,
PF MRI ELBOW W/O CONTRAST RIGHT,72900040P,CDM,972,RC,73221,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.55,556.78,
PF MRI ORBIT FACE  and  NECK W/O  and  W/CONTRAST MATRL,72900003P,CDM,972,RC,70543,HCPCS,Outpatient,,,970,727.5,,892.4,92,,,percent of total billed charges,92% of total billed charges,9.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,902.1,93,,,percent of total billed charges,93% of total billed charges,873,90,,,percent of total billed charges,90% of total billed charges,873,90,,,percent of total billed charges,90% of total billed charges,940.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,940.9,97,,,percent of total billed charges,97% of total billed charges,727.5,75,,,percent of total billed charges,75% of total billed charges,931.2,96,,,percent of total billed charges,96% of total billed charges,9.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,727.5,75,,,percent of total billed charges,75% of total billed charges,727.5,75,,,percent of total billed charges,75% of total billed charges,9.37,940.9,
PF MRI ORBIT FACE  and  NECK W/CONTRAST MATERIAL,72900002P,CDM,972,RC,70542,HCPCS,Outpatient,,,769,576.75,,707.48,92,,,percent of total billed charges,92% of total billed charges,7.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.17,93,,,percent of total billed charges,93% of total billed charges,692.1,90,,,percent of total billed charges,90% of total billed charges,692.1,90,,,percent of total billed charges,90% of total billed charges,745.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,745.93,97,,,percent of total billed charges,97% of total billed charges,576.75,75,,,percent of total billed charges,75% of total billed charges,738.24,96,,,percent of total billed charges,96% of total billed charges,7.73,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,576.75,75,,,percent of total billed charges,75% of total billed charges,576.75,75,,,percent of total billed charges,75% of total billed charges,7.73,745.93,
PF MRI ORBIT FACE  and /NECK W/O CONTRAST,72900001P,CDM,972,RC,70540,HCPCS,Outpatient,,,647,485.25,,595.24,92,,,percent of total billed charges,92% of total billed charges,6.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,601.71,93,,,percent of total billed charges,93% of total billed charges,582.3,90,,,percent of total billed charges,90% of total billed charges,582.3,90,,,percent of total billed charges,90% of total billed charges,627.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,627.59,97,,,percent of total billed charges,97% of total billed charges,485.25,75,,,percent of total billed charges,75% of total billed charges,621.12,96,,,percent of total billed charges,96% of total billed charges,6.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485.25,75,,,percent of total billed charges,75% of total billed charges,485.25,75,,,percent of total billed charges,75% of total billed charges,6.4,627.59,
PF MRI FEMUR W/ + W/O CONTRAST BILATERAL,72900054P,CDM,972,RC,73720,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,9.31,938.96,
PF MRI FEMUR W/ + W/O CONTRAST LEFT,72900053P,CDM,972,RC,73720,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,9.31,938.96,
PF MRI FEMUR W/ + W/O CONTRAST RIGHT,72900053P,CDM,972,RC,73720,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,9.31,938.96,
PF MRI FEMUR W/ CONTRAST BILATERAL,72900052P,CDM,972,RC,73719,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,7.54,729.44,
PF MRI FEMUR W/ CONTRAST LEFT,72900051P,CDM,972,RC,73719,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,7.54,729.44,
PF MRI FEMUR W/ CONTRAST RIGHT,72900051P,CDM,972,RC,73719,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,7.54,729.44,
PF MRI FEMUR W/O CONTRAST BILATERAL,72900050P,CDM,972,RC,73718,HCPCS,Outpatient,,,639,479.25,,587.88,92,,,percent of total billed charges,92% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594.27,93,,,percent of total billed charges,93% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,619.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,619.83,97,,,percent of total billed charges,97% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,613.44,96,,,percent of total billed charges,96% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,479.25,75,,,percent of total billed charges,75% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,6.29,619.83,
PF MRI FEMUR W/O CONTRAST LEFT,72900049P,CDM,972,RC,73718,HCPCS,Outpatient,,,639,479.25,,587.88,92,,,percent of total billed charges,92% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594.27,93,,,percent of total billed charges,93% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,619.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,619.83,97,,,percent of total billed charges,97% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,613.44,96,,,percent of total billed charges,96% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,479.25,75,,,percent of total billed charges,75% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,6.29,619.83,
PF MRI FEMUR W/O CONTRAST RIGHT,72900049P,CDM,972,RC,73718,HCPCS,Outpatient,,,639,479.25,,587.88,92,,,percent of total billed charges,92% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594.27,93,,,percent of total billed charges,93% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,619.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,619.83,97,,,percent of total billed charges,97% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,613.44,96,,,percent of total billed charges,96% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,479.25,75,,,percent of total billed charges,75% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,6.29,619.83,
PF MRI FOOT W/ + W/O CONTRAST BILATERAL,72900054P,CDM,972,RC,73720,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,9.31,938.96,
PF MRI FOOT W/ + W/O CONTRAST LEFT,72900053P,CDM,972,RC,73720,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,9.31,938.96,
PF MRI FOOT W/ + W/O CONTRAST RIGHT,72900053P,CDM,972,RC,73720,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,9.31,938.96,
PF MRI FOOT W/ CONTRAST BILATERAL,72900052P,CDM,972,RC,73719,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,7.54,729.44,
PF MRI FOOT W/ CONTRAST LEFT,72900051P,CDM,972,RC,73719,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,7.54,729.44,
PF MRI FOOT W/ CONTRAST RIGHT,72900051P,CDM,972,RC,73719,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,7.54,729.44,
PF MRI FOOT W/O CONTRAST BILATERAL,72900050P,CDM,972,RC,73718,HCPCS,Outpatient,,,639,479.25,,587.88,92,,,percent of total billed charges,92% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594.27,93,,,percent of total billed charges,93% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,619.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,619.83,97,,,percent of total billed charges,97% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,613.44,96,,,percent of total billed charges,96% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,479.25,75,,,percent of total billed charges,75% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,6.29,619.83,
PF MRI FOOT W/O CONTRAST LEFT,72900049P,CDM,972,RC,73718,HCPCS,Outpatient,,,639,479.25,,587.88,92,,,percent of total billed charges,92% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594.27,93,,,percent of total billed charges,93% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,619.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,619.83,97,,,percent of total billed charges,97% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,613.44,96,,,percent of total billed charges,96% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,479.25,75,,,percent of total billed charges,75% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,6.29,619.83,
PF MRI FOOT W/O CONTRAST RIGHT,72900049P,CDM,972,RC,73718,HCPCS,Outpatient,,,639,479.25,,587.88,92,,,percent of total billed charges,92% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594.27,93,,,percent of total billed charges,93% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,619.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,619.83,97,,,percent of total billed charges,97% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,613.44,96,,,percent of total billed charges,96% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,479.25,75,,,percent of total billed charges,75% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,6.29,619.83,
PF MRI UPPER EXTREM OTHER THAN JT W/O & W/CONT BIL,72900039P,CDM,972,RC,73040,HCPCS,Outpatient,,,1777,1332.75,,1634.84,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1652.61,93,,,percent of total billed charges,93% of total billed charges,1599.3,90,,,percent of total billed charges,90% of total billed charges,1599.3,90,,,percent of total billed charges,90% of total billed charges,1723.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1723.69,97,,,percent of total billed charges,97% of total billed charges,1332.75,75,,,percent of total billed charges,75% of total billed charges,1705.92,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1332.75,75,,,percent of total billed charges,75% of total billed charges,1332.75,75,,,percent of total billed charges,75% of total billed charges,3.91,1723.69,
PF MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAST,72900075P,CDM,972,RC,73220,HCPCS,Outpatient,,,1184,888,,1089.28,92,,,percent of total billed charges,92% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1101.12,93,,,percent of total billed charges,93% of total billed charges,1065.6,90,,,percent of total billed charges,90% of total billed charges,1065.6,90,,,percent of total billed charges,90% of total billed charges,1148.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1148.48,97,,,percent of total billed charges,97% of total billed charges,888,75,,,percent of total billed charges,75% of total billed charges,1136.64,96,,,percent of total billed charges,96% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,888,75,,,percent of total billed charges,75% of total billed charges,888,75,,,percent of total billed charges,75% of total billed charges,11.89,1148.48,
PF MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAST,72900075P,CDM,972,RC,73040,HCPCS,Outpatient,,,1184,888,,1089.28,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1101.12,93,,,percent of total billed charges,93% of total billed charges,1065.6,90,,,percent of total billed charges,90% of total billed charges,1065.6,90,,,percent of total billed charges,90% of total billed charges,1148.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1148.48,97,,,percent of total billed charges,97% of total billed charges,888,75,,,percent of total billed charges,75% of total billed charges,1136.64,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,888,75,,,percent of total billed charges,75% of total billed charges,888,75,,,percent of total billed charges,75% of total billed charges,3.91,1148.48,
PF MRI FOREARM W/ CONTRAST BILATERAL,72900037P,CDM,972,RC,73219,HCPCS,Outpatient,,,954,715.5,,877.68,92,,,percent of total billed charges,92% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,887.22,93,,,percent of total billed charges,93% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,925.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,925.38,97,,,percent of total billed charges,97% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,915.84,96,,,percent of total billed charges,96% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.5,75,,,percent of total billed charges,75% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,9.96,925.38,
PF MRI FOREARM W/ CONTRAST LEFT,72900036P,CDM,972,RC,73219,HCPCS,Outpatient,,,954,715.5,,877.68,92,,,percent of total billed charges,92% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,887.22,93,,,percent of total billed charges,93% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,925.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,925.38,97,,,percent of total billed charges,97% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,915.84,96,,,percent of total billed charges,96% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.5,75,,,percent of total billed charges,75% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,9.96,925.38,
PF MRI FOREARM W/ CONTRAST RIGHT,72900036P,CDM,972,RC,73219,HCPCS,Outpatient,,,954,715.5,,877.68,92,,,percent of total billed charges,92% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,887.22,93,,,percent of total billed charges,93% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,925.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,925.38,97,,,percent of total billed charges,97% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,915.84,96,,,percent of total billed charges,96% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.5,75,,,percent of total billed charges,75% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,9.96,925.38,
PF MRI FOREARM UPPER EXTREMITY OTH THAN JT W/O CONTRST BIL,72900035P,CDM,972,RC,73218,HCPCS,Outpatient,,,875,656.25,,805,92,,,percent of total billed charges,92% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,813.75,93,,,percent of total billed charges,93% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,848.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,848.75,97,,,percent of total billed charges,97% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,840,96,,,percent of total billed charges,96% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,656.25,75,,,percent of total billed charges,75% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,9.39,848.75,
PF MRI FOREARM UPPER EXTREMITY OTH THAN JT W/O CONTRST LEFT,72900034P,CDM,972,RC,73218,HCPCS,Outpatient,,,875,656.25,,805,92,,,percent of total billed charges,92% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,813.75,93,,,percent of total billed charges,93% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,848.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,848.75,97,,,percent of total billed charges,97% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,840,96,,,percent of total billed charges,96% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,656.25,75,,,percent of total billed charges,75% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,9.39,848.75,
PF MRI FOREARM UPPER EXTREMITY OTH THAN JT W/O CONTRST RIGHT,72900034P,CDM,972,RC,73218,HCPCS,Outpatient,,,875,656.25,,805,92,,,percent of total billed charges,92% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,813.75,93,,,percent of total billed charges,93% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,848.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,848.75,97,,,percent of total billed charges,97% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,840,96,,,percent of total billed charges,96% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,656.25,75,,,percent of total billed charges,75% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,9.39,848.75,
PF MRI UPPER EXTREM OTHER THAN JT W/O & W/CONT BIL,72900039P,CDM,972,RC,73220,HCPCS,Outpatient,,,1777,1332.75,,1634.84,92,,,percent of total billed charges,92% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1652.61,93,,,percent of total billed charges,93% of total billed charges,1599.3,90,,,percent of total billed charges,90% of total billed charges,1599.3,90,,,percent of total billed charges,90% of total billed charges,1723.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1723.69,97,,,percent of total billed charges,97% of total billed charges,1332.75,75,,,percent of total billed charges,75% of total billed charges,1705.92,96,,,percent of total billed charges,96% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1332.75,75,,,percent of total billed charges,75% of total billed charges,1332.75,75,,,percent of total billed charges,75% of total billed charges,11.89,1723.69,
PF MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAST,72900075P,CDM,972,RC,73220,HCPCS,Outpatient,,,1184,888,,1089.28,92,,,percent of total billed charges,92% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1101.12,93,,,percent of total billed charges,93% of total billed charges,1065.6,90,,,percent of total billed charges,90% of total billed charges,1065.6,90,,,percent of total billed charges,90% of total billed charges,1148.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1148.48,97,,,percent of total billed charges,97% of total billed charges,888,75,,,percent of total billed charges,75% of total billed charges,1136.64,96,,,percent of total billed charges,96% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,888,75,,,percent of total billed charges,75% of total billed charges,888,75,,,percent of total billed charges,75% of total billed charges,11.89,1148.48,
PF XR SHOULDER ARTHROGRAPHY RS&I BILATERAL,71800180P,CDM,972,RC,73220,HCPCS,Outpatient,,,1184,888,,1089.28,92,,,percent of total billed charges,92% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1101.12,93,,,percent of total billed charges,93% of total billed charges,1065.6,90,,,percent of total billed charges,90% of total billed charges,1065.6,90,,,percent of total billed charges,90% of total billed charges,1148.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1148.48,97,,,percent of total billed charges,97% of total billed charges,888,75,,,percent of total billed charges,75% of total billed charges,1136.64,96,,,percent of total billed charges,96% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,888,75,,,percent of total billed charges,75% of total billed charges,888,75,,,percent of total billed charges,75% of total billed charges,11.89,1148.48,
PF MRI HAND W/ CONTRAST BILATERAL,72900037P,CDM,972,RC,73219,HCPCS,Outpatient,,,954,715.5,,877.68,92,,,percent of total billed charges,92% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,887.22,93,,,percent of total billed charges,93% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,925.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,925.38,97,,,percent of total billed charges,97% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,915.84,96,,,percent of total billed charges,96% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.5,75,,,percent of total billed charges,75% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,9.96,925.38,
PF MRI HAND W/ CONTRAST LEFT,72900036P,CDM,972,RC,73219,HCPCS,Outpatient,,,954,715.5,,877.68,92,,,percent of total billed charges,92% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,887.22,93,,,percent of total billed charges,93% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,925.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,925.38,97,,,percent of total billed charges,97% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,915.84,96,,,percent of total billed charges,96% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.5,75,,,percent of total billed charges,75% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,9.96,925.38,
PF MRI HAND W/ CONTRAST RIGHT,72900036P,CDM,972,RC,73219,HCPCS,Outpatient,,,954,715.5,,877.68,92,,,percent of total billed charges,92% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,887.22,93,,,percent of total billed charges,93% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,925.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,925.38,97,,,percent of total billed charges,97% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,915.84,96,,,percent of total billed charges,96% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.5,75,,,percent of total billed charges,75% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,9.96,925.38,
PF MRI HAND UPPER EXTREMITY OTH THAN JT W/O CONTRST BIL,72900035P,CDM,972,RC,73218,HCPCS,Outpatient,,,875,656.25,,805,92,,,percent of total billed charges,92% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,813.75,93,,,percent of total billed charges,93% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,848.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,848.75,97,,,percent of total billed charges,97% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,840,96,,,percent of total billed charges,96% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,656.25,75,,,percent of total billed charges,75% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,9.39,848.75,
PF MRI HAND UPPER EXTREMITY OTH THAN JT W/O CONTRAST LEFT,72900034P,CDM,972,RC,73218,HCPCS,Outpatient,,,875,656.25,,805,92,,,percent of total billed charges,92% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,813.75,93,,,percent of total billed charges,93% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,848.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,848.75,97,,,percent of total billed charges,97% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,840,96,,,percent of total billed charges,96% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,656.25,75,,,percent of total billed charges,75% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,9.39,848.75,
PF MRI HAND UPPER EXTREMITY OTH THAN JT W/O CONTRAST RIGHT,72900034P,CDM,972,RC,73218,HCPCS,Outpatient,,,875,656.25,,805,92,,,percent of total billed charges,92% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,813.75,93,,,percent of total billed charges,93% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,848.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,848.75,97,,,percent of total billed charges,97% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,840,96,,,percent of total billed charges,96% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,656.25,75,,,percent of total billed charges,75% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,9.39,848.75,
PF MRI HIP W/ + W/O CONTRAST BILATERAL,72900060P,CDM,972,RC,73723,HCPCS,Outpatient,,,1115,836.25,,1025.8,92,,,percent of total billed charges,92% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1036.95,93,,,percent of total billed charges,93% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1081.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1081.55,97,,,percent of total billed charges,97% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,1070.4,96,,,percent of total billed charges,96% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,836.25,75,,,percent of total billed charges,75% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,11.03,1081.55,
PF MRI HIP W/ + W/O CONTRAST LEFT,72900059P,CDM,972,RC,73723,HCPCS,Outpatient,,,1115,836.25,,1025.8,92,,,percent of total billed charges,92% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1036.95,93,,,percent of total billed charges,93% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1081.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1081.55,97,,,percent of total billed charges,97% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,1070.4,96,,,percent of total billed charges,96% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,836.25,75,,,percent of total billed charges,75% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,11.03,1081.55,
PF MRI HIP W/ + W/O CONTRAST RIGHT,72900059P,CDM,972,RC,73723,HCPCS,Outpatient,,,1115,836.25,,1025.8,92,,,percent of total billed charges,92% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1036.95,93,,,percent of total billed charges,93% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1081.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1081.55,97,,,percent of total billed charges,97% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,1070.4,96,,,percent of total billed charges,96% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,836.25,75,,,percent of total billed charges,75% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,11.03,1081.55,
PF MRI HIP W/ CONTRAST BILATERAL,72900058P,CDM,972,RC,73722,HCPCS,Outpatient,,,906,679.5,,833.52,92,,,percent of total billed charges,92% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.58,93,,,percent of total billed charges,93% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,878.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,878.82,97,,,percent of total billed charges,97% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,869.76,96,,,percent of total billed charges,96% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,679.5,75,,,percent of total billed charges,75% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,9.32,878.82,
PF MRI HIP W/ CONTRAST LEFT,72900057P,CDM,972,RC,73722,HCPCS,Outpatient,,,906,679.5,,833.52,92,,,percent of total billed charges,92% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.58,93,,,percent of total billed charges,93% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,878.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,878.82,97,,,percent of total billed charges,97% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,869.76,96,,,percent of total billed charges,96% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,679.5,75,,,percent of total billed charges,75% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,9.32,878.82,
PF MRI HIP W/ CONTRAST RIGHT,72900057P,CDM,972,RC,73722,HCPCS,Outpatient,,,906,679.5,,833.52,92,,,percent of total billed charges,92% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.58,93,,,percent of total billed charges,93% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,878.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,878.82,97,,,percent of total billed charges,97% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,869.76,96,,,percent of total billed charges,96% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,679.5,75,,,percent of total billed charges,75% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,9.32,878.82,
PF MRI HIP W/O CONTRAST BILATERAL,72900056P,CDM,972,RC,73721,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.53,556.78,
PF MRI HIP W/O CONTRAST LEFT,72900055P,CDM,972,RC,73721,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.53,556.78,
PF MRI HIP W/O CONTRAST RIGHT,72900055P,CDM,972,RC,73721,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.53,556.78,
PF MRI UPPER EXTREM OTHER THAN JT W/O & W/CONT BIL,72900039P,CDM,972,RC,73220,HCPCS,Outpatient,,,1777,1332.75,,1634.84,92,,,percent of total billed charges,92% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1652.61,93,,,percent of total billed charges,93% of total billed charges,1599.3,90,,,percent of total billed charges,90% of total billed charges,1599.3,90,,,percent of total billed charges,90% of total billed charges,1723.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1723.69,97,,,percent of total billed charges,97% of total billed charges,1332.75,75,,,percent of total billed charges,75% of total billed charges,1705.92,96,,,percent of total billed charges,96% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1332.75,75,,,percent of total billed charges,75% of total billed charges,1332.75,75,,,percent of total billed charges,75% of total billed charges,11.89,1723.69,
PF MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAST,72900075P,CDM,972,RC,73220,HCPCS,Outpatient,,,1184,888,,1089.28,92,,,percent of total billed charges,92% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1101.12,93,,,percent of total billed charges,93% of total billed charges,1065.6,90,,,percent of total billed charges,90% of total billed charges,1065.6,90,,,percent of total billed charges,90% of total billed charges,1148.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1148.48,97,,,percent of total billed charges,97% of total billed charges,888,75,,,percent of total billed charges,75% of total billed charges,1136.64,96,,,percent of total billed charges,96% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,888,75,,,percent of total billed charges,75% of total billed charges,888,75,,,percent of total billed charges,75% of total billed charges,11.89,1148.48,
PF MRI HUMERUS W/ CONTRAST BILATERAL,72900037P,CDM,972,RC,73219,HCPCS,Outpatient,,,954,715.5,,877.68,92,,,percent of total billed charges,92% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,887.22,93,,,percent of total billed charges,93% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,925.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,925.38,97,,,percent of total billed charges,97% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,915.84,96,,,percent of total billed charges,96% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.5,75,,,percent of total billed charges,75% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,9.96,925.38,
PF MRI HUMERUS W/ CONTRAST LEFT,72900036P,CDM,972,RC,73219,HCPCS,Outpatient,,,954,715.5,,877.68,92,,,percent of total billed charges,92% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,887.22,93,,,percent of total billed charges,93% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,925.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,925.38,97,,,percent of total billed charges,97% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,915.84,96,,,percent of total billed charges,96% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.5,75,,,percent of total billed charges,75% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,9.96,925.38,
PF MRI HUMERUS UPPER EXTREMITY OTH THAN JT W/CONTRAST RT,72900036P,CDM,972,RC,73219,HCPCS,Outpatient,,,954,715.5,,877.68,92,,,percent of total billed charges,92% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,887.22,93,,,percent of total billed charges,93% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,858.6,90,,,percent of total billed charges,90% of total billed charges,925.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,925.38,97,,,percent of total billed charges,97% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,915.84,96,,,percent of total billed charges,96% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,715.5,75,,,percent of total billed charges,75% of total billed charges,715.5,75,,,percent of total billed charges,75% of total billed charges,9.96,925.38,
PF MRI HUMERUS UPPER EXTREMITY OTH THAN JT W/O CONTRST BIL,72900035P,CDM,972,RC,73218,HCPCS,Outpatient,,,875,656.25,,805,92,,,percent of total billed charges,92% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,813.75,93,,,percent of total billed charges,93% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,848.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,848.75,97,,,percent of total billed charges,97% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,840,96,,,percent of total billed charges,96% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,656.25,75,,,percent of total billed charges,75% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,9.39,848.75,
PF MRI HUMERUS UPPER EXTREMITY OTH THAN JT W/O CONTRST LEFT,72900034P,CDM,972,RC,73218,HCPCS,Outpatient,,,875,656.25,,805,92,,,percent of total billed charges,92% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,813.75,93,,,percent of total billed charges,93% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,848.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,848.75,97,,,percent of total billed charges,97% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,840,96,,,percent of total billed charges,96% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,656.25,75,,,percent of total billed charges,75% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,9.39,848.75,
PF MRI HUMERUS UPPER EXTREMITY OTH THAN JT W/O CONTRST RIGHT,72900034P,CDM,972,RC,73218,HCPCS,Outpatient,,,875,656.25,,805,92,,,percent of total billed charges,92% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,813.75,93,,,percent of total billed charges,93% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,787.5,90,,,percent of total billed charges,90% of total billed charges,848.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,848.75,97,,,percent of total billed charges,97% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,840,96,,,percent of total billed charges,96% of total billed charges,9.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,656.25,75,,,percent of total billed charges,75% of total billed charges,656.25,75,,,percent of total billed charges,75% of total billed charges,9.39,848.75,
PF MRI KNEE W/ + W/O CONTRAST BILATERAL,72900060P,CDM,972,RC,73723,HCPCS,Outpatient,,,1115,836.25,,1025.8,92,,,percent of total billed charges,92% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1036.95,93,,,percent of total billed charges,93% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1081.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1081.55,97,,,percent of total billed charges,97% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,1070.4,96,,,percent of total billed charges,96% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,836.25,75,,,percent of total billed charges,75% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,11.03,1081.55,
PF MRI KNEE W/ + W/O CONTRAST LEFT,72900059P,CDM,972,RC,73723,HCPCS,Outpatient,,,1115,836.25,,1025.8,92,,,percent of total billed charges,92% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1036.95,93,,,percent of total billed charges,93% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1081.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1081.55,97,,,percent of total billed charges,97% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,1070.4,96,,,percent of total billed charges,96% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,836.25,75,,,percent of total billed charges,75% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,11.03,1081.55,
PF MRI KNEE W/ + W/O CONTRAST RIGHT,72900059P,CDM,972,RC,73723,HCPCS,Outpatient,,,1115,836.25,,1025.8,92,,,percent of total billed charges,92% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1036.95,93,,,percent of total billed charges,93% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1003.5,90,,,percent of total billed charges,90% of total billed charges,1081.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1081.55,97,,,percent of total billed charges,97% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,1070.4,96,,,percent of total billed charges,96% of total billed charges,11.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,836.25,75,,,percent of total billed charges,75% of total billed charges,836.25,75,,,percent of total billed charges,75% of total billed charges,11.03,1081.55,
PF MRI KNEE W/ CONTRAST BILATERAL,72900058P,CDM,972,RC,73722,HCPCS,Outpatient,,,906,679.5,,833.52,92,,,percent of total billed charges,92% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.58,93,,,percent of total billed charges,93% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,878.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,878.82,97,,,percent of total billed charges,97% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,869.76,96,,,percent of total billed charges,96% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,679.5,75,,,percent of total billed charges,75% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,9.32,878.82,
PF MRI KNEE W/ CONTRAST LEFT,72900057P,CDM,972,RC,73722,HCPCS,Outpatient,,,906,679.5,,833.52,92,,,percent of total billed charges,92% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.58,93,,,percent of total billed charges,93% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,878.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,878.82,97,,,percent of total billed charges,97% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,869.76,96,,,percent of total billed charges,96% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,679.5,75,,,percent of total billed charges,75% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,9.32,878.82,
PF MRI KNEE W/ CONTRAST RIGHT,72900057P,CDM,972,RC,73722,HCPCS,Outpatient,,,906,679.5,,833.52,92,,,percent of total billed charges,92% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,842.58,93,,,percent of total billed charges,93% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,815.4,90,,,percent of total billed charges,90% of total billed charges,878.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,878.82,97,,,percent of total billed charges,97% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,869.76,96,,,percent of total billed charges,96% of total billed charges,9.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,679.5,75,,,percent of total billed charges,75% of total billed charges,679.5,75,,,percent of total billed charges,75% of total billed charges,9.32,878.82,
PF MRI KNEE W/O CONTRAST BILATERAL,72900056P,CDM,972,RC,73721,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.53,556.78,
PF MRI KNEE W/O CONTRAST LEFT,72900055P,CDM,972,RC,73721,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.53,556.78,
PF MRI KNEE W/ CONTRAST RIGHT,72900055P,CDM,972,RC,73721,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.53,556.78,
PF MRI PELVIS BEFORE AND AFTER CONTRAST,72900030P,CDM,972,RC,72197,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,9.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,9.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,9.22,938.96,
PF MRI PELVIS W/ CONTRAST,72900029P,CDM,972,RC,72196,HCPCS,Outpatient,,,771,578.25,,709.32,92,,,percent of total billed charges,92% of total billed charges,7.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717.03,93,,,percent of total billed charges,93% of total billed charges,693.9,90,,,percent of total billed charges,90% of total billed charges,693.9,90,,,percent of total billed charges,90% of total billed charges,747.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,747.87,97,,,percent of total billed charges,97% of total billed charges,578.25,75,,,percent of total billed charges,75% of total billed charges,740.16,96,,,percent of total billed charges,96% of total billed charges,7.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,578.25,75,,,percent of total billed charges,75% of total billed charges,578.25,75,,,percent of total billed charges,75% of total billed charges,7.55,747.87,
PF MRI PELVIS W/O CONTRAST,72900028P,CDM,972,RC,72195,HCPCS,Outpatient,,,658,493.5,,605.36,92,,,percent of total billed charges,92% of total billed charges,6.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,611.94,93,,,percent of total billed charges,93% of total billed charges,592.2,90,,,percent of total billed charges,90% of total billed charges,592.2,90,,,percent of total billed charges,90% of total billed charges,638.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,638.26,97,,,percent of total billed charges,97% of total billed charges,493.5,75,,,percent of total billed charges,75% of total billed charges,631.68,96,,,percent of total billed charges,96% of total billed charges,6.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,493.5,75,,,percent of total billed charges,75% of total billed charges,493.5,75,,,percent of total billed charges,75% of total billed charges,6.3,638.26,
PF MRI SACRUM/COCCYX W/ + W/O CONTRAST,72900030P,CDM,972,RC,72197,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,9.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,9.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,9.22,938.96,
PF MRI SACRUM/COCCYX W/ CONTRAST,72900029P,CDM,972,RC,72196,HCPCS,Outpatient,,,771,578.25,,709.32,92,,,percent of total billed charges,92% of total billed charges,7.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717.03,93,,,percent of total billed charges,93% of total billed charges,693.9,90,,,percent of total billed charges,90% of total billed charges,693.9,90,,,percent of total billed charges,90% of total billed charges,747.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,747.87,97,,,percent of total billed charges,97% of total billed charges,578.25,75,,,percent of total billed charges,75% of total billed charges,740.16,96,,,percent of total billed charges,96% of total billed charges,7.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,578.25,75,,,percent of total billed charges,75% of total billed charges,578.25,75,,,percent of total billed charges,75% of total billed charges,7.55,747.87,
PF MRI SACRUM/COCCYX W/O CONTRAST,72900028P,CDM,972,RC,72195,HCPCS,Outpatient,,,658,493.5,,605.36,92,,,percent of total billed charges,92% of total billed charges,6.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,611.94,93,,,percent of total billed charges,93% of total billed charges,592.2,90,,,percent of total billed charges,90% of total billed charges,592.2,90,,,percent of total billed charges,90% of total billed charges,638.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,638.26,97,,,percent of total billed charges,97% of total billed charges,493.5,75,,,percent of total billed charges,75% of total billed charges,631.68,96,,,percent of total billed charges,96% of total billed charges,6.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,493.5,75,,,percent of total billed charges,75% of total billed charges,493.5,75,,,percent of total billed charges,75% of total billed charges,6.3,638.26,
PF MRI SHOULDER W/ + W/O CONTRAST BILATERAL,72900045P,CDM,972,RC,73223,HCPCS,Outpatient,,,1119,839.25,,1029.48,92,,,percent of total billed charges,92% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.67,93,,,percent of total billed charges,93% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1085.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1085.43,97,,,percent of total billed charges,97% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,1074.24,96,,,percent of total billed charges,96% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,839.25,75,,,percent of total billed charges,75% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,11.07,1085.43,
PF MRI SHOULDER W/ + W/O CONTRAST LEFT,72900044P,CDM,972,RC,73223,HCPCS,Outpatient,,,1119,839.25,,1029.48,92,,,percent of total billed charges,92% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.67,93,,,percent of total billed charges,93% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1085.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1085.43,97,,,percent of total billed charges,97% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,1074.24,96,,,percent of total billed charges,96% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,839.25,75,,,percent of total billed charges,75% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,11.07,1085.43,
PF MRI SHOULDER W/ + W/O CONTRAST RIGHT,72900044P,CDM,972,RC,73223,HCPCS,Outpatient,,,1119,839.25,,1029.48,92,,,percent of total billed charges,92% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.67,93,,,percent of total billed charges,93% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1085.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1085.43,97,,,percent of total billed charges,97% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,1074.24,96,,,percent of total billed charges,96% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,839.25,75,,,percent of total billed charges,75% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,11.07,1085.43,
PF MRI SHOULDER W/ CONTRAST BILATERAL,72900043P,CDM,972,RC,73222,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,9.3,876.88,
PF MRI SHOULDER W/ CONTRAST LEFT,72900042P,CDM,972,RC,73222,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,9.3,876.88,
PF MRI SHOULDER W/ CONTRAST RIGHT,72900042P,CDM,972,RC,73222,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,9.3,876.88,
PF MRI SHOULDER W/O CONTRAST BILATERAL,72900041P,CDM,972,RC,73221,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.55,556.78,
PF MRI SHOULDER W/O CONTRAST LEFT,72900040P,CDM,972,RC,73221,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.55,556.78,
PF MRI SHOULDER W/O CONTRAST RIGHT,72900040P,CDM,972,RC,73221,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.55,556.78,
PF MRI SPINE CERVICAL W/ + W/O CONTRAST,72900025P,CDM,972,RC,72156,HCPCS,Outpatient,,,916,687,,842.72,92,,,percent of total billed charges,92% of total billed charges,8.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,851.88,93,,,percent of total billed charges,93% of total billed charges,824.4,90,,,percent of total billed charges,90% of total billed charges,824.4,90,,,percent of total billed charges,90% of total billed charges,888.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,888.52,97,,,percent of total billed charges,97% of total billed charges,687,75,,,percent of total billed charges,75% of total billed charges,879.36,96,,,percent of total billed charges,96% of total billed charges,8.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,687,75,,,percent of total billed charges,75% of total billed charges,687,75,,,percent of total billed charges,75% of total billed charges,8.46,888.52,
PF MRI SPINE CERVICAL W/ CONTRAST,72900020P,CDM,972,RC,72142,HCPCS,Outpatient,,,787,590.25,,724.04,92,,,percent of total billed charges,92% of total billed charges,7.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,731.91,93,,,percent of total billed charges,93% of total billed charges,708.3,90,,,percent of total billed charges,90% of total billed charges,708.3,90,,,percent of total billed charges,90% of total billed charges,763.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,763.39,97,,,percent of total billed charges,97% of total billed charges,590.25,75,,,percent of total billed charges,75% of total billed charges,755.52,96,,,percent of total billed charges,96% of total billed charges,7.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,590.25,75,,,percent of total billed charges,75% of total billed charges,590.25,75,,,percent of total billed charges,75% of total billed charges,7.69,763.39,
PF MRI SPINE CERVICAL W/O CONTRAST,72900019P,CDM,972,RC,72141,HCPCS,Outpatient,,,591,443.25,,543.72,92,,,percent of total billed charges,92% of total billed charges,4.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,549.63,93,,,percent of total billed charges,93% of total billed charges,531.9,90,,,percent of total billed charges,90% of total billed charges,531.9,90,,,percent of total billed charges,90% of total billed charges,573.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,573.27,97,,,percent of total billed charges,97% of total billed charges,443.25,75,,,percent of total billed charges,75% of total billed charges,567.36,96,,,percent of total billed charges,96% of total billed charges,4.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,443.25,75,,,percent of total billed charges,75% of total billed charges,443.25,75,,,percent of total billed charges,75% of total billed charges,4.91,573.27,
PF MRI SPINE LUMBAR W/ + W/O CONTRAST,72900027P,CDM,972,RC,72158,HCPCS,Outpatient,,,910,682.5,,837.2,92,,,percent of total billed charges,92% of total billed charges,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,846.3,93,,,percent of total billed charges,93% of total billed charges,819,90,,,percent of total billed charges,90% of total billed charges,819,90,,,percent of total billed charges,90% of total billed charges,882.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,882.7,97,,,percent of total billed charges,97% of total billed charges,682.5,75,,,percent of total billed charges,75% of total billed charges,873.6,96,,,percent of total billed charges,96% of total billed charges,8.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,682.5,75,,,percent of total billed charges,75% of total billed charges,682.5,75,,,percent of total billed charges,75% of total billed charges,8.44,882.7,
PF MRI SPINE LUMBAR W/ CONTRAST,72900024P,CDM,972,RC,72149,HCPCS,Outpatient,,,772,579,,710.24,92,,,percent of total billed charges,92% of total billed charges,7.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717.96,93,,,percent of total billed charges,93% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,748.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,748.84,97,,,percent of total billed charges,97% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,741.12,96,,,percent of total billed charges,96% of total billed charges,7.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,579,75,,,percent of total billed charges,75% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,7.53,748.84,
PF MRI SPINE LUMBAR W/O CONTRAST,72900023P,CDM,972,RC,72148,HCPCS,Outpatient,,,544,408,,500.48,92,,,percent of total billed charges,92% of total billed charges,4.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,505.92,93,,,percent of total billed charges,93% of total billed charges,489.6,90,,,percent of total billed charges,90% of total billed charges,489.6,90,,,percent of total billed charges,90% of total billed charges,527.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,527.68,97,,,percent of total billed charges,97% of total billed charges,408,75,,,percent of total billed charges,75% of total billed charges,522.24,96,,,percent of total billed charges,96% of total billed charges,4.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,408,75,,,percent of total billed charges,75% of total billed charges,408,75,,,percent of total billed charges,75% of total billed charges,4.92,527.68,
PF MRI SPINE THORACIC W/ + W/O CONTRAST,72900026P,CDM,972,RC,72157,HCPCS,Outpatient,,,922,691.5,,848.24,92,,,percent of total billed charges,92% of total billed charges,8.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,857.46,93,,,percent of total billed charges,93% of total billed charges,829.8,90,,,percent of total billed charges,90% of total billed charges,829.8,90,,,percent of total billed charges,90% of total billed charges,894.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,894.34,97,,,percent of total billed charges,97% of total billed charges,691.5,75,,,percent of total billed charges,75% of total billed charges,885.12,96,,,percent of total billed charges,96% of total billed charges,8.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,691.5,75,,,percent of total billed charges,75% of total billed charges,691.5,75,,,percent of total billed charges,75% of total billed charges,8.48,894.34,
PF MRI SPINE THORACIC W/ CONTRAST,72900022P,CDM,972,RC,72147,HCPCS,Outpatient,,,779,584.25,,716.68,92,,,percent of total billed charges,92% of total billed charges,7.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,724.47,93,,,percent of total billed charges,93% of total billed charges,701.1,90,,,percent of total billed charges,90% of total billed charges,701.1,90,,,percent of total billed charges,90% of total billed charges,755.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,755.63,97,,,percent of total billed charges,97% of total billed charges,584.25,75,,,percent of total billed charges,75% of total billed charges,747.84,96,,,percent of total billed charges,96% of total billed charges,7.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,584.25,75,,,percent of total billed charges,75% of total billed charges,584.25,75,,,percent of total billed charges,75% of total billed charges,7.62,755.63,
PF MRI SPINE THORACIC W/O CONTRAST,72900021P,CDM,972,RC,72146,HCPCS,Outpatient,,,583,437.25,,536.36,92,,,percent of total billed charges,92% of total billed charges,4.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,542.19,93,,,percent of total billed charges,93% of total billed charges,524.7,90,,,percent of total billed charges,90% of total billed charges,524.7,90,,,percent of total billed charges,90% of total billed charges,565.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,565.51,97,,,percent of total billed charges,97% of total billed charges,437.25,75,,,percent of total billed charges,75% of total billed charges,559.68,96,,,percent of total billed charges,96% of total billed charges,4.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.25,75,,,percent of total billed charges,75% of total billed charges,437.25,75,,,percent of total billed charges,75% of total billed charges,4.9,565.51,
PF MRI TIBIA/FIBULA W/ + W/O CONTRAST LEFT,72900053P,CDM,972,RC,73720,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,9.31,938.96,
PF MRI TIBIA/FIBULA W/ + W/O CONTRAST RIGHT,72900053P,CDM,972,RC,73720,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,9.31,938.96,
PF MRI TIBIA/FIBULA W/ + W/O CONTRAST BILAT,72900054P,CDM,972,RC,73720,HCPCS,Outpatient,,,968,726,,890.56,92,,,percent of total billed charges,92% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,900.24,93,,,percent of total billed charges,93% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,871.2,90,,,percent of total billed charges,90% of total billed charges,938.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,938.96,97,,,percent of total billed charges,97% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,929.28,96,,,percent of total billed charges,96% of total billed charges,9.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,726,75,,,percent of total billed charges,75% of total billed charges,726,75,,,percent of total billed charges,75% of total billed charges,9.31,938.96,
PF MRI TIBIA/FIBULA W/ CONTRAST BILATERAL,72900052P,CDM,972,RC,73719,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,7.54,729.44,
PF MRI TIBIA/FIBULA W/ CONTRAST LEFT,72900051P,CDM,972,RC,73719,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,7.54,729.44,
PF MRI TIBIA/FIBULA W/ CONTRAST RIGHT,72900051P,CDM,972,RC,73719,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,7.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,7.54,729.44,
PF MRI TIBIA/FIBULA W/O CONTRAST BILATERAL,72900050P,CDM,972,RC,73718,HCPCS,Outpatient,,,639,479.25,,587.88,92,,,percent of total billed charges,92% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594.27,93,,,percent of total billed charges,93% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,619.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,619.83,97,,,percent of total billed charges,97% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,613.44,96,,,percent of total billed charges,96% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,479.25,75,,,percent of total billed charges,75% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,6.29,619.83,
PF MRI TIBIA/FIBULA W/O CONTRAST LEFT,72900049P,CDM,972,RC,73718,HCPCS,Outpatient,,,639,479.25,,587.88,92,,,percent of total billed charges,92% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594.27,93,,,percent of total billed charges,93% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,619.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,619.83,97,,,percent of total billed charges,97% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,613.44,96,,,percent of total billed charges,96% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,479.25,75,,,percent of total billed charges,75% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,6.29,619.83,
PF MRI TIBIA/FIBULA W/O CONTRAST RIGHT,72900049P,CDM,972,RC,73718,HCPCS,Outpatient,,,639,479.25,,587.88,92,,,percent of total billed charges,92% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594.27,93,,,percent of total billed charges,93% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,575.1,90,,,percent of total billed charges,90% of total billed charges,619.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,619.83,97,,,percent of total billed charges,97% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,613.44,96,,,percent of total billed charges,96% of total billed charges,6.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,479.25,75,,,percent of total billed charges,75% of total billed charges,479.25,75,,,percent of total billed charges,75% of total billed charges,6.29,619.83,
PF MRI WRIST W/ + W/O CONTRAST BILATERAL,72900045P,CDM,972,RC,73223,HCPCS,Outpatient,,,1119,839.25,,1029.48,92,,,percent of total billed charges,92% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.67,93,,,percent of total billed charges,93% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1085.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1085.43,97,,,percent of total billed charges,97% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,1074.24,96,,,percent of total billed charges,96% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,839.25,75,,,percent of total billed charges,75% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,11.07,1085.43,
PF MRI WRIST W/ + W/O CONTRAST LEFT,72900044P,CDM,972,RC,73223,HCPCS,Outpatient,,,1119,839.25,,1029.48,92,,,percent of total billed charges,92% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.67,93,,,percent of total billed charges,93% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1085.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1085.43,97,,,percent of total billed charges,97% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,1074.24,96,,,percent of total billed charges,96% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,839.25,75,,,percent of total billed charges,75% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,11.07,1085.43,
PF MRI WRIST W/ + W/O CONTRAST RIGHT,72900044P,CDM,972,RC,73223,HCPCS,Outpatient,,,1119,839.25,,1029.48,92,,,percent of total billed charges,92% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.67,93,,,percent of total billed charges,93% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1007.1,90,,,percent of total billed charges,90% of total billed charges,1085.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1085.43,97,,,percent of total billed charges,97% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,1074.24,96,,,percent of total billed charges,96% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,839.25,75,,,percent of total billed charges,75% of total billed charges,839.25,75,,,percent of total billed charges,75% of total billed charges,11.07,1085.43,
PF MRI WRIST W/ CONTRAST BILATERAL,72900043P,CDM,972,RC,73222,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,9.3,876.88,
PF MRI WRIST W/ CONTRAST LEFT,72900042P,CDM,972,RC,73222,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,9.3,876.88,
PF MRI WRIST W/ CONTRAST RIGHT,72900042P,CDM,972,RC,73222,HCPCS,Outpatient,,,904,678,,831.68,92,,,percent of total billed charges,92% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.72,93,,,percent of total billed charges,93% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,813.6,90,,,percent of total billed charges,90% of total billed charges,876.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,876.88,97,,,percent of total billed charges,97% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,867.84,96,,,percent of total billed charges,96% of total billed charges,9.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,678,75,,,percent of total billed charges,75% of total billed charges,678,75,,,percent of total billed charges,75% of total billed charges,9.3,876.88,
PF MRI WRIST W/O CONTRAST BILATERAL,72900041P,CDM,972,RC,73221,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.55,556.78,
PF MRI WRIST W/O CONTRAST LEFT,72900040P,CDM,972,RC,73221,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.55,556.78,
PF MRI WRIST W/O CONTRAST RIGHT,72900040P,CDM,972,RC,73221,HCPCS,Outpatient,,,574,430.5,,528.08,92,,,percent of total billed charges,92% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,533.82,93,,,percent of total billed charges,93% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,516.6,90,,,percent of total billed charges,90% of total billed charges,556.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,556.78,97,,,percent of total billed charges,97% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,551.04,96,,,percent of total billed charges,96% of total billed charges,5.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.5,75,,,percent of total billed charges,75% of total billed charges,430.5,75,,,percent of total billed charges,75% of total billed charges,5.55,556.78,
PF NM BONE  and /JOINT IMAGING LIMITED AREA,73000011P,CDM,974,RC,78300,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,6.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,6.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,6.96,305.55,
PF NM BONE  and /JOINT IMAGING WHOLE BODY,73000012P,CDM,974,RC,78306,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,93,,,percent of total billed charges,93% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,485,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485,97,,,percent of total billed charges,97% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,480,96,,,percent of total billed charges,96% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375,75,,,percent of total billed charges,75% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,9.02,485,
PF NM BONE  & JOINT IMAGING 3 PHASE STUDY,73000013P,CDM,974,RC,78315,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges,10.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,93,,,percent of total billed charges,93% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,485,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485,97,,,percent of total billed charges,97% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,480,96,,,percent of total billed charges,96% of total billed charges,10.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375,75,,,percent of total billed charges,75% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,10.93,485,
PF NM CARD BLD POOL GATD PLANAR 1 STDY REST/STRESS,73000015P,CDM,974,RC,78472,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges,6.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,93,,,percent of total billed charges,93% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,485,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485,97,,,percent of total billed charges,97% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,480,96,,,percent of total billed charges,96% of total billed charges,6.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375,75,,,percent of total billed charges,75% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,6.79,485,
PF NM GASTRIC EMPTYING IMAGING STUDY,73000007P,CDM,974,RC,78264,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges,10.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,93,,,percent of total billed charges,93% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,485,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485,97,,,percent of total billed charges,97% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,480,96,,,percent of total billed charges,96% of total billed charges,10.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375,75,,,percent of total billed charges,75% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,10.79,485,
PF NM ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,73000009P,CDM,974,RC,78278,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,11.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,11.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,11.05,305.55,
PF NM HEPATOBILIARY SYST IMAGING W/GALLBLADDER,73000005P,CDM,974,RC,78226,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,93,,,percent of total billed charges,93% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,485,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485,97,,,percent of total billed charges,97% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,480,96,,,percent of total billed charges,96% of total billed charges,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375,75,,,percent of total billed charges,75% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,10.41,485,
PF NM HEPATOBIL SYST IMAG INC GB W/PHARM INTERV,73000006P,CDM,974,RC,78227,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges,14.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,93,,,percent of total billed charges,93% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,485,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485,97,,,percent of total billed charges,97% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,480,96,,,percent of total billed charges,96% of total billed charges,14.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375,75,,,percent of total billed charges,75% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,14.2,485,
PF NM INTESTINE IMAGING,73000010P,CDM,974,RC,78290,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,10.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,10.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,10.92,305.55,
PF NM KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE,73000020P,CDM,974,RC,78709,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,93,,,percent of total billed charges,93% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,485,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485,97,,,percent of total billed charges,97% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,480,96,,,percent of total billed charges,96% of total billed charges,11.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375,75,,,percent of total billed charges,75% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,11.07,485,
PF NM KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX,73000019P,CDM,974,RC,78708,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,93,,,percent of total billed charges,93% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,485,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485,97,,,percent of total billed charges,97% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,480,96,,,percent of total billed charges,96% of total billed charges,5.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375,75,,,percent of total billed charges,75% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,5.5,485,
PF NM PULMONARY PERFUSION IMAGING PARTICULATE,73000017P,CDM,974,RC,78580,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,7.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,7.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,7.39,305.55,
PF NM PULMONARY VENTILATION  and  PERFUSION IMAGING,73000018P,CDM,974,RC,78582,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges,10.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,93,,,percent of total billed charges,93% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,485,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485,97,,,percent of total billed charges,97% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,480,96,,,percent of total billed charges,96% of total billed charges,10.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375,75,,,percent of total billed charges,75% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,10.13,485,
PF NM PULMONARY VENTILATION IMAGING,73000016P,CDM,974,RC,78579,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,5.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,5.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,5.99,305.55,
PF NM MYOCARDIAL SPECT MULTIPLE STUDIES,73000014P,CDM,974,RC,78452,HCPCS,Outpatient,,,500,375,,460,92,,,percent of total billed charges,92% of total billed charges,14.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,93,,,percent of total billed charges,93% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,450,90,,,percent of total billed charges,90% of total billed charges,485,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,485,97,,,percent of total billed charges,97% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,480,96,,,percent of total billed charges,96% of total billed charges,14.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375,75,,,percent of total billed charges,75% of total billed charges,375,75,,,percent of total billed charges,75% of total billed charges,14.55,485,
PF NM PARATHYROID PLANAR IMAGING,73000004P,CDM,974,RC,78070,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,9.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,9.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,9.37,305.55,
PF NM THYROID UPTAKE W/BLD FLOW SINGLE/MULT QUANT,73000003P,CDM,974,RC,78014,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,7.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,7.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,7.81,305.55,
PF NM THYROID IMAGING WITH VASCULAR FLOW,73000002P,CDM,974,RC,78013,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,6.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,6.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,6.41,305.55,
PF NM THYROID UPTAKE SINGL/MULTI QUANT MEASUREMENT,73000001P,CDM,974,RC,78012,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,3.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,3.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,3.31,305.55,
PF NM UREA BREATH TEST C-14 ISOTOPIC ANALYSIS,73000008P,CDM,974,RC,78268,HCPCS,Outpatient,,,489,366.75,,449.88,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,454.77,93,,,percent of total billed charges,93% of total billed charges,440.1,90,,,percent of total billed charges,90% of total billed charges,440.1,90,,,percent of total billed charges,90% of total billed charges,474.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,474.33,97,,,percent of total billed charges,97% of total billed charges,366.75,75,,,percent of total billed charges,75% of total billed charges,469.44,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,366.75,75,,,percent of total billed charges,75% of total billed charges,366.75,75,,,percent of total billed charges,75% of total billed charges,366.75,474.33,
PF US AAA SCREENING,72600008P,CDM,972,RC,76706,HCPCS,Outpatient,,,291,218.25,,267.72,92,,,percent of total billed charges,92% of total billed charges,3.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,270.63,93,,,percent of total billed charges,93% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,282.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,282.27,97,,,percent of total billed charges,97% of total billed charges,218.25,75,,,percent of total billed charges,75% of total billed charges,279.36,96,,,percent of total billed charges,96% of total billed charges,3.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.25,75,,,percent of total billed charges,75% of total billed charges,218.25,75,,,percent of total billed charges,75% of total billed charges,3.07,282.27,
PF US ABDOMEN COMPLETE,72600006P,CDM,972,RC,76700,HCPCS,Outpatient,,,320,240,,294.4,92,,,percent of total billed charges,92% of total billed charges,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297.6,93,,,percent of total billed charges,93% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,310.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,310.4,97,,,percent of total billed charges,97% of total billed charges,240,75,,,percent of total billed charges,75% of total billed charges,307.2,96,,,percent of total billed charges,96% of total billed charges,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,240,75,,,percent of total billed charges,75% of total billed charges,240,75,,,percent of total billed charges,75% of total billed charges,3.26,310.4,
PF US ABDOMEN LIMITED,72600007P,CDM,972,RC,76705,HCPCS,Outpatient,,,239,179.25,,219.88,92,,,percent of total billed charges,92% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222.27,93,,,percent of total billed charges,93% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,231.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.83,97,,,percent of total billed charges,97% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,229.44,96,,,percent of total billed charges,96% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.25,75,,,percent of total billed charges,75% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,2.33,231.83,
PF US BIOPSY LIVER,78001482P,CDM,972,RC,47000,HCPCS,Outpatient,,,950,712.5,,874,92,,,percent of total billed charges,92% of total billed charges,7.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,883.5,93,,,percent of total billed charges,93% of total billed charges,855,90,,,percent of total billed charges,90% of total billed charges,855,90,,,percent of total billed charges,90% of total billed charges,921.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,921.5,97,,,percent of total billed charges,97% of total billed charges,712.5,75,,,percent of total billed charges,75% of total billed charges,912,96,,,percent of total billed charges,96% of total billed charges,7.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,712.5,75,,,percent of total billed charges,75% of total billed charges,712.5,75,,,percent of total billed charges,75% of total billed charges,7.58,921.5,
PF US BIOPSY LYMPH NODE BILATERAL,78002217P,CDM,972,RC,38505,HCPCS,Outpatient,,,225,168.75,,207,92,,,percent of total billed charges,92% of total billed charges,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,209.25,93,,,percent of total billed charges,93% of total billed charges,202.5,90,,,percent of total billed charges,90% of total billed charges,202.5,90,,,percent of total billed charges,90% of total billed charges,218.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.25,97,,,percent of total billed charges,97% of total billed charges,168.75,75,,,percent of total billed charges,75% of total billed charges,216,96,,,percent of total billed charges,96% of total billed charges,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.75,75,,,percent of total billed charges,75% of total billed charges,168.75,75,,,percent of total billed charges,75% of total billed charges,7.25,218.25,
PF US BIOPSY LYMPH NODE LEFT,78002201P,CDM,972,RC,38505,HCPCS,Outpatient,,,225,168.75,,207,92,,,percent of total billed charges,92% of total billed charges,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,209.25,93,,,percent of total billed charges,93% of total billed charges,202.5,90,,,percent of total billed charges,90% of total billed charges,202.5,90,,,percent of total billed charges,90% of total billed charges,218.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.25,97,,,percent of total billed charges,97% of total billed charges,168.75,75,,,percent of total billed charges,75% of total billed charges,216,96,,,percent of total billed charges,96% of total billed charges,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.75,75,,,percent of total billed charges,75% of total billed charges,168.75,75,,,percent of total billed charges,75% of total billed charges,7.25,218.25,
PF US BIOPSY LYMPH NODE RIGHT,78002201P,CDM,972,RC,38505,HCPCS,Outpatient,,,225,168.75,,207,92,,,percent of total billed charges,92% of total billed charges,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,209.25,93,,,percent of total billed charges,93% of total billed charges,202.5,90,,,percent of total billed charges,90% of total billed charges,202.5,90,,,percent of total billed charges,90% of total billed charges,218.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.25,97,,,percent of total billed charges,97% of total billed charges,168.75,75,,,percent of total billed charges,75% of total billed charges,216,96,,,percent of total billed charges,96% of total billed charges,7.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.75,75,,,percent of total billed charges,75% of total billed charges,168.75,75,,,percent of total billed charges,75% of total billed charges,7.25,218.25,
PF BIOPSY SOFT TISSUE OF NECK OR THORAX,78002197P,CDM,972,RC,21550,HCPCS,Outpatient,,,414,310.5,,380.88,92,,,percent of total billed charges,92% of total billed charges,13.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,385.02,93,,,percent of total billed charges,93% of total billed charges,372.6,90,,,percent of total billed charges,90% of total billed charges,372.6,90,,,percent of total billed charges,90% of total billed charges,401.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,401.58,97,,,percent of total billed charges,97% of total billed charges,310.5,75,,,percent of total billed charges,75% of total billed charges,397.44,96,,,percent of total billed charges,96% of total billed charges,13.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,310.5,75,,,percent of total billed charges,75% of total billed charges,310.5,75,,,percent of total billed charges,75% of total billed charges,13.82,401.58,
PF-FINE NEEDLE ASPIRATION BX W/US GDN EA ADD'L,78002853P,CDM,972,RC,10006,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.6,93,,,percent of total billed charges,93% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,116.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.4,97,,,percent of total billed charges,97% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,115.2,96,,,percent of total billed charges,96% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90,75,,,percent of total billed charges,75% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,4.42,116.4,
PF-FINE NEEDLE ASPIRATION BX W/US GDN EA ADD'L,78002853P,CDM,972,RC,10006,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.6,93,,,percent of total billed charges,93% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,116.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.4,97,,,percent of total billed charges,97% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,115.2,96,,,percent of total billed charges,96% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90,75,,,percent of total billed charges,75% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,4.42,116.4,
PF BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUIDE RT,78002195P,CDM,972,RC,19083,HCPCS,Outpatient,,,408,306,,375.36,92,,,percent of total billed charges,92% of total billed charges,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,379.44,93,,,percent of total billed charges,93% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,395.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,395.76,97,,,percent of total billed charges,97% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,391.68,96,,,percent of total billed charges,96% of total billed charges,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306,75,,,percent of total billed charges,75% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,14.17,395.76,
PF BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUIDE RT,78002195P,CDM,972,RC,19083,HCPCS,Outpatient,,,408,306,,375.36,92,,,percent of total billed charges,92% of total billed charges,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,379.44,93,,,percent of total billed charges,93% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,395.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,395.76,97,,,percent of total billed charges,97% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,391.68,96,,,percent of total billed charges,96% of total billed charges,14.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306,75,,,percent of total billed charges,75% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,14.17,395.76,
PF US BREAST UNILATERAL COMPLETE BILATERAL,72600046P,CDM,972,RC,76641,HCPCS,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges,2.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,128.34,93,,,percent of total billed charges,93% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,133.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,133.86,97,,,percent of total billed charges,97% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges,132.48,96,,,percent of total billed charges,96% of total billed charges,2.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.5,75,,,percent of total billed charges,75% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges,2.63,133.86,
PF US BREAST UNILATERAL COMPLETE,72600045P,CDM,972,RC,76641,HCPCS,Outpatient,,,92,69,,84.64,92,,,percent of total billed charges,92% of total billed charges,2.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.56,93,,,percent of total billed charges,93% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,89.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,89.24,97,,,percent of total billed charges,97% of total billed charges,69,75,,,percent of total billed charges,75% of total billed charges,88.32,96,,,percent of total billed charges,96% of total billed charges,2.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69,75,,,percent of total billed charges,75% of total billed charges,69,75,,,percent of total billed charges,75% of total billed charges,2.63,89.24,
PF US BREAST UNILATERAL COMPLETE BILATERAL,72600045P,CDM,972,RC,76641,HCPCS,Outpatient,,,92,69,,84.64,92,,,percent of total billed charges,92% of total billed charges,2.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.56,93,,,percent of total billed charges,93% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,89.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,89.24,97,,,percent of total billed charges,97% of total billed charges,69,75,,,percent of total billed charges,75% of total billed charges,88.32,96,,,percent of total billed charges,96% of total billed charges,2.63,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69,75,,,percent of total billed charges,75% of total billed charges,69,75,,,percent of total billed charges,75% of total billed charges,2.63,89.24,
PF PUNCTURE ASPIRATION OF CYST OF BREAST BILATERAL,78002213P,CDM,972,RC,19000,HCPCS,Outpatient,,,112,84,,103.04,92,,,percent of total billed charges,92% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.16,93,,,percent of total billed charges,93% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,108.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,108.64,97,,,percent of total billed charges,97% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,107.52,96,,,percent of total billed charges,96% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84,75,,,percent of total billed charges,75% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,4.42,108.64,
PF PUNCTURE ASPIRATION OF CYST OF BREAST EA ADD'L,78002278P,CDM,972,RC,19001,HCPCS,Outpatient,,,112,84,,103.04,92,,,percent of total billed charges,92% of total billed charges,2.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.16,93,,,percent of total billed charges,93% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,108.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,108.64,97,,,percent of total billed charges,97% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,107.52,96,,,percent of total billed charges,96% of total billed charges,2.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84,75,,,percent of total billed charges,75% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,2.07,108.64,
PF PUNCTURE ASPIRATION OF CYST OF BREAST LEFT,78002193P,CDM,972,RC,19000,HCPCS,Outpatient,,,112,84,,103.04,92,,,percent of total billed charges,92% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.16,93,,,percent of total billed charges,93% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,108.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,108.64,97,,,percent of total billed charges,97% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,107.52,96,,,percent of total billed charges,96% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84,75,,,percent of total billed charges,75% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,4.42,108.64,
PF PUNCTURE ASPIRATION OF CYST OF BREAST RIGHT,78002193P,CDM,972,RC,19000,HCPCS,Outpatient,,,112,84,,103.04,92,,,percent of total billed charges,92% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.16,93,,,percent of total billed charges,93% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,108.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,108.64,97,,,percent of total billed charges,97% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,107.52,96,,,percent of total billed charges,96% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84,75,,,percent of total billed charges,75% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,4.42,108.64,
PF US BREAST LIMITED BILAT,72600005P,CDM,972,RC,76642,HCPCS,Outpatient,,,230,172.5,,211.6,92,,,percent of total billed charges,92% of total billed charges,2.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.9,93,,,percent of total billed charges,93% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,223.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.1,97,,,percent of total billed charges,97% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,220.8,96,,,percent of total billed charges,96% of total billed charges,2.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.5,75,,,percent of total billed charges,75% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,2.1,223.1,
PF US BREAST LIMITED LEFT,72600004P,CDM,972,RC,76642,HCPCS,Outpatient,,,230,172.5,,211.6,92,,,percent of total billed charges,92% of total billed charges,2.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.9,93,,,percent of total billed charges,93% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,223.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.1,97,,,percent of total billed charges,97% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,220.8,96,,,percent of total billed charges,96% of total billed charges,2.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.5,75,,,percent of total billed charges,75% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,2.1,223.1,
PF US BREAST LIMITED RIGHT,72600004P,CDM,972,RC,76642,HCPCS,Outpatient,,,230,172.5,,211.6,92,,,percent of total billed charges,92% of total billed charges,2.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.9,93,,,percent of total billed charges,93% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,223.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.1,97,,,percent of total billed charges,97% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,220.8,96,,,percent of total billed charges,96% of total billed charges,2.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.5,75,,,percent of total billed charges,75% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,2.1,223.1,
PF US CAROTID DUPLEX BILATERAL,72600038P,CDM,972,RC,93880,HCPCS,Outpatient,,,492,369,,452.64,92,,,percent of total billed charges,92% of total billed charges,6.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,457.56,93,,,percent of total billed charges,93% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,477.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,477.24,97,,,percent of total billed charges,97% of total billed charges,369,75,,,percent of total billed charges,75% of total billed charges,472.32,96,,,percent of total billed charges,96% of total billed charges,6.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,369,75,,,percent of total billed charges,75% of total billed charges,369,75,,,percent of total billed charges,75% of total billed charges,6.08,477.24,
PF US CHEST,72600003P,CDM,972,RC,76604,HCPCS,Outpatient,,,213,159.75,,195.96,92,,,percent of total billed charges,92% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,198.09,93,,,percent of total billed charges,93% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,206.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,206.61,97,,,percent of total billed charges,97% of total billed charges,159.75,75,,,percent of total billed charges,75% of total billed charges,204.48,96,,,percent of total billed charges,96% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,159.75,75,,,percent of total billed charges,75% of total billed charges,159.75,75,,,percent of total billed charges,75% of total billed charges,1.32,206.61,
PF US ECHO 2D COMP W/ COLOR FLOW DOPPLER,72600035P,CDM,972,RC,93306,HCPCS,Outpatient,,,537,402.75,,494.04,92,,,percent of total billed charges,92% of total billed charges,5.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,499.41,93,,,percent of total billed charges,93% of total billed charges,483.3,90,,,percent of total billed charges,90% of total billed charges,483.3,90,,,percent of total billed charges,90% of total billed charges,520.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,520.89,97,,,percent of total billed charges,97% of total billed charges,402.75,75,,,percent of total billed charges,75% of total billed charges,515.52,96,,,percent of total billed charges,96% of total billed charges,5.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,402.75,75,,,percent of total billed charges,75% of total billed charges,402.75,75,,,percent of total billed charges,75% of total billed charges,5.26,520.89,
PF US ECHO 2D LIMITED,72600036P,CDM,972,RC,93308,HCPCS,Outpatient,,,267,200.25,,245.64,92,,,percent of total billed charges,92% of total billed charges,3.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,248.31,93,,,percent of total billed charges,93% of total billed charges,240.3,90,,,percent of total billed charges,90% of total billed charges,240.3,90,,,percent of total billed charges,90% of total billed charges,258.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,258.99,97,,,percent of total billed charges,97% of total billed charges,200.25,75,,,percent of total billed charges,75% of total billed charges,256.32,96,,,percent of total billed charges,96% of total billed charges,3.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,200.25,75,,,percent of total billed charges,75% of total billed charges,200.25,75,,,percent of total billed charges,75% of total billed charges,3.11,258.99,
PF US ENCEPHALOGRAM,72600001P,CDM,972,RC,76506,HCPCS,Outpatient,,,314,235.5,,288.88,92,,,percent of total billed charges,92% of total billed charges,3.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.02,93,,,percent of total billed charges,93% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,304.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.58,97,,,percent of total billed charges,97% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,301.44,96,,,percent of total billed charges,96% of total billed charges,3.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,235.5,75,,,percent of total billed charges,75% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,3.11,304.58,
PF US EXTREMITY NON-VASC REAL-TIME IMG LMTD LT,72600029P,CDM,972,RC,76882,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,140.43,93,,,percent of total billed charges,93% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,146.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.47,97,,,percent of total billed charges,97% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,144.96,96,,,percent of total billed charges,96% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,113.25,75,,,percent of total billed charges,75% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,1.34,146.47,
PF US EXTREMITY NON-VASC REAL-TIME IMG LMTD RT,72600029P,CDM,972,RC,76882,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,140.43,93,,,percent of total billed charges,93% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,146.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.47,97,,,percent of total billed charges,97% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,144.96,96,,,percent of total billed charges,96% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,113.25,75,,,percent of total billed charges,75% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,1.34,146.47,
PF US EXTREMITY NON-VASC REAL-TIME IMG LMTD BIL,72600029P,CDM,972,RC,76882,HCPCS,Outpatient,,,226.5,169.88,,208.38,92,,,percent of total billed charges,92% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,210.65,93,,,percent of total billed charges,93% of total billed charges,203.85,90,,,percent of total billed charges,90% of total billed charges,203.85,90,,,percent of total billed charges,90% of total billed charges,219.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.71,97,,,percent of total billed charges,97% of total billed charges,169.88,75,,,percent of total billed charges,75% of total billed charges,217.44,96,,,percent of total billed charges,96% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,169.88,75,,,percent of total billed charges,75% of total billed charges,169.88,75,,,percent of total billed charges,75% of total billed charges,1.34,219.71,
PF US FETAL BIOPHYSICAL PROFILE W/ NON-STR,72600021P,CDM,972,RC,76818,HCPCS,Outpatient,,,310,232.5,,285.2,92,,,percent of total billed charges,92% of total billed charges,3.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.3,93,,,percent of total billed charges,93% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,300.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.7,97,,,percent of total billed charges,97% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,297.6,96,,,percent of total billed charges,96% of total billed charges,3.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,232.5,75,,,percent of total billed charges,75% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,3.21,300.7,
PF US FETAL BIOPHYSICAL PROFLE W/O NON-STRESS TEST,72600022P,CDM,972,RC,76819,HCPCS,Outpatient,,,226,169.5,,207.92,92,,,percent of total billed charges,92% of total billed charges,2.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,210.18,93,,,percent of total billed charges,93% of total billed charges,203.4,90,,,percent of total billed charges,90% of total billed charges,203.4,90,,,percent of total billed charges,90% of total billed charges,219.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.22,97,,,percent of total billed charges,97% of total billed charges,169.5,75,,,percent of total billed charges,75% of total billed charges,216.96,96,,,percent of total billed charges,96% of total billed charges,2.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,169.5,75,,,percent of total billed charges,75% of total billed charges,169.5,75,,,percent of total billed charges,75% of total billed charges,2.26,219.22,
PF-FINE NEEDLE ASPIRATION BX W/US GDN EA ADD'L,78002853P,CDM,972,RC,10006,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.6,93,,,percent of total billed charges,93% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,116.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.4,97,,,percent of total billed charges,97% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,115.2,96,,,percent of total billed charges,96% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90,75,,,percent of total billed charges,75% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,4.42,116.4,
PF FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION,78000001P,CDM,972,RC,10005,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,6.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,6.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,6.83,201.76,
PF US GALLBLADDER,72600007P,CDM,972,RC,76705,HCPCS,Outpatient,,,293,219.75,,269.56,92,,,percent of total billed charges,92% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,272.49,93,,,percent of total billed charges,93% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,284.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.21,97,,,percent of total billed charges,97% of total billed charges,219.75,75,,,percent of total billed charges,75% of total billed charges,281.28,96,,,percent of total billed charges,96% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.75,75,,,percent of total billed charges,75% of total billed charges,219.75,75,,,percent of total billed charges,75% of total billed charges,2.33,284.21,
PF US GUIDED NEEDLE PLACEMENT: REPORT,72600031P,CDM,972,RC,76942,HCPCS,Outpatient,,,642,481.5,,590.64,92,,,percent of total billed charges,92% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,597.06,93,,,percent of total billed charges,93% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,622.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,622.74,97,,,percent of total billed charges,97% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,616.32,96,,,percent of total billed charges,96% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,481.5,75,,,percent of total billed charges,75% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,1.25,622.74,
PF US HEAD/NECK SOFT TISSUE,72600002P,CDM,972,RC,76536,HCPCS,Outpatient,,,305,228.75,,280.6,92,,,percent of total billed charges,92% of total billed charges,3.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,283.65,93,,,percent of total billed charges,93% of total billed charges,274.5,90,,,percent of total billed charges,90% of total billed charges,274.5,90,,,percent of total billed charges,90% of total billed charges,295.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,295.85,97,,,percent of total billed charges,97% of total billed charges,228.75,75,,,percent of total billed charges,75% of total billed charges,292.8,96,,,percent of total billed charges,96% of total billed charges,3.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.75,75,,,percent of total billed charges,75% of total billed charges,228.75,75,,,percent of total billed charges,75% of total billed charges,3.17,295.85,
PF US HIPS INFANT DYNAMIC,72600030P,CDM,972,RC,76885,HCPCS,Outpatient,,,375,281.25,,345,92,,,percent of total billed charges,92% of total billed charges,4.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,348.75,93,,,percent of total billed charges,93% of total billed charges,337.5,90,,,percent of total billed charges,90% of total billed charges,337.5,90,,,percent of total billed charges,90% of total billed charges,363.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,363.75,97,,,percent of total billed charges,97% of total billed charges,281.25,75,,,percent of total billed charges,75% of total billed charges,360,96,,,percent of total billed charges,96% of total billed charges,4.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,281.25,75,,,percent of total billed charges,75% of total billed charges,281.25,75,,,percent of total billed charges,75% of total billed charges,4.03,363.75,
PF US LOWER EXT VENOUS DUPLEX BILATERAL,72600043P,CDM,972,RC,93970,HCPCS,Outpatient,,,492,369,,452.64,92,,,percent of total billed charges,92% of total billed charges,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,457.56,93,,,percent of total billed charges,93% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,477.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,477.24,97,,,percent of total billed charges,97% of total billed charges,369,75,,,percent of total billed charges,75% of total billed charges,472.32,96,,,percent of total billed charges,96% of total billed charges,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,369,75,,,percent of total billed charges,75% of total billed charges,369,75,,,percent of total billed charges,75% of total billed charges,6.15,477.24,
PF US LOWER EXT VENOUS DUPLEX LEFT,72600044P,CDM,972,RC,93971,HCPCS,Outpatient,,,190,142.5,,174.8,92,,,percent of total billed charges,92% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.7,93,,,percent of total billed charges,93% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,184.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.3,97,,,percent of total billed charges,97% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,182.4,96,,,percent of total billed charges,96% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.5,75,,,percent of total billed charges,75% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,3.94,184.3,
PF US LOWER EXT VENOUS DUPLEX RIGHT,72600044P,CDM,972,RC,93971,HCPCS,Outpatient,,,190,142.5,,174.8,92,,,percent of total billed charges,92% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.7,93,,,percent of total billed charges,93% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,184.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.3,97,,,percent of total billed charges,97% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,182.4,96,,,percent of total billed charges,96% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.5,75,,,percent of total billed charges,75% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,3.94,184.3,
PF US OB DETAILED COMPLETE EA ADDL GEST,72600017P,CDM,972,RC,76812,HCPCS,Outpatient,,,524,393,,482.08,92,,,percent of total billed charges,92% of total billed charges,4.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,487.32,93,,,percent of total billed charges,93% of total billed charges,471.6,90,,,percent of total billed charges,90% of total billed charges,471.6,90,,,percent of total billed charges,90% of total billed charges,508.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,508.28,97,,,percent of total billed charges,97% of total billed charges,393,75,,,percent of total billed charges,75% of total billed charges,503.04,96,,,percent of total billed charges,96% of total billed charges,4.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,393,75,,,percent of total billed charges,75% of total billed charges,393,75,,,percent of total billed charges,75% of total billed charges,4.27,508.28,
PF US OB DETAILED COMPLETE FIRST GEST,72600016P,CDM,972,RC,76811,HCPCS,Outpatient,,,602,451.5,,553.84,92,,,percent of total billed charges,92% of total billed charges,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,559.86,93,,,percent of total billed charges,93% of total billed charges,541.8,90,,,percent of total billed charges,90% of total billed charges,541.8,90,,,percent of total billed charges,90% of total billed charges,583.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,583.94,97,,,percent of total billed charges,97% of total billed charges,451.5,75,,,percent of total billed charges,75% of total billed charges,577.92,96,,,percent of total billed charges,96% of total billed charges,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,451.5,75,,,percent of total billed charges,75% of total billed charges,451.5,75,,,percent of total billed charges,75% of total billed charges,3.86,583.94,
PF US OB DETAILED MULTI,72600016P,CDM,972,RC,76811,HCPCS,Outpatient,,,524,393,,482.08,92,,,percent of total billed charges,92% of total billed charges,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,487.32,93,,,percent of total billed charges,93% of total billed charges,471.6,90,,,percent of total billed charges,90% of total billed charges,471.6,90,,,percent of total billed charges,90% of total billed charges,508.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,508.28,97,,,percent of total billed charges,97% of total billed charges,393,75,,,percent of total billed charges,75% of total billed charges,503.04,96,,,percent of total billed charges,96% of total billed charges,3.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,393,75,,,percent of total billed charges,75% of total billed charges,393,75,,,percent of total billed charges,75% of total billed charges,3.86,508.28,
PF US OB FOLLOW UP,72600019P,CDM,972,RC,76816,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,2.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,2.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,2.69,289.06,
PF US OB GREATER THAN 14 WEEKS EA ADDL GEST,72600015P,CDM,972,RC,76810,HCPCS,Outpatient,,,314,235.5,,288.88,92,,,percent of total billed charges,92% of total billed charges,1.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.02,93,,,percent of total billed charges,93% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,304.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.58,97,,,percent of total billed charges,97% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,301.44,96,,,percent of total billed charges,96% of total billed charges,1.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,235.5,75,,,percent of total billed charges,75% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,1.7,304.58,
PF US OB GREATER THAN 14 WEEKS MULTI,72600014P,CDM,972,RC,76805,HCPCS,Outpatient,,,314,235.5,,288.88,92,,,percent of total billed charges,92% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.02,93,,,percent of total billed charges,93% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,304.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.58,97,,,percent of total billed charges,97% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,301.44,96,,,percent of total billed charges,96% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,235.5,75,,,percent of total billed charges,75% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,3.61,304.58,
PF US OB GREATER THAN 14 WEEKS SINGLE,72600014P,CDM,972,RC,76805,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,93,,,percent of total billed charges,93% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,72.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72.75,97,,,percent of total billed charges,97% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,72,96,,,percent of total billed charges,96% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.25,75,,,percent of total billed charges,75% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,3.61,72.75,
PF US OB LESS THAN 14 WEEKS EA ADDL GEST,72600013P,CDM,972,RC,76802,HCPCS,Outpatient,,,314,235.5,,288.88,92,,,percent of total billed charges,92% of total billed charges,0.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.02,93,,,percent of total billed charges,93% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,304.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.58,97,,,percent of total billed charges,97% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,301.44,96,,,percent of total billed charges,96% of total billed charges,0.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,235.5,75,,,percent of total billed charges,75% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,0.72,304.58,
PF US OB LESS THAN 14 WEEKS MULTI,72600012P,CDM,972,RC,76801,HCPCS,Outpatient,,,314,235.5,,288.88,92,,,percent of total billed charges,92% of total billed charges,2.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.02,93,,,percent of total billed charges,93% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,282.6,90,,,percent of total billed charges,90% of total billed charges,304.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.58,97,,,percent of total billed charges,97% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,301.44,96,,,percent of total billed charges,96% of total billed charges,2.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,235.5,75,,,percent of total billed charges,75% of total billed charges,235.5,75,,,percent of total billed charges,75% of total billed charges,2.72,304.58,
PF US OB LESS THAN 14 WEEKS SINGLE,72600012P,CDM,972,RC,76801,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges,2.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,93,,,percent of total billed charges,93% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,72.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72.75,97,,,percent of total billed charges,97% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,72,96,,,percent of total billed charges,96% of total billed charges,2.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.25,75,,,percent of total billed charges,75% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,2.72,72.75,
PF US OB LIMITED,72600018P,CDM,972,RC,76815,HCPCS,Outpatient,,,284,213,,261.28,92,,,percent of total billed charges,92% of total billed charges,2.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,264.12,93,,,percent of total billed charges,93% of total billed charges,255.6,90,,,percent of total billed charges,90% of total billed charges,255.6,90,,,percent of total billed charges,90% of total billed charges,275.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.48,97,,,percent of total billed charges,97% of total billed charges,213,75,,,percent of total billed charges,75% of total billed charges,272.64,96,,,percent of total billed charges,96% of total billed charges,2.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213,75,,,percent of total billed charges,75% of total billed charges,213,75,,,percent of total billed charges,75% of total billed charges,2.02,275.48,
PF US OB TRANSVAGINAL,72600020P,CDM,972,RC,76817,HCPCS,Outpatient,,,253,189.75,,232.76,92,,,percent of total billed charges,92% of total billed charges,2.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,235.29,93,,,percent of total billed charges,93% of total billed charges,227.7,90,,,percent of total billed charges,90% of total billed charges,227.7,90,,,percent of total billed charges,90% of total billed charges,245.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.41,97,,,percent of total billed charges,97% of total billed charges,189.75,75,,,percent of total billed charges,75% of total billed charges,242.88,96,,,percent of total billed charges,96% of total billed charges,2.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.75,75,,,percent of total billed charges,75% of total billed charges,189.75,75,,,percent of total billed charges,75% of total billed charges,2.25,245.41,
PF ABDOMINAL PARACENTESIS DX/THER W/IMAGING GUIDANCE,78001497P,CDM,972,RC,49083,HCPCS,Outpatient,,,447,335.25,,411.24,92,,,percent of total billed charges,92% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,415.71,93,,,percent of total billed charges,93% of total billed charges,402.3,90,,,percent of total billed charges,90% of total billed charges,402.3,90,,,percent of total billed charges,90% of total billed charges,433.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,433.59,97,,,percent of total billed charges,97% of total billed charges,335.25,75,,,percent of total billed charges,75% of total billed charges,429.12,96,,,percent of total billed charges,96% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,335.25,75,,,percent of total billed charges,75% of total billed charges,335.25,75,,,percent of total billed charges,75% of total billed charges,9.02,433.59,
PF US PELVIC COMPLETE,72600026P,CDM,972,RC,76856,HCPCS,Outpatient,,,235,176.25,,216.2,92,,,percent of total billed charges,92% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.55,93,,,percent of total billed charges,93% of total billed charges,211.5,90,,,percent of total billed charges,90% of total billed charges,211.5,90,,,percent of total billed charges,90% of total billed charges,227.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,227.95,97,,,percent of total billed charges,97% of total billed charges,176.25,75,,,percent of total billed charges,75% of total billed charges,225.6,96,,,percent of total billed charges,96% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.25,75,,,percent of total billed charges,75% of total billed charges,176.25,75,,,percent of total billed charges,75% of total billed charges,2.8,227.95,
PF US PELVIC LTD,72600027P,CDM,972,RC,76857,HCPCS,Outpatient,,,166,124.5,,152.72,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.38,93,,,percent of total billed charges,93% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,161.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.02,97,,,percent of total billed charges,97% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,159.36,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,124.5,75,,,percent of total billed charges,75% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,1.18,161.02,
PF US RETROPERITONEAL COMPLETE,72600009P,CDM,972,RC,76770,HCPCS,Outpatient,,,296,222,,272.32,92,,,percent of total billed charges,92% of total billed charges,2.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.28,93,,,percent of total billed charges,93% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,287.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,287.12,97,,,percent of total billed charges,97% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,284.16,96,,,percent of total billed charges,96% of total billed charges,2.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222,75,,,percent of total billed charges,75% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,2.81,287.12,
PF US RETROPERITONEAL LIMITED,72600010P,CDM,972,RC,76775,HCPCS,Outpatient,,,211,158.25,,194.12,92,,,percent of total billed charges,92% of total billed charges,1.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,196.23,93,,,percent of total billed charges,93% of total billed charges,189.9,90,,,percent of total billed charges,90% of total billed charges,189.9,90,,,percent of total billed charges,90% of total billed charges,204.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.67,97,,,percent of total billed charges,97% of total billed charges,158.25,75,,,percent of total billed charges,75% of total billed charges,202.56,96,,,percent of total billed charges,96% of total billed charges,1.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.25,75,,,percent of total billed charges,75% of total billed charges,158.25,75,,,percent of total billed charges,75% of total billed charges,1.4,204.67,
PF US SCROTUM (CONTENTS),72600028P,CDM,972,RC,76870,HCPCS,Outpatient,,,275,206.25,,253,92,,,percent of total billed charges,92% of total billed charges,2.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.75,93,,,percent of total billed charges,93% of total billed charges,247.5,90,,,percent of total billed charges,90% of total billed charges,247.5,90,,,percent of total billed charges,90% of total billed charges,266.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,266.75,97,,,percent of total billed charges,97% of total billed charges,206.25,75,,,percent of total billed charges,75% of total billed charges,264,96,,,percent of total billed charges,96% of total billed charges,2.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,206.25,75,,,percent of total billed charges,75% of total billed charges,206.25,75,,,percent of total billed charges,75% of total billed charges,2.7,266.75,
PF US ABDOMINAL REAL TIME W/IMAGE LIMITED,72600007P,CDM,972,RC,76705,HCPCS,Outpatient,,,239,179.25,,219.88,92,,,percent of total billed charges,92% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222.27,93,,,percent of total billed charges,93% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,231.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.83,97,,,percent of total billed charges,97% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,229.44,96,,,percent of total billed charges,96% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.25,75,,,percent of total billed charges,75% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,2.33,231.83,
PF US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,72600027P,CDM,972,RC,76857,HCPCS,Outpatient,,,166,124.5,,152.72,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.38,93,,,percent of total billed charges,93% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,161.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.02,97,,,percent of total billed charges,97% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,159.36,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,124.5,75,,,percent of total billed charges,75% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,1.18,161.02,
PF US CHEST REAL TIME W/IMAGE DOCUMENTATION,72600003P,CDM,972,RC,76604,HCPCS,Outpatient,,,213,159.75,,195.96,92,,,percent of total billed charges,92% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,198.09,93,,,percent of total billed charges,93% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,191.7,90,,,percent of total billed charges,90% of total billed charges,206.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,206.61,97,,,percent of total billed charges,97% of total billed charges,159.75,75,,,percent of total billed charges,75% of total billed charges,204.48,96,,,percent of total billed charges,96% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,159.75,75,,,percent of total billed charges,75% of total billed charges,159.75,75,,,percent of total billed charges,75% of total billed charges,1.32,206.61,
PF US SOFT TISSUE GROIN,72600029P,CDM,972,RC,76882,HCPCS,Outpatient,,,151,113.25,,138.92,92,,,percent of total billed charges,92% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,140.43,93,,,percent of total billed charges,93% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,135.9,90,,,percent of total billed charges,90% of total billed charges,146.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.47,97,,,percent of total billed charges,97% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,144.96,96,,,percent of total billed charges,96% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,113.25,75,,,percent of total billed charges,75% of total billed charges,113.25,75,,,percent of total billed charges,75% of total billed charges,1.34,146.47,
PF US SPINAL CANAL,72600011P,CDM,972,RC,76800,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,4.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,4.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,4.12,383.15,
PF CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE,41600278,CDM,972,RC,77078,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges,3.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.02,93,,,percent of total billed charges,93% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,110.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.58,97,,,percent of total billed charges,97% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,109.44,96,,,percent of total billed charges,96% of total billed charges,3.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.5,75,,,percent of total billed charges,75% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,3.43,110.58,
PF THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING,78001280P,CDM,972,RC,32555,HCPCS,Outpatient,,,440,330,,404.8,92,,,percent of total billed charges,92% of total billed charges,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,409.2,93,,,percent of total billed charges,93% of total billed charges,396,90,,,percent of total billed charges,90% of total billed charges,396,90,,,percent of total billed charges,90% of total billed charges,426.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,426.8,97,,,percent of total billed charges,97% of total billed charges,330,75,,,percent of total billed charges,75% of total billed charges,422.4,96,,,percent of total billed charges,96% of total billed charges,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,330,75,,,percent of total billed charges,75% of total billed charges,330,75,,,percent of total billed charges,75% of total billed charges,9.65,426.8,
PF US THYROID,72600002P,CDM,972,RC,76536,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges,3.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.11,93,,,percent of total billed charges,93% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,317.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,317.19,97,,,percent of total billed charges,97% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,313.92,96,,,percent of total billed charges,96% of total billed charges,3.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.25,75,,,percent of total billed charges,75% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,3.17,317.19,
PF US TRANSVAGINAL NON-OB,72600024P,CDM,972,RC,76830,HCPCS,Outpatient,,,327,245.25,,300.84,92,,,percent of total billed charges,92% of total billed charges,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,304.11,93,,,percent of total billed charges,93% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,294.3,90,,,percent of total billed charges,90% of total billed charges,317.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,317.19,97,,,percent of total billed charges,97% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,313.92,96,,,percent of total billed charges,96% of total billed charges,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.25,75,,,percent of total billed charges,75% of total billed charges,245.25,75,,,percent of total billed charges,75% of total billed charges,3.54,317.19,
PF US UPPER EXT VENOUS DUPLEX BILATERAL,72600043P,CDM,972,RC,93970,HCPCS,Outpatient,,,492,369,,452.64,92,,,percent of total billed charges,92% of total billed charges,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,457.56,93,,,percent of total billed charges,93% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,477.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,477.24,97,,,percent of total billed charges,97% of total billed charges,369,75,,,percent of total billed charges,75% of total billed charges,472.32,96,,,percent of total billed charges,96% of total billed charges,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,369,75,,,percent of total billed charges,75% of total billed charges,369,75,,,percent of total billed charges,75% of total billed charges,6.15,477.24,
PF US UPPER EXT VENOUS DUPLEX LEFT,72600044P,CDM,972,RC,93971,HCPCS,Outpatient,,,190,142.5,,174.8,92,,,percent of total billed charges,92% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.7,93,,,percent of total billed charges,93% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,184.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.3,97,,,percent of total billed charges,97% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,182.4,96,,,percent of total billed charges,96% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.5,75,,,percent of total billed charges,75% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,3.94,184.3,
PF US UPPER EXT VENOUS DUPLEX RIGHT,72600044P,CDM,972,RC,93971,HCPCS,Outpatient,,,190,142.5,,174.8,92,,,percent of total billed charges,92% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.7,93,,,percent of total billed charges,93% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,184.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.3,97,,,percent of total billed charges,97% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,182.4,96,,,percent of total billed charges,96% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.5,75,,,percent of total billed charges,75% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,3.94,184.3,
PF XR A-C JOINTS BI W/WO WEIGHTED DISTR,71800182P,CDM,972,RC,73050,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges,0.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.61,93,,,percent of total billed charges,93% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,74.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.69,97,,,percent of total billed charges,97% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,73.92,96,,,percent of total billed charges,96% of total billed charges,0.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.75,75,,,percent of total billed charges,75% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,0.96,74.69,
PF XR ABDOMEN 1 VIEW,71800351P,CDM,972,RC,74018,HCPCS,Outpatient,,,81,60.75,,74.52,92,,,percent of total billed charges,92% of total billed charges,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.33,93,,,percent of total billed charges,93% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,78.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.57,97,,,percent of total billed charges,97% of total billed charges,60.75,75,,,percent of total billed charges,75% of total billed charges,77.76,96,,,percent of total billed charges,96% of total billed charges,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,60.75,75,,,percent of total billed charges,75% of total billed charges,60.75,75,,,percent of total billed charges,75% of total billed charges,1.02,78.57,
PF XR ABDOMEN 2 VIEWS,71800515P,CDM,972,RC,74019,HCPCS,Outpatient,,,100,75,,92,92,,,percent of total billed charges,92% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93,93,,,percent of total billed charges,93% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97,97,,,percent of total billed charges,97% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,96,96,,,percent of total billed charges,96% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75,75,,,percent of total billed charges,75% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,1.17,97,
PF XR ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,71800355P,CDM,972,RC,74022,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges,1.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.55,93,,,percent of total billed charges,93% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,130.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.95,97,,,percent of total billed charges,97% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,129.6,96,,,percent of total billed charges,96% of total billed charges,1.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.25,75,,,percent of total billed charges,75% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,1.48,130.95,
PF XR ANKLE 2 VIEWS BILATERAL,71800301P,CDM,972,RC,73600,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,1.12,84.39,
PF XR ANKLE 2 VIEWS LEFT,71800299P,CDM,972,RC,73600,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,1.12,84.39,
PF XR ANKLE 2 VIEWS RIGHT,71800299P,CDM,972,RC,73600,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,1.12,84.39,
PF XR ANKLE COMPLETE MINIMUM 3 VIEWS BILATERAL,71800305P,CDM,972,RC,73610,HCPCS,Outpatient,,,100,75,,92,92,,,percent of total billed charges,92% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93,93,,,percent of total billed charges,93% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97,97,,,percent of total billed charges,97% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,96,96,,,percent of total billed charges,96% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75,75,,,percent of total billed charges,75% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,1.25,97,
PF XR ANKLE COMPLETE 3+ VIEWS LEFT,71800303P,CDM,972,RC,73610,HCPCS,Outpatient,,,100,75,,92,92,,,percent of total billed charges,92% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93,93,,,percent of total billed charges,93% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97,97,,,percent of total billed charges,97% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,96,96,,,percent of total billed charges,96% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75,75,,,percent of total billed charges,75% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,1.25,97,
PF XR ANKLE COMPLETE 3+ VIEWS RIGHT,71800303P,CDM,972,RC,73610,HCPCS,Outpatient,,,100,75,,92,92,,,percent of total billed charges,92% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93,93,,,percent of total billed charges,93% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97,97,,,percent of total billed charges,97% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,96,96,,,percent of total billed charges,96% of total billed charges,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75,75,,,percent of total billed charges,75% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,1.25,97,
PF XR ANKLE ARTHROGRAPHY RS&I BILATERAL,71800309P,CDM,972,RC,73615,HCPCS,Outpatient,,,546,409.5,,502.32,92,,,percent of total billed charges,92% of total billed charges,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,507.78,93,,,percent of total billed charges,93% of total billed charges,491.4,90,,,percent of total billed charges,90% of total billed charges,491.4,90,,,percent of total billed charges,90% of total billed charges,529.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,529.62,97,,,percent of total billed charges,97% of total billed charges,409.5,75,,,percent of total billed charges,75% of total billed charges,524.16,96,,,percent of total billed charges,96% of total billed charges,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,409.5,75,,,percent of total billed charges,75% of total billed charges,409.5,75,,,percent of total billed charges,75% of total billed charges,3.76,529.62,
PF XR ANKLE ARTHROGRAPHY RS&I,71800307P,CDM,972,RC,73615,HCPCS,Outpatient,,,364,273,,334.88,92,,,percent of total billed charges,92% of total billed charges,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,338.52,93,,,percent of total billed charges,93% of total billed charges,327.6,90,,,percent of total billed charges,90% of total billed charges,327.6,90,,,percent of total billed charges,90% of total billed charges,353.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,353.08,97,,,percent of total billed charges,97% of total billed charges,273,75,,,percent of total billed charges,75% of total billed charges,349.44,96,,,percent of total billed charges,96% of total billed charges,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,273,75,,,percent of total billed charges,75% of total billed charges,273,75,,,percent of total billed charges,75% of total billed charges,3.76,353.08,
PF XR ELBOW ARTHROGRAPHY RS&I,71800198P,CDM,972,RC,73040,HCPCS,Outpatient,,,364,273,,334.88,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,338.52,93,,,percent of total billed charges,93% of total billed charges,327.6,90,,,percent of total billed charges,90% of total billed charges,327.6,90,,,percent of total billed charges,90% of total billed charges,353.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,353.08,97,,,percent of total billed charges,97% of total billed charges,273,75,,,percent of total billed charges,75% of total billed charges,349.44,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,273,75,,,percent of total billed charges,75% of total billed charges,273,75,,,percent of total billed charges,75% of total billed charges,3.91,353.08,
PF XR HIP ARTHROGRAPHY RS&I BILATERAL,71800267P,CDM,972,RC,73525,HCPCS,Outpatient,,,551,413.25,,506.92,92,,,percent of total billed charges,92% of total billed charges,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,512.43,93,,,percent of total billed charges,93% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,495.9,90,,,percent of total billed charges,90% of total billed charges,534.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534.47,97,,,percent of total billed charges,97% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,528.96,96,,,percent of total billed charges,96% of total billed charges,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.25,75,,,percent of total billed charges,75% of total billed charges,413.25,75,,,percent of total billed charges,75% of total billed charges,3.76,534.47,
PF XR HIP ARTHROGRAPHY RS&I,71800265P,CDM,972,RC,73525,HCPCS,Outpatient,,,367,275.25,,337.64,92,,,percent of total billed charges,92% of total billed charges,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,341.31,93,,,percent of total billed charges,93% of total billed charges,330.3,90,,,percent of total billed charges,90% of total billed charges,330.3,90,,,percent of total billed charges,90% of total billed charges,355.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,355.99,97,,,percent of total billed charges,97% of total billed charges,275.25,75,,,percent of total billed charges,75% of total billed charges,352.32,96,,,percent of total billed charges,96% of total billed charges,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.25,75,,,percent of total billed charges,75% of total billed charges,275.25,75,,,percent of total billed charges,75% of total billed charges,3.76,355.99,
PF XR HIP ARTHROGRAPHY RS&I,71800265P,CDM,972,RC,73525,HCPCS,Outpatient,,,367,275.25,,337.64,92,,,percent of total billed charges,92% of total billed charges,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,341.31,93,,,percent of total billed charges,93% of total billed charges,330.3,90,,,percent of total billed charges,90% of total billed charges,330.3,90,,,percent of total billed charges,90% of total billed charges,355.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,355.99,97,,,percent of total billed charges,97% of total billed charges,275.25,75,,,percent of total billed charges,75% of total billed charges,352.32,96,,,percent of total billed charges,96% of total billed charges,3.76,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.25,75,,,percent of total billed charges,75% of total billed charges,275.25,75,,,percent of total billed charges,75% of total billed charges,3.76,355.99,
PF XR ARTHROGRAM INJECTION ANKLE BILAT,78000938P,CDM,972,RC,27648,HCPCS,Outpatient,,,299,224.25,,275.08,92,,,percent of total billed charges,92% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,278.07,93,,,percent of total billed charges,93% of total billed charges,269.1,90,,,percent of total billed charges,90% of total billed charges,269.1,90,,,percent of total billed charges,90% of total billed charges,290.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,290.03,97,,,percent of total billed charges,97% of total billed charges,224.25,75,,,percent of total billed charges,75% of total billed charges,287.04,96,,,percent of total billed charges,96% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,224.25,75,,,percent of total billed charges,75% of total billed charges,224.25,75,,,percent of total billed charges,75% of total billed charges,5.56,290.03,
PF XR ARTHROGRAM INJECTION ANKLE LEFT,78000936P,CDM,972,RC,27648,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186,93,,,percent of total billed charges,93% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,194,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194,97,,,percent of total billed charges,97% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,192,96,,,percent of total billed charges,96% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150,75,,,percent of total billed charges,75% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,5.56,194,
PF XR ARTHROGRAM INJECTION ANKLE RIGHT,78000936P,CDM,972,RC,27648,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186,93,,,percent of total billed charges,93% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,194,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194,97,,,percent of total billed charges,97% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,192,96,,,percent of total billed charges,96% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150,75,,,percent of total billed charges,75% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,5.56,194,
PF XR ARTHROGRAM INJECTION ELBOW BILAT,78000505P,CDM,972,RC,24220,HCPCS,Outpatient,,,317,237.75,,291.64,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,294.81,93,,,percent of total billed charges,93% of total billed charges,285.3,90,,,percent of total billed charges,90% of total billed charges,285.3,90,,,percent of total billed charges,90% of total billed charges,307.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,307.49,97,,,percent of total billed charges,97% of total billed charges,237.75,75,,,percent of total billed charges,75% of total billed charges,304.32,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237.75,75,,,percent of total billed charges,75% of total billed charges,237.75,75,,,percent of total billed charges,75% of total billed charges,5.78,307.49,
PF XR ARTHROGRAM INJECTION ELBOW LEFT,78000503P,CDM,972,RC,24220,HCPCS,Outpatient,,,211,158.25,,194.12,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,196.23,93,,,percent of total billed charges,93% of total billed charges,189.9,90,,,percent of total billed charges,90% of total billed charges,189.9,90,,,percent of total billed charges,90% of total billed charges,204.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.67,97,,,percent of total billed charges,97% of total billed charges,158.25,75,,,percent of total billed charges,75% of total billed charges,202.56,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.25,75,,,percent of total billed charges,75% of total billed charges,158.25,75,,,percent of total billed charges,75% of total billed charges,5.78,204.67,
PF XR ARTHROGRAM INJECTION ELBOW RIGHT,78000503P,CDM,972,RC,24220,HCPCS,Outpatient,,,211,158.25,,194.12,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,196.23,93,,,percent of total billed charges,93% of total billed charges,189.9,90,,,percent of total billed charges,90% of total billed charges,189.9,90,,,percent of total billed charges,90% of total billed charges,204.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.67,97,,,percent of total billed charges,97% of total billed charges,158.25,75,,,percent of total billed charges,75% of total billed charges,202.56,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.25,75,,,percent of total billed charges,75% of total billed charges,158.25,75,,,percent of total billed charges,75% of total billed charges,5.78,204.67,
PF XR ARTHROGRAM INJECTION HIP BILAT,78002215P,CDM,972,RC,27093,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.54,93,,,percent of total billed charges,93% of total billed charges,160.2,90,,,percent of total billed charges,90% of total billed charges,160.2,90,,,percent of total billed charges,90% of total billed charges,172.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.66,97,,,percent of total billed charges,97% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges,170.88,96,,,percent of total billed charges,96% of total billed charges,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,133.5,75,,,percent of total billed charges,75% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges,6.38,172.66,
PF XR ARTHROGRAM INJECTION HIP LEFT,78002199P,CDM,972,RC,27093,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.54,93,,,percent of total billed charges,93% of total billed charges,160.2,90,,,percent of total billed charges,90% of total billed charges,160.2,90,,,percent of total billed charges,90% of total billed charges,172.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.66,97,,,percent of total billed charges,97% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges,170.88,96,,,percent of total billed charges,96% of total billed charges,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,133.5,75,,,percent of total billed charges,75% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges,6.38,172.66,
PF XR ARTHROGRAM INJECTION HIP RIGHT,78002199P,CDM,972,RC,27093,HCPCS,Outpatient,,,178,133.5,,163.76,92,,,percent of total billed charges,92% of total billed charges,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.54,93,,,percent of total billed charges,93% of total billed charges,160.2,90,,,percent of total billed charges,90% of total billed charges,160.2,90,,,percent of total billed charges,90% of total billed charges,172.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.66,97,,,percent of total billed charges,97% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges,170.88,96,,,percent of total billed charges,96% of total billed charges,6.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,133.5,75,,,percent of total billed charges,75% of total billed charges,133.5,75,,,percent of total billed charges,75% of total billed charges,6.38,172.66,
PF XR ARTHROGRAM INJECTION KNEE BILAT,78000835P,CDM,972,RC,27369,HCPCS,Outpatient,,,340,255,,312.8,92,,,percent of total billed charges,92% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,316.2,93,,,percent of total billed charges,93% of total billed charges,306,90,,,percent of total billed charges,90% of total billed charges,306,90,,,percent of total billed charges,90% of total billed charges,329.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.8,97,,,percent of total billed charges,97% of total billed charges,255,75,,,percent of total billed charges,75% of total billed charges,326.4,96,,,percent of total billed charges,96% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255,75,,,percent of total billed charges,75% of total billed charges,255,75,,,percent of total billed charges,75% of total billed charges,3.81,329.8,
PF XR ARTHROGRAM INJECTION KNEE LEFT,78000833P,CDM,972,RC,27369,HCPCS,Outpatient,,,227,170.25,,208.84,92,,,percent of total billed charges,92% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,211.11,93,,,percent of total billed charges,93% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,220.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,220.19,97,,,percent of total billed charges,97% of total billed charges,170.25,75,,,percent of total billed charges,75% of total billed charges,217.92,96,,,percent of total billed charges,96% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,170.25,75,,,percent of total billed charges,75% of total billed charges,170.25,75,,,percent of total billed charges,75% of total billed charges,3.81,220.19,
PF XR ARTHROGRAM INJECTION KNEE RIGHT,78000833P,CDM,972,RC,27369,HCPCS,Outpatient,,,227,170.25,,208.84,92,,,percent of total billed charges,92% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,211.11,93,,,percent of total billed charges,93% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,204.3,90,,,percent of total billed charges,90% of total billed charges,220.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,220.19,97,,,percent of total billed charges,97% of total billed charges,170.25,75,,,percent of total billed charges,75% of total billed charges,217.92,96,,,percent of total billed charges,96% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,170.25,75,,,percent of total billed charges,75% of total billed charges,170.25,75,,,percent of total billed charges,75% of total billed charges,3.81,220.19,
PF INJECTION SHOULDER ARTHROGRAPHY RIGHT,78000428P,CDM,972,RC,23350,HCPCS,Outpatient,,,191,143.25,,175.72,92,,,percent of total billed charges,92% of total billed charges,4.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.63,93,,,percent of total billed charges,93% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,185.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.27,97,,,percent of total billed charges,97% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,183.36,96,,,percent of total billed charges,96% of total billed charges,4.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.25,75,,,percent of total billed charges,75% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,4.4,185.27,
PF INJECTION SHOULDER ARTHROGRAPHY LEFT,78000428P,CDM,972,RC,23350,HCPCS,Outpatient,,,191,143.25,,175.72,92,,,percent of total billed charges,92% of total billed charges,4.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.63,93,,,percent of total billed charges,93% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,185.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.27,97,,,percent of total billed charges,97% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,183.36,96,,,percent of total billed charges,96% of total billed charges,4.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.25,75,,,percent of total billed charges,75% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,4.4,185.27,
PF INJECTION SHOULDER ARTHROGRAPHY BILATERAL,78000430P,CDM,972,RC,23350,HCPCS,Outpatient,,,287,215.25,,264.04,92,,,percent of total billed charges,92% of total billed charges,4.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,266.91,93,,,percent of total billed charges,93% of total billed charges,258.3,90,,,percent of total billed charges,90% of total billed charges,258.3,90,,,percent of total billed charges,90% of total billed charges,278.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,278.39,97,,,percent of total billed charges,97% of total billed charges,215.25,75,,,percent of total billed charges,75% of total billed charges,275.52,96,,,percent of total billed charges,96% of total billed charges,4.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,215.25,75,,,percent of total billed charges,75% of total billed charges,215.25,75,,,percent of total billed charges,75% of total billed charges,4.4,278.39,
PF XR ARTHROGRAM INJECTION WRIST BILAT,78000585P,CDM,972,RC,25246,HCPCS,Outpatient,,,293,219.75,,269.56,92,,,percent of total billed charges,92% of total billed charges,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,272.49,93,,,percent of total billed charges,93% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,263.7,90,,,percent of total billed charges,90% of total billed charges,284.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,284.21,97,,,percent of total billed charges,97% of total billed charges,219.75,75,,,percent of total billed charges,75% of total billed charges,281.28,96,,,percent of total billed charges,96% of total billed charges,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.75,75,,,percent of total billed charges,75% of total billed charges,219.75,75,,,percent of total billed charges,75% of total billed charges,6.55,284.21,
PF XR SHOULDER ARTHROGRAPHY RS&I BILATERAL,71800180P,CDM,972,RC,73040,HCPCS,Outpatient,,,541,405.75,,497.72,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,503.13,93,,,percent of total billed charges,93% of total billed charges,486.9,90,,,percent of total billed charges,90% of total billed charges,486.9,90,,,percent of total billed charges,90% of total billed charges,524.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,524.77,97,,,percent of total billed charges,97% of total billed charges,405.75,75,,,percent of total billed charges,75% of total billed charges,519.36,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,405.75,75,,,percent of total billed charges,75% of total billed charges,405.75,75,,,percent of total billed charges,75% of total billed charges,3.91,524.77,
PF XR ARTHROGRAM INJECTION WRIST LEFT,78000583P,CDM,972,RC,25246,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.35,93,,,percent of total billed charges,93% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,189.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.15,97,,,percent of total billed charges,97% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,187.2,96,,,percent of total billed charges,96% of total billed charges,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.25,75,,,percent of total billed charges,75% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,6.55,189.15,
PF XR ARTHROGRAM INJECTION WRIST RIGHT,78000583P,CDM,972,RC,25246,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.35,93,,,percent of total billed charges,93% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,189.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.15,97,,,percent of total billed charges,97% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,187.2,96,,,percent of total billed charges,96% of total billed charges,6.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.25,75,,,percent of total billed charges,75% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,6.55,189.15,
PF XR KNEE ARTHROGRAPHY RS&I BILATERAL,71800289P,CDM,972,RC,73580,HCPCS,Outpatient,,,607,455.25,,558.44,92,,,percent of total billed charges,92% of total billed charges,3.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564.51,93,,,percent of total billed charges,93% of total billed charges,546.3,90,,,percent of total billed charges,90% of total billed charges,546.3,90,,,percent of total billed charges,90% of total billed charges,588.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,588.79,97,,,percent of total billed charges,97% of total billed charges,455.25,75,,,percent of total billed charges,75% of total billed charges,582.72,96,,,percent of total billed charges,96% of total billed charges,3.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.25,75,,,percent of total billed charges,75% of total billed charges,455.25,75,,,percent of total billed charges,75% of total billed charges,3.04,588.79,
PF XR KNEE ARTHROGRAPHY RS&I,71800287P,CDM,972,RC,73580,HCPCS,Outpatient,,,405,303.75,,372.6,92,,,percent of total billed charges,92% of total billed charges,3.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,376.65,93,,,percent of total billed charges,93% of total billed charges,364.5,90,,,percent of total billed charges,90% of total billed charges,364.5,90,,,percent of total billed charges,90% of total billed charges,392.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,392.85,97,,,percent of total billed charges,97% of total billed charges,303.75,75,,,percent of total billed charges,75% of total billed charges,388.8,96,,,percent of total billed charges,96% of total billed charges,3.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,303.75,75,,,percent of total billed charges,75% of total billed charges,303.75,75,,,percent of total billed charges,75% of total billed charges,3.04,392.85,
PF XR KNEE ARTHROGRAPHY RS&I,71800287P,CDM,972,RC,73580,HCPCS,Outpatient,,,405,303.75,,372.6,92,,,percent of total billed charges,92% of total billed charges,3.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,376.65,93,,,percent of total billed charges,93% of total billed charges,364.5,90,,,percent of total billed charges,90% of total billed charges,364.5,90,,,percent of total billed charges,90% of total billed charges,392.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,392.85,97,,,percent of total billed charges,97% of total billed charges,303.75,75,,,percent of total billed charges,75% of total billed charges,388.8,96,,,percent of total billed charges,96% of total billed charges,3.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,303.75,75,,,percent of total billed charges,75% of total billed charges,303.75,75,,,percent of total billed charges,75% of total billed charges,3.04,392.85,
PF XR SHOULDER ARTHROGRAPHY RS&I BILATERAL,71800180P,CDM,972,RC,73040,HCPCS,Outpatient,,,541,405.75,,497.72,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,503.13,93,,,percent of total billed charges,93% of total billed charges,486.9,90,,,percent of total billed charges,90% of total billed charges,486.9,90,,,percent of total billed charges,90% of total billed charges,524.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,524.77,97,,,percent of total billed charges,97% of total billed charges,405.75,75,,,percent of total billed charges,75% of total billed charges,519.36,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,405.75,75,,,percent of total billed charges,75% of total billed charges,405.75,75,,,percent of total billed charges,75% of total billed charges,3.91,524.77,
PF XR SHOULDER ARTHROGRAPHY RS&I,71800178P,CDM,972,RC,73040,HCPCS,Outpatient,,,361,270.75,,332.12,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,335.73,93,,,percent of total billed charges,93% of total billed charges,324.9,90,,,percent of total billed charges,90% of total billed charges,324.9,90,,,percent of total billed charges,90% of total billed charges,350.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,350.17,97,,,percent of total billed charges,97% of total billed charges,270.75,75,,,percent of total billed charges,75% of total billed charges,346.56,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,270.75,75,,,percent of total billed charges,75% of total billed charges,270.75,75,,,percent of total billed charges,75% of total billed charges,3.91,350.17,
PF XR SHOULDER ARTHROGRAPHY RS&I,71800178P,CDM,972,RC,73040,HCPCS,Outpatient,,,361,270.75,,332.12,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,335.73,93,,,percent of total billed charges,93% of total billed charges,324.9,90,,,percent of total billed charges,90% of total billed charges,324.9,90,,,percent of total billed charges,90% of total billed charges,350.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,350.17,97,,,percent of total billed charges,97% of total billed charges,270.75,75,,,percent of total billed charges,75% of total billed charges,346.56,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,270.75,75,,,percent of total billed charges,75% of total billed charges,270.75,75,,,percent of total billed charges,75% of total billed charges,3.91,350.17,
PF XR WRIST ARTHROGRAPHY RS&I BILATERAL,71800220P,CDM,972,RC,73040,HCPCS,Outpatient,,,562,421.5,,517.04,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,522.66,93,,,percent of total billed charges,93% of total billed charges,505.8,90,,,percent of total billed charges,90% of total billed charges,505.8,90,,,percent of total billed charges,90% of total billed charges,545.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,545.14,97,,,percent of total billed charges,97% of total billed charges,421.5,75,,,percent of total billed charges,75% of total billed charges,539.52,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,421.5,75,,,percent of total billed charges,75% of total billed charges,421.5,75,,,percent of total billed charges,75% of total billed charges,3.91,545.14,
PF XR WRIST ARTHROGRAPHY RS&I,71800218P,CDM,972,RC,73040,HCPCS,Outpatient,,,374,280.5,,344.08,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,347.82,93,,,percent of total billed charges,93% of total billed charges,336.6,90,,,percent of total billed charges,90% of total billed charges,336.6,90,,,percent of total billed charges,90% of total billed charges,362.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,362.78,97,,,percent of total billed charges,97% of total billed charges,280.5,75,,,percent of total billed charges,75% of total billed charges,359.04,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,280.5,75,,,percent of total billed charges,75% of total billed charges,280.5,75,,,percent of total billed charges,75% of total billed charges,3.91,362.78,
PF XR WRIST ARTHROGRAPHY RS&I,71800218P,CDM,972,RC,73040,HCPCS,Outpatient,,,374,280.5,,344.08,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,347.82,93,,,percent of total billed charges,93% of total billed charges,336.6,90,,,percent of total billed charges,90% of total billed charges,336.6,90,,,percent of total billed charges,90% of total billed charges,362.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,362.78,97,,,percent of total billed charges,97% of total billed charges,280.5,75,,,percent of total billed charges,75% of total billed charges,359.04,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,280.5,75,,,percent of total billed charges,75% of total billed charges,280.5,75,,,percent of total billed charges,75% of total billed charges,3.91,362.78,
PF XR BARIUM ENEMA COMPLETE,71800379P,CDM,972,RC,74270,HCPCS,Outpatient,,,429,321.75,,394.68,92,,,percent of total billed charges,92% of total billed charges,3.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,398.97,93,,,percent of total billed charges,93% of total billed charges,386.1,90,,,percent of total billed charges,90% of total billed charges,386.1,90,,,percent of total billed charges,90% of total billed charges,416.13,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,416.13,97,,,percent of total billed charges,97% of total billed charges,321.75,75,,,percent of total billed charges,75% of total billed charges,411.84,96,,,percent of total billed charges,96% of total billed charges,3.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321.75,75,,,percent of total billed charges,75% of total billed charges,321.75,75,,,percent of total billed charges,75% of total billed charges,3.89,416.13,
PF XR BARIUM ENEMA W/ AIR COMPLETE,71800381P,CDM,972,RC,74280,HCPCS,Outpatient,,,618,463.5,,568.56,92,,,percent of total billed charges,92% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,574.74,93,,,percent of total billed charges,93% of total billed charges,556.2,90,,,percent of total billed charges,90% of total billed charges,556.2,90,,,percent of total billed charges,90% of total billed charges,599.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,599.46,97,,,percent of total billed charges,97% of total billed charges,463.5,75,,,percent of total billed charges,75% of total billed charges,593.28,96,,,percent of total billed charges,96% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,463.5,75,,,percent of total billed charges,75% of total billed charges,463.5,75,,,percent of total billed charges,75% of total billed charges,6.09,599.46,
PF XR BONE AGE STUDIES,71800484P,CDM,972,RC,77072,HCPCS,Outpatient,,,80,60,,73.6,92,,,percent of total billed charges,92% of total billed charges,0.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.4,93,,,percent of total billed charges,93% of total billed charges,72,90,,,percent of total billed charges,90% of total billed charges,72,90,,,percent of total billed charges,90% of total billed charges,77.6,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,77.6,97,,,percent of total billed charges,97% of total billed charges,60,75,,,percent of total billed charges,75% of total billed charges,76.8,96,,,percent of total billed charges,96% of total billed charges,0.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,60,75,,,percent of total billed charges,75% of total billed charges,60,75,,,percent of total billed charges,75% of total billed charges,0.86,77.6,
PF XR BONE LENGTH STUDY,71800486P,CDM,972,RC,77073,HCPCS,Outpatient,,,121,90.75,,111.32,92,,,percent of total billed charges,92% of total billed charges,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,112.53,93,,,percent of total billed charges,93% of total billed charges,108.9,90,,,percent of total billed charges,90% of total billed charges,108.9,90,,,percent of total billed charges,90% of total billed charges,117.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117.37,97,,,percent of total billed charges,97% of total billed charges,90.75,75,,,percent of total billed charges,75% of total billed charges,116.16,96,,,percent of total billed charges,96% of total billed charges,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90.75,75,,,percent of total billed charges,75% of total billed charges,90.75,75,,,percent of total billed charges,75% of total billed charges,1.39,117.37,
PF XR CALCANEUS MINIMUM 2 VIEWS BILATERAL,71800321P,CDM,972,RC,73650,HCPCS,Outpatient,,,117,87.75,,107.64,92,,,percent of total billed charges,92% of total billed charges,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,108.81,93,,,percent of total billed charges,93% of total billed charges,105.3,90,,,percent of total billed charges,90% of total billed charges,105.3,90,,,percent of total billed charges,90% of total billed charges,113.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,113.49,97,,,percent of total billed charges,97% of total billed charges,87.75,75,,,percent of total billed charges,75% of total billed charges,112.32,96,,,percent of total billed charges,96% of total billed charges,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,87.75,75,,,percent of total billed charges,75% of total billed charges,87.75,75,,,percent of total billed charges,75% of total billed charges,1,113.49,
PF XR CALCANEUS MINIMUM 2 VIEWS LT,71800319P,CDM,972,RC,73650,HCPCS,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72.54,93,,,percent of total billed charges,93% of total billed charges,70.2,90,,,percent of total billed charges,90% of total billed charges,70.2,90,,,percent of total billed charges,90% of total billed charges,75.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.66,97,,,percent of total billed charges,97% of total billed charges,58.5,75,,,percent of total billed charges,75% of total billed charges,74.88,96,,,percent of total billed charges,96% of total billed charges,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,58.5,75,,,percent of total billed charges,75% of total billed charges,58.5,75,,,percent of total billed charges,75% of total billed charges,1,75.66,
PF XR CALCANEUS MINIMUM 2 VIEWS RT,71800319P,CDM,972,RC,73650,HCPCS,Outpatient,,,78,58.5,,71.76,92,,,percent of total billed charges,92% of total billed charges,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72.54,93,,,percent of total billed charges,93% of total billed charges,70.2,90,,,percent of total billed charges,90% of total billed charges,70.2,90,,,percent of total billed charges,90% of total billed charges,75.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.66,97,,,percent of total billed charges,97% of total billed charges,58.5,75,,,percent of total billed charges,75% of total billed charges,74.88,96,,,percent of total billed charges,96% of total billed charges,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,58.5,75,,,percent of total billed charges,75% of total billed charges,58.5,75,,,percent of total billed charges,75% of total billed charges,1,75.66,
PF XR CHEST SINGLE VIEW,71800060P,CDM,972,RC,71045,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges,0.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.1,93,,,percent of total billed charges,93% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,67.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,67.9,97,,,percent of total billed charges,97% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,67.2,96,,,percent of total billed charges,96% of total billed charges,0.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,52.5,75,,,percent of total billed charges,75% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,0.87,67.9,
PF XR CHEST 1 VIEW PORTABLE,71800060P,CDM,972,RC,71045,HCPCS,Outpatient,,,70,52.5,,64.4,92,,,percent of total billed charges,92% of total billed charges,0.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.1,93,,,percent of total billed charges,93% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,63,90,,,percent of total billed charges,90% of total billed charges,67.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,67.9,97,,,percent of total billed charges,97% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,67.2,96,,,percent of total billed charges,96% of total billed charges,0.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,52.5,75,,,percent of total billed charges,75% of total billed charges,52.5,75,,,percent of total billed charges,75% of total billed charges,0.87,67.9,
PF XR CHEST 2 VIEWS,71800062P,CDM,972,RC,71046,HCPCS,Outpatient,,,91,68.25,,83.72,92,,,percent of total billed charges,92% of total billed charges,1.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.63,93,,,percent of total billed charges,93% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,88.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,88.27,97,,,percent of total billed charges,97% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,87.36,96,,,percent of total billed charges,96% of total billed charges,1.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,68.25,75,,,percent of total billed charges,75% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,1.08,88.27,
PF XR CHOLANGIOGRAM IN OR,71800385P,CDM,972,RC,74300,HCPCS,Outpatient,,,131,98.25,,120.52,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,121.83,93,,,percent of total billed charges,93% of total billed charges,117.9,90,,,percent of total billed charges,90% of total billed charges,117.9,90,,,percent of total billed charges,90% of total billed charges,127.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,127.07,97,,,percent of total billed charges,97% of total billed charges,98.25,75,,,percent of total billed charges,75% of total billed charges,125.76,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,98.25,75,,,percent of total billed charges,75% of total billed charges,98.25,75,,,percent of total billed charges,75% of total billed charges,98.25,127.07,
PF XR CHOLANGIOGRAM IN OR ADD SET(S),71800387P,CDM,972,RC,74301,HCPCS,Outpatient,,,82,61.5,,75.44,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,76.26,93,,,percent of total billed charges,93% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,73.8,90,,,percent of total billed charges,90% of total billed charges,79.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,79.54,97,,,percent of total billed charges,97% of total billed charges,61.5,75,,,percent of total billed charges,75% of total billed charges,78.72,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,61.5,75,,,percent of total billed charges,75% of total billed charges,61.5,75,,,percent of total billed charges,75% of total billed charges,61.5,79.54,
PF XR CLAVICLE COMPLETE BILATERAL,71800164P,CDM,972,RC,73000,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,1.12,84.39,
PF XR CLAVICLE COMPLETE LEFT,71800162P,CDM,972,RC,73000,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,1.12,84.39,
PF XR CLAVICLE COMPLETE RIGHT,71800162P,CDM,972,RC,73000,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,1.12,84.39,
PF XR COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,71800381P,CDM,972,RC,74280,HCPCS,Outpatient,,,316,237,,290.72,92,,,percent of total billed charges,92% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,293.88,93,,,percent of total billed charges,93% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,306.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.52,97,,,percent of total billed charges,97% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,303.36,96,,,percent of total billed charges,96% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237,75,,,percent of total billed charges,75% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,6.09,306.52,
PF XR CYSTOGRAM,71800404P,CDM,972,RC,74430,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117.18,93,,,percent of total billed charges,93% of total billed charges,113.4,90,,,percent of total billed charges,90% of total billed charges,113.4,90,,,percent of total billed charges,90% of total billed charges,122.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,122.22,97,,,percent of total billed charges,97% of total billed charges,94.5,75,,,percent of total billed charges,75% of total billed charges,120.96,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,94.5,75,,,percent of total billed charges,75% of total billed charges,94.5,75,,,percent of total billed charges,75% of total billed charges,1.18,122.22,
PF XR ELBOW 1 VIEW BILATERAL,71800190P,CDM,972,RC,73070,HCPCS,Outpatient,,,79,59.25,,72.68,92,,,percent of total billed charges,92% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.47,93,,,percent of total billed charges,93% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,76.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.63,97,,,percent of total billed charges,97% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,75.84,96,,,percent of total billed charges,96% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,59.25,75,,,percent of total billed charges,75% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,1.01,76.63,
PF XR ELBOW 1 VIEW LEFT,71800188P,CDM,972,RC,73070,HCPCS,Outpatient,,,79,59.25,,72.68,92,,,percent of total billed charges,92% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.47,93,,,percent of total billed charges,93% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,76.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.63,97,,,percent of total billed charges,97% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,75.84,96,,,percent of total billed charges,96% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,59.25,75,,,percent of total billed charges,75% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,1.01,76.63,
PF XR ELBOW 1 VIEW RIGHT,71800188P,CDM,972,RC,73070,HCPCS,Outpatient,,,79,59.25,,72.68,92,,,percent of total billed charges,92% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.47,93,,,percent of total billed charges,93% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,76.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.63,97,,,percent of total billed charges,97% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,75.84,96,,,percent of total billed charges,96% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,59.25,75,,,percent of total billed charges,75% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,1.01,76.63,
PF XR ELBOW 2 VIEWS BILATERAL,71800191P,CDM,972,RC,73070,HCPCS,Outpatient,,,79,59.25,,72.68,92,,,percent of total billed charges,92% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.47,93,,,percent of total billed charges,93% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,76.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.63,97,,,percent of total billed charges,97% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,75.84,96,,,percent of total billed charges,96% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,59.25,75,,,percent of total billed charges,75% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,1.01,76.63,
PF XR ELBOW 2 VIEWS LEFT,71800189P,CDM,972,RC,73070,HCPCS,Outpatient,,,79,59.25,,72.68,92,,,percent of total billed charges,92% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.47,93,,,percent of total billed charges,93% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,76.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.63,97,,,percent of total billed charges,97% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,75.84,96,,,percent of total billed charges,96% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,59.25,75,,,percent of total billed charges,75% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,1.01,76.63,
PF XR ELBOW 2 VIEWS RIGHT,71800189P,CDM,972,RC,73070,HCPCS,Outpatient,,,79,59.25,,72.68,92,,,percent of total billed charges,92% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.47,93,,,percent of total billed charges,93% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,76.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.63,97,,,percent of total billed charges,97% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,75.84,96,,,percent of total billed charges,96% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,59.25,75,,,percent of total billed charges,75% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,1.01,76.63,
PF XR ELBOW COMPLETE 3+ VIEWS BILATERAL,71800196P,CDM,972,RC,73080,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.12,85.36,
PF XR ELBOW COMPLETE 3+ VIEWS LEFT,71800194P,CDM,972,RC,73080,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.12,85.36,
PF XR ELBOW COMPLETE 3+ VIEWS RIGHT,71800194P,CDM,972,RC,73080,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.12,85.36,
PF XR ESOPHAGUS,71800370P,CDM,972,RC,74220,HCPCS,Outpatient,,,273,204.75,,251.16,92,,,percent of total billed charges,92% of total billed charges,2.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,253.89,93,,,percent of total billed charges,93% of total billed charges,245.7,90,,,percent of total billed charges,90% of total billed charges,245.7,90,,,percent of total billed charges,90% of total billed charges,264.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,264.81,97,,,percent of total billed charges,97% of total billed charges,204.75,75,,,percent of total billed charges,75% of total billed charges,262.08,96,,,percent of total billed charges,96% of total billed charges,2.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.75,75,,,percent of total billed charges,75% of total billed charges,204.75,75,,,percent of total billed charges,75% of total billed charges,2.66,264.81,
PF XR FACET INJECTION CERV/THOR LV1 LEFT,78001756P,CDM,972,RC,64490,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,386.88,93,,,percent of total billed charges,93% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,403.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.52,97,,,percent of total billed charges,97% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,399.36,96,,,percent of total billed charges,96% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312,75,,,percent of total billed charges,75% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,8.5,403.52,
PF XR FACET INJECTION CERV/THOR LV1 RIGHT,78001756P,CDM,972,RC,64490,HCPCS,Outpatient,,,416,312,,382.72,92,,,percent of total billed charges,92% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,386.88,93,,,percent of total billed charges,93% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,374.4,90,,,percent of total billed charges,90% of total billed charges,403.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.52,97,,,percent of total billed charges,97% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,399.36,96,,,percent of total billed charges,96% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312,75,,,percent of total billed charges,75% of total billed charges,312,75,,,percent of total billed charges,75% of total billed charges,8.5,403.52,
PF XR FACET INJECTION CERV/THOR LV2 LEFT,78001758P,CDM,972,RC,64491,HCPCS,Outpatient,,,191,143.25,,175.72,92,,,percent of total billed charges,92% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.63,93,,,percent of total billed charges,93% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,185.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.27,97,,,percent of total billed charges,97% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,183.36,96,,,percent of total billed charges,96% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.25,75,,,percent of total billed charges,75% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,5.28,185.27,
XR FACET INJECTION CERV/THOR LV2 RIGHT,78001758P,CDM,972,RC,64491,HCPCS,Outpatient,,,191,143.25,,175.72,92,,,percent of total billed charges,92% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.63,93,,,percent of total billed charges,93% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,171.9,90,,,percent of total billed charges,90% of total billed charges,185.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,185.27,97,,,percent of total billed charges,97% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,183.36,96,,,percent of total billed charges,96% of total billed charges,5.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.25,75,,,percent of total billed charges,75% of total billed charges,143.25,75,,,percent of total billed charges,75% of total billed charges,5.28,185.27,
PF XR FACET INJECTION CERV/THOR LV3+ RIGHT,78001760P,CDM,972,RC,64492,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.56,93,,,percent of total billed charges,93% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,186.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.24,97,,,percent of total billed charges,97% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,184.32,96,,,percent of total billed charges,96% of total billed charges,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144,75,,,percent of total billed charges,75% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,5.32,186.24,
PF XR FACET INJECTION CERV/THOR LV3+ LEFT,78001760P,CDM,972,RC,64492,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.56,93,,,percent of total billed charges,93% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,186.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.24,97,,,percent of total billed charges,97% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,184.32,96,,,percent of total billed charges,96% of total billed charges,5.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144,75,,,percent of total billed charges,75% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,5.32,186.24,
PF XR FACET INJECTION LUMB/SACR LV1 LEFT,78001762P,CDM,972,RC,64493,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,7.18,343.38,
PF XR FACET INJECTION LUMB/SACR LV1 RIGHT,78001762P,CDM,972,RC,64493,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,7.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,7.18,343.38,
PF XR FACET INJECTION LUMB/SACR LV2 LEFT,78001764P,CDM,972,RC,64494,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.55,93,,,percent of total billed charges,93% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,130.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.95,97,,,percent of total billed charges,97% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,129.6,96,,,percent of total billed charges,96% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.25,75,,,percent of total billed charges,75% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,4.45,130.95,
PF XR FACET INJECTION LUMB/SACR LV2 RIGHT,78001764P,CDM,972,RC,64494,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.55,93,,,percent of total billed charges,93% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,130.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.95,97,,,percent of total billed charges,97% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,129.6,96,,,percent of total billed charges,96% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.25,75,,,percent of total billed charges,75% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,4.45,130.95,
PF XR FACET INJECTION LUMB/SACR LV3+ LEFT,78001766P,CDM,972,RC,64495,HCPCS,Outpatient,,,137,102.75,,126.04,92,,,percent of total billed charges,92% of total billed charges,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.41,93,,,percent of total billed charges,93% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,132.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.89,97,,,percent of total billed charges,97% of total billed charges,102.75,75,,,percent of total billed charges,75% of total billed charges,131.52,96,,,percent of total billed charges,96% of total billed charges,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102.75,75,,,percent of total billed charges,75% of total billed charges,102.75,75,,,percent of total billed charges,75% of total billed charges,4.48,132.89,
PF XR FACET INJECTION LUMB/SACR LV3+ RIGHT,78001766P,CDM,972,RC,64495,HCPCS,Outpatient,,,137,102.75,,126.04,92,,,percent of total billed charges,92% of total billed charges,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.41,93,,,percent of total billed charges,93% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,123.3,90,,,percent of total billed charges,90% of total billed charges,132.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.89,97,,,percent of total billed charges,97% of total billed charges,102.75,75,,,percent of total billed charges,75% of total billed charges,131.52,96,,,percent of total billed charges,96% of total billed charges,4.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102.75,75,,,percent of total billed charges,75% of total billed charges,102.75,75,,,percent of total billed charges,75% of total billed charges,4.48,132.89,
PF XR FACIAL BONES 3+ VIEWS,71800010P,CDM,972,RC,70150,HCPCS,Outpatient,,,129,96.75,,118.68,92,,,percent of total billed charges,92% of total billed charges,1.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,119.97,93,,,percent of total billed charges,93% of total billed charges,116.1,90,,,percent of total billed charges,90% of total billed charges,116.1,90,,,percent of total billed charges,90% of total billed charges,125.13,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.13,97,,,percent of total billed charges,97% of total billed charges,96.75,75,,,percent of total billed charges,75% of total billed charges,123.84,96,,,percent of total billed charges,96% of total billed charges,1.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,96.75,75,,,percent of total billed charges,75% of total billed charges,96.75,75,,,percent of total billed charges,75% of total billed charges,1.48,125.13,
PF XR FACIAL BONES < 3 VIEWS,71800008P,CDM,972,RC,70140,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,1.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,1.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,1.05,84.39,
PF XR FEMUR 2 VIEWS BILAT,71800269P,CDM,972,RC,73552,HCPCS,Outpatient,,,95,71.25,,87.4,92,,,percent of total billed charges,92% of total billed charges,1.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,88.35,93,,,percent of total billed charges,93% of total billed charges,85.5,90,,,percent of total billed charges,90% of total billed charges,85.5,90,,,percent of total billed charges,90% of total billed charges,92.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,92.15,97,,,percent of total billed charges,97% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges,91.2,96,,,percent of total billed charges,96% of total billed charges,1.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.25,75,,,percent of total billed charges,75% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges,1.2,92.15,
PF XR FEMUR 2 VIEWS LEFT,71800269P,CDM,972,RC,73552,HCPCS,Outpatient,,,95,71.25,,87.4,92,,,percent of total billed charges,92% of total billed charges,1.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,88.35,93,,,percent of total billed charges,93% of total billed charges,85.5,90,,,percent of total billed charges,90% of total billed charges,85.5,90,,,percent of total billed charges,90% of total billed charges,92.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,92.15,97,,,percent of total billed charges,97% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges,91.2,96,,,percent of total billed charges,96% of total billed charges,1.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.25,75,,,percent of total billed charges,75% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges,1.2,92.15,
PF XR FEMUR 2 VIEWS RIGHT,71800269P,CDM,972,RC,73552,HCPCS,Outpatient,,,95,71.25,,87.4,92,,,percent of total billed charges,92% of total billed charges,1.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,88.35,93,,,percent of total billed charges,93% of total billed charges,85.5,90,,,percent of total billed charges,90% of total billed charges,85.5,90,,,percent of total billed charges,90% of total billed charges,92.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,92.15,97,,,percent of total billed charges,97% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges,91.2,96,,,percent of total billed charges,96% of total billed charges,1.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.25,75,,,percent of total billed charges,75% of total billed charges,71.25,75,,,percent of total billed charges,75% of total billed charges,1.2,92.15,
PF XR FINGER MINIMUM 2 VIEWS BILATERAL,71800521P,CDM,972,RC,73140,HCPCS,Outpatient,,,152,114,,139.84,92,,,percent of total billed charges,92% of total billed charges,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.36,93,,,percent of total billed charges,93% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,147.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.44,97,,,percent of total billed charges,97% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,145.92,96,,,percent of total billed charges,96% of total billed charges,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,114,75,,,percent of total billed charges,75% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,1.36,147.44,
PF XR FINGER MINIMUM 2 VIEWS LT,71800230P,CDM,972,RC,73140,HCPCS,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,1.36,97.97,
PF XR FINGER MINIMUM 2 VIEWS LT,71800230P,CDM,972,RC,73140,HCPCS,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,1.36,97.97,
PF XR FINGER MINIMUM 2 VIEWS RT,71800230P,CDM,972,RC,73140,HCPCS,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,1.36,97.97,
PF XR FINGER MINIMUM 2 VIEWS RT,71800230P,CDM,972,RC,73140,HCPCS,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,1.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,1.36,97.97,
PF XR FLUORO GUIDANCE NEEDLE LOC SPINE,71800468P,CDM,972,RC,77003,HCPCS,Outpatient,,,286,214.5,,263.12,92,,,percent of total billed charges,92% of total billed charges,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.98,93,,,percent of total billed charges,93% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,257.4,90,,,percent of total billed charges,90% of total billed charges,277.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.42,97,,,percent of total billed charges,97% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,274.56,96,,,percent of total billed charges,96% of total billed charges,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.5,75,,,percent of total billed charges,75% of total billed charges,214.5,75,,,percent of total billed charges,75% of total billed charges,2.93,277.42,
PF XR FLUORO GUIDANCE NEEDLE PLACEMENT,71800466P,CDM,972,RC,77002,HCPCS,Outpatient,,,316,237,,290.72,92,,,percent of total billed charges,92% of total billed charges,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,293.88,93,,,percent of total billed charges,93% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,306.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.52,97,,,percent of total billed charges,97% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,303.36,96,,,percent of total billed charges,96% of total billed charges,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237,75,,,percent of total billed charges,75% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,3.36,306.52,
PF XR FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,71800466P,CDM,972,RC,77002,HCPCS,Outpatient,,,316,237,,290.72,92,,,percent of total billed charges,92% of total billed charges,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,293.88,93,,,percent of total billed charges,93% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,306.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.52,97,,,percent of total billed charges,97% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,303.36,96,,,percent of total billed charges,96% of total billed charges,3.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237,75,,,percent of total billed charges,75% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,3.36,306.52,
PF XR FLUOROSCOPY UNDER 1 HOUR,71800420P,CDM,972,RC,76000,HCPCS,Outpatient,,,127,95.25,,116.84,92,,,percent of total billed charges,92% of total billed charges,1.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,118.11,93,,,percent of total billed charges,93% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,123.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,123.19,97,,,percent of total billed charges,97% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,121.92,96,,,percent of total billed charges,96% of total billed charges,1.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,95.25,75,,,percent of total billed charges,75% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,1.24,123.19,
PF XR FOOT 2 VIEWS BILATERAL,71800313P,CDM,972,RC,73620,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,1.01,73.72,
PF XR FOOT 2 VIEWS LEFT,71800311P,CDM,972,RC,73620,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,1.01,73.72,
PF XR FOOT 2 VIEWS RIGHT,71800311P,CDM,972,RC,73620,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,1.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,1.01,73.72,
PF XR FOOT COMPLETE 3+ VIEWS BILATERAL,71800317P,CDM,972,RC,73630,HCPCS,Outpatient,,,93,69.75,,85.56,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,86.49,93,,,percent of total billed charges,93% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,90.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90.21,97,,,percent of total billed charges,97% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,89.28,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,75,,,percent of total billed charges,75% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,1.18,90.21,
PF XR FOOT COMPLETE 3+ VIEWS LEFT,71800315P,CDM,972,RC,73630,HCPCS,Outpatient,,,93,69.75,,85.56,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,86.49,93,,,percent of total billed charges,93% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,90.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90.21,97,,,percent of total billed charges,97% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,89.28,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,75,,,percent of total billed charges,75% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,1.18,90.21,
PF XR FOOT COMPLETE 3+ VIEWS RIGHT,71800315P,CDM,972,RC,73630,HCPCS,Outpatient,,,93,69.75,,85.56,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,86.49,93,,,percent of total billed charges,93% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,90.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90.21,97,,,percent of total billed charges,97% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,89.28,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,75,,,percent of total billed charges,75% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,1.18,90.21,
PF XR FOREARM 2 VIEWS BILATERAL,71800317P,CDM,972,RC,73090,HCPCS,Outpatient,,,79,59.25,,72.68,92,,,percent of total billed charges,92% of total billed charges,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.47,93,,,percent of total billed charges,93% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,76.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.63,97,,,percent of total billed charges,97% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,75.84,96,,,percent of total billed charges,96% of total billed charges,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,59.25,75,,,percent of total billed charges,75% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,1.02,76.63,
PF XR FOREARM 2 VIEWS LEFT,71800315P,CDM,972,RC,73090,HCPCS,Outpatient,,,79,59.25,,72.68,92,,,percent of total billed charges,92% of total billed charges,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.47,93,,,percent of total billed charges,93% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,76.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.63,97,,,percent of total billed charges,97% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,75.84,96,,,percent of total billed charges,96% of total billed charges,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,59.25,75,,,percent of total billed charges,75% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,1.02,76.63,
PF XR FOREARM 2 VIEWS RIGHT,71800315P,CDM,972,RC,73090,HCPCS,Outpatient,,,79,59.25,,72.68,92,,,percent of total billed charges,92% of total billed charges,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.47,93,,,percent of total billed charges,93% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,71.1,90,,,percent of total billed charges,90% of total billed charges,76.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.63,97,,,percent of total billed charges,97% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,75.84,96,,,percent of total billed charges,96% of total billed charges,1.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,59.25,75,,,percent of total billed charges,75% of total billed charges,59.25,75,,,percent of total billed charges,75% of total billed charges,1.02,76.63,
PF XR FOREIGN BODY LOCALIZATION CHILD 1 VW,71800422P,CDM,972,RC,76010,HCPCS,Outpatient,,,81,60.75,,74.52,92,,,percent of total billed charges,92% of total billed charges,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.33,93,,,percent of total billed charges,93% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,72.9,90,,,percent of total billed charges,90% of total billed charges,78.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.57,97,,,percent of total billed charges,97% of total billed charges,60.75,75,,,percent of total billed charges,75% of total billed charges,77.76,96,,,percent of total billed charges,96% of total billed charges,1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,60.75,75,,,percent of total billed charges,75% of total billed charges,60.75,75,,,percent of total billed charges,75% of total billed charges,1,78.57,
PF XR FOREIGN BODY LOCALIZATION EYE,71800002P,CDM,972,RC,70030,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.11,85.36,
PF XR HAND 2 VIEWS BILATERAL,71800224P,CDM,972,RC,73120,HCPCS,Outpatient,,,84,63,,77.28,92,,,percent of total billed charges,92% of total billed charges,1.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.12,93,,,percent of total billed charges,93% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,81.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.48,97,,,percent of total billed charges,97% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,80.64,96,,,percent of total billed charges,96% of total billed charges,1.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63,75,,,percent of total billed charges,75% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,1.09,81.48,
PF XR HAND 2 VIEWS LEFT,71800222P,CDM,972,RC,73120,HCPCS,Outpatient,,,84,63,,77.28,92,,,percent of total billed charges,92% of total billed charges,1.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.12,93,,,percent of total billed charges,93% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,81.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.48,97,,,percent of total billed charges,97% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,80.64,96,,,percent of total billed charges,96% of total billed charges,1.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63,75,,,percent of total billed charges,75% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,1.09,81.48,
PF XR HAND 2 VIEWS RIGHT,71800222P,CDM,972,RC,73120,HCPCS,Outpatient,,,84,63,,77.28,92,,,percent of total billed charges,92% of total billed charges,1.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.12,93,,,percent of total billed charges,93% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,81.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.48,97,,,percent of total billed charges,97% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,80.64,96,,,percent of total billed charges,96% of total billed charges,1.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63,75,,,percent of total billed charges,75% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,1.09,81.48,
PF XR HAND COMPLETE 3+ VIEWS BILATERAL,71800228P,CDM,972,RC,73130,HCPCS,Outpatient,,,99,74.25,,91.08,92,,,percent of total billed charges,92% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,92.07,93,,,percent of total billed charges,93% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,96.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,96.03,97,,,percent of total billed charges,97% of total billed charges,74.25,75,,,percent of total billed charges,75% of total billed charges,95.04,96,,,percent of total billed charges,96% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.25,75,,,percent of total billed charges,75% of total billed charges,74.25,75,,,percent of total billed charges,75% of total billed charges,1.27,96.03,
PF XR HAND COMPLETE 3+ VIEWS LEFT,71800226P,CDM,972,RC,73130,HCPCS,Outpatient,,,99,74.25,,91.08,92,,,percent of total billed charges,92% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,92.07,93,,,percent of total billed charges,93% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,96.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,96.03,97,,,percent of total billed charges,97% of total billed charges,74.25,75,,,percent of total billed charges,75% of total billed charges,95.04,96,,,percent of total billed charges,96% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.25,75,,,percent of total billed charges,75% of total billed charges,74.25,75,,,percent of total billed charges,75% of total billed charges,1.27,96.03,
PF XR HAND COMPLETE 3+ VIEWS RIGHT,71800226P,CDM,972,RC,73130,HCPCS,Outpatient,,,99,74.25,,91.08,92,,,percent of total billed charges,92% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,92.07,93,,,percent of total billed charges,93% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,89.1,90,,,percent of total billed charges,90% of total billed charges,96.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,96.03,97,,,percent of total billed charges,97% of total billed charges,74.25,75,,,percent of total billed charges,75% of total billed charges,95.04,96,,,percent of total billed charges,96% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.25,75,,,percent of total billed charges,75% of total billed charges,74.25,75,,,percent of total billed charges,75% of total billed charges,1.27,96.03,
PF XR HIP 1 VIEW LEFT,71800255P,CDM,972,RC,73501,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.1,85.36,
PF XR HIP 1 VIEW RIGHT,71800255P,CDM,972,RC,73501,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.1,85.36,
PF XR HIP WITH PELVIS 1 VIEW BILATERAL,71800257P,CDM,972,RC,73501,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.1,85.36,
PF XR HIP 1 VIEW W/ AP PELVIS LEFT,71800255P,CDM,972,RC,73501,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.1,85.36,
PF XR HIP 1 VIEW W/ AP PELVIS RIGHT,71800255P,CDM,972,RC,73501,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.1,85.36,
PF XR HIP 2-3 VIEWS LEFT,71800259P,CDM,972,RC,73502,HCPCS,Outpatient,,,127,95.25,,116.84,92,,,percent of total billed charges,92% of total billed charges,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,118.11,93,,,percent of total billed charges,93% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,123.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,123.19,97,,,percent of total billed charges,97% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,121.92,96,,,percent of total billed charges,96% of total billed charges,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,95.25,75,,,percent of total billed charges,75% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,1.55,123.19,
PF XR HIPS 2-3 VIEWS RIGHT,71800259P,CDM,972,RC,73502,HCPCS,Outpatient,,,127,95.25,,116.84,92,,,percent of total billed charges,92% of total billed charges,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,118.11,93,,,percent of total billed charges,93% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,123.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,123.19,97,,,percent of total billed charges,97% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,121.92,96,,,percent of total billed charges,96% of total billed charges,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,95.25,75,,,percent of total billed charges,75% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,1.55,123.19,
PF XR HIP 2-3 VIEWS W/AP PELVIS LEFT,71800259P,CDM,972,RC,73502,HCPCS,Outpatient,,,127,95.25,,116.84,92,,,percent of total billed charges,92% of total billed charges,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,118.11,93,,,percent of total billed charges,93% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,123.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,123.19,97,,,percent of total billed charges,97% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,121.92,96,,,percent of total billed charges,96% of total billed charges,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,95.25,75,,,percent of total billed charges,75% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,1.55,123.19,
PF XR HIP 2-3 VIEWS W/AP PELVIS RIGHT,71800259P,CDM,972,RC,73502,HCPCS,Outpatient,,,127,95.25,,116.84,92,,,percent of total billed charges,92% of total billed charges,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,118.11,93,,,percent of total billed charges,93% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,123.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,123.19,97,,,percent of total billed charges,97% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,121.92,96,,,percent of total billed charges,96% of total billed charges,1.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,95.25,75,,,percent of total billed charges,75% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,1.55,123.19,
PF XR HIPS 2 VIEWS W/AP PELVIS BILAT,71800263P,CDM,972,RC,73521,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,1.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,1.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,1.33,107.67,
PF XR HUMERUS BILAT,71800186P,CDM,972,RC,73060,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.98,93,,,percent of total billed charges,93% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,83.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.42,97,,,percent of total billed charges,97% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,82.56,96,,,percent of total billed charges,96% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.5,75,,,percent of total billed charges,75% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,1.11,83.42,
PF XR HUMERUS LEFT,71800184P,CDM,972,RC,73060,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.98,93,,,percent of total billed charges,93% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,83.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.42,97,,,percent of total billed charges,97% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,82.56,96,,,percent of total billed charges,96% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.5,75,,,percent of total billed charges,75% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,1.11,83.42,
PF XR HUMERUS RIGHT,71800184P,CDM,972,RC,73060,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.98,93,,,percent of total billed charges,93% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,83.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.42,97,,,percent of total billed charges,97% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,82.56,96,,,percent of total billed charges,96% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.5,75,,,percent of total billed charges,75% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,1.11,83.42,
PF XR HYSTEROSALPINGOGRAPHY RS&I,71800414P,CDM,972,RC,74740,HCPCS,Outpatient,,,267,200.25,,245.64,92,,,percent of total billed charges,92% of total billed charges,2.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,248.31,93,,,percent of total billed charges,93% of total billed charges,240.3,90,,,percent of total billed charges,90% of total billed charges,240.3,90,,,percent of total billed charges,90% of total billed charges,258.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,258.99,97,,,percent of total billed charges,97% of total billed charges,200.25,75,,,percent of total billed charges,75% of total billed charges,256.32,96,,,percent of total billed charges,96% of total billed charges,2.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,200.25,75,,,percent of total billed charges,75% of total billed charges,200.25,75,,,percent of total billed charges,75% of total billed charges,2.88,258.99,
XR IVP,71800396P,CDM,972,RC,74400,HCPCS,Outpatient,,,375,281.25,,345,92,,,percent of total billed charges,92% of total billed charges,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,348.75,93,,,percent of total billed charges,93% of total billed charges,337.5,90,,,percent of total billed charges,90% of total billed charges,337.5,90,,,percent of total billed charges,90% of total billed charges,363.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,363.75,97,,,percent of total billed charges,97% of total billed charges,281.25,75,,,percent of total billed charges,75% of total billed charges,360,96,,,percent of total billed charges,96% of total billed charges,4.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,281.25,75,,,percent of total billed charges,75% of total billed charges,281.25,75,,,percent of total billed charges,75% of total billed charges,4.41,363.75,
PF XR KNEE 1 VIEW STANDING AP BILATERAL,71800285P,CDM,972,RC,73565,HCPCS,Outpatient,,,110,82.5,,101.2,92,,,percent of total billed charges,92% of total billed charges,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102.3,93,,,percent of total billed charges,93% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,99,90,,,percent of total billed charges,90% of total billed charges,106.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.7,97,,,percent of total billed charges,97% of total billed charges,82.5,75,,,percent of total billed charges,75% of total billed charges,105.6,96,,,percent of total billed charges,96% of total billed charges,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,82.5,75,,,percent of total billed charges,75% of total billed charges,82.5,75,,,percent of total billed charges,75% of total billed charges,1.38,106.7,
PF XR KNEE 1 OR 2 VIEWS BILATERAL,71800275P,CDM,972,RC,73560,HCPCS,Outpatient,,,92,69,,84.64,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.56,93,,,percent of total billed charges,93% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,89.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,89.24,97,,,percent of total billed charges,97% of total billed charges,69,75,,,percent of total billed charges,75% of total billed charges,88.32,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69,75,,,percent of total billed charges,75% of total billed charges,69,75,,,percent of total billed charges,75% of total billed charges,1.18,89.24,
PF XR KNEE 1 OR 2 VIEWS LEFT,71800273P,CDM,972,RC,73560,HCPCS,Outpatient,,,92,69,,84.64,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.56,93,,,percent of total billed charges,93% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,89.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,89.24,97,,,percent of total billed charges,97% of total billed charges,69,75,,,percent of total billed charges,75% of total billed charges,88.32,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69,75,,,percent of total billed charges,75% of total billed charges,69,75,,,percent of total billed charges,75% of total billed charges,1.18,89.24,
PF XR KNEE 1 OR 2 VIEWS RIGHT,71800273P,CDM,972,RC,73560,HCPCS,Outpatient,,,92,69,,84.64,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.56,93,,,percent of total billed charges,93% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,82.8,90,,,percent of total billed charges,90% of total billed charges,89.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,89.24,97,,,percent of total billed charges,97% of total billed charges,69,75,,,percent of total billed charges,75% of total billed charges,88.32,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69,75,,,percent of total billed charges,75% of total billed charges,69,75,,,percent of total billed charges,75% of total billed charges,1.18,89.24,
PF XR KNEE 3 VIEWS BILATERAL,71800279P,CDM,972,RC,73562,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,1.38,107.67,
PF XR KNEE 3 VIEWS LEFT,71800277P,CDM,972,RC,73562,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,1.38,107.67,
PF XR KNEE 3 VIEWS RIGHT,71800277P,CDM,972,RC,73562,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,1.38,107.67,
PF XR KNEE COMPLETE 4+ VIEWS BILATERAL,71800283P,CDM,972,RC,73564,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges,1.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,93,,,percent of total billed charges,93% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,121.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,121.25,97,,,percent of total billed charges,97% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,120,96,,,percent of total billed charges,96% of total billed charges,1.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.75,75,,,percent of total billed charges,75% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,1.52,121.25,
PF XR KNEE COMPLETE 4+ VIEWS LEFT,71800281P,CDM,972,RC,73564,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges,1.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,93,,,percent of total billed charges,93% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,121.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,121.25,97,,,percent of total billed charges,97% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,120,96,,,percent of total billed charges,96% of total billed charges,1.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.75,75,,,percent of total billed charges,75% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,1.52,121.25,
PF XR KNEE COMPLETE 4+ VIEWS RIGHT,71800281P,CDM,972,RC,73564,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges,1.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,93,,,percent of total billed charges,93% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,121.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,121.25,97,,,percent of total billed charges,97% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,120,96,,,percent of total billed charges,96% of total billed charges,1.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.75,75,,,percent of total billed charges,75% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,1.52,121.25,
PF XR LOWER EXTREMITY INFANT 2 VIEWS BILAT,71800297P,CDM,972,RC,73592,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.98,93,,,percent of total billed charges,93% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,83.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.42,97,,,percent of total billed charges,97% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,82.56,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.5,75,,,percent of total billed charges,75% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,1.1,83.42,
PF XR LOWER EXTREMITY INFANT 2 VIEWS LEFT,71800295P,CDM,972,RC,73592,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.98,93,,,percent of total billed charges,93% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,83.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.42,97,,,percent of total billed charges,97% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,82.56,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.5,75,,,percent of total billed charges,75% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,1.1,83.42,
PF XR LOWER EXTREMITY INFANT 2 VIEWS RIGHT,71800295P,CDM,972,RC,73592,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.98,93,,,percent of total billed charges,93% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,83.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.42,97,,,percent of total billed charges,97% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,82.56,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.5,75,,,percent of total billed charges,75% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,1.1,83.42,
PF XR MANDIBLE COMPLETE 4+ VIEWS,71800006P,CDM,972,RC,70110,HCPCS,Outpatient,,,119,89.25,,109.48,92,,,percent of total billed charges,92% of total billed charges,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.67,93,,,percent of total billed charges,93% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,115.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,115.43,97,,,percent of total billed charges,97% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,114.24,96,,,percent of total billed charges,96% of total billed charges,1.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,89.25,75,,,percent of total billed charges,75% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,1.38,115.43,
PF XR MANDIBLE LESS THAN 4 VIEWS,71800004P,CDM,972,RC,70100,HCPCS,Outpatient,,,104,78,,95.68,92,,,percent of total billed charges,92% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,96.72,93,,,percent of total billed charges,93% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,93.6,90,,,percent of total billed charges,90% of total billed charges,100.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.88,97,,,percent of total billed charges,97% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges,99.84,96,,,percent of total billed charges,96% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78,75,,,percent of total billed charges,75% of total billed charges,78,75,,,percent of total billed charges,75% of total billed charges,1.32,100.88,
PF XR MODIFIED BARIUM SWALLOW,71800372P,CDM,972,RC,74230,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,3.71,343.38,
PF MYELOGRAPHY VIA LUMBAR INJECTION S  and  I 2+ REGN,78002211P,CDM,972,RC,62305,HCPCS,Outpatient,,,323,242.25,,297.16,92,,,percent of total billed charges,92% of total billed charges,10.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.39,93,,,percent of total billed charges,93% of total billed charges,290.7,90,,,percent of total billed charges,90% of total billed charges,290.7,90,,,percent of total billed charges,90% of total billed charges,313.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,313.31,97,,,percent of total billed charges,97% of total billed charges,242.25,75,,,percent of total billed charges,75% of total billed charges,310.08,96,,,percent of total billed charges,96% of total billed charges,10.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,242.25,75,,,percent of total billed charges,75% of total billed charges,242.25,75,,,percent of total billed charges,75% of total billed charges,10.11,313.31,
PF MYELOGRAPHY LUMBAR INJECTION CERVCAL WITH S  and  I,78002205P,CDM,972,RC,62302,HCPCS,Outpatient,,,313,234.75,,287.96,92,,,percent of total billed charges,92% of total billed charges,10.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,291.09,93,,,percent of total billed charges,93% of total billed charges,281.7,90,,,percent of total billed charges,90% of total billed charges,281.7,90,,,percent of total billed charges,90% of total billed charges,303.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,303.61,97,,,percent of total billed charges,97% of total billed charges,234.75,75,,,percent of total billed charges,75% of total billed charges,300.48,96,,,percent of total billed charges,96% of total billed charges,10.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,234.75,75,,,percent of total billed charges,75% of total billed charges,234.75,75,,,percent of total billed charges,75% of total billed charges,10.01,303.61,
PF MYELOGRAPHY LUMBAR INJECT LUMBOSACRAL WI/S  and  I,78002209P,CDM,972,RC,62304,HCPCS,Outpatient,,,310,232.5,,285.2,92,,,percent of total billed charges,92% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.3,93,,,percent of total billed charges,93% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,300.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.7,97,,,percent of total billed charges,97% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,297.6,96,,,percent of total billed charges,96% of total billed charges,9.96,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,232.5,75,,,percent of total billed charges,75% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,9.96,300.7,
PF MYELOGRAPHY LUMBAR INJECT THORACIC WITH S  and  I,78002207P,CDM,972,RC,62303,HCPCS,Outpatient,,,320,240,,294.4,92,,,percent of total billed charges,92% of total billed charges,9.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297.6,93,,,percent of total billed charges,93% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,310.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,310.4,97,,,percent of total billed charges,97% of total billed charges,240,75,,,percent of total billed charges,75% of total billed charges,307.2,96,,,percent of total billed charges,96% of total billed charges,9.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,240,75,,,percent of total billed charges,75% of total billed charges,240,75,,,percent of total billed charges,75% of total billed charges,9.74,310.4,
PF XR NASAL BONES 3+ VIEWS,71800012P,CDM,972,RC,70160,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,95.79,93,,,percent of total billed charges,93% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,99.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,99.91,97,,,percent of total billed charges,97% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges,98.88,96,,,percent of total billed charges,96% of total billed charges,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,77.25,75,,,percent of total billed charges,75% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges,1.29,99.91,
PF XR NECK SOFT TISSUE,71800030P,CDM,972,RC,70360,HCPCS,Outpatient,,,85,63.75,,78.2,92,,,percent of total billed charges,92% of total billed charges,1.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.05,93,,,percent of total billed charges,93% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,82.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,82.45,97,,,percent of total billed charges,97% of total billed charges,63.75,75,,,percent of total billed charges,75% of total billed charges,81.6,96,,,percent of total billed charges,96% of total billed charges,1.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63.75,75,,,percent of total billed charges,75% of total billed charges,63.75,75,,,percent of total billed charges,75% of total billed charges,1.05,82.45,
PF XR ORBITS COMPLETE,71800014P,CDM,972,RC,70200,HCPCS,Outpatient,,,131,98.25,,120.52,92,,,percent of total billed charges,92% of total billed charges,1.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,121.83,93,,,percent of total billed charges,93% of total billed charges,117.9,90,,,percent of total billed charges,90% of total billed charges,117.9,90,,,percent of total billed charges,90% of total billed charges,127.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.07,97,,,percent of total billed charges,97% of total billed charges,98.25,75,,,percent of total billed charges,75% of total billed charges,125.76,96,,,percent of total billed charges,96% of total billed charges,1.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,98.25,75,,,percent of total billed charges,75% of total billed charges,98.25,75,,,percent of total billed charges,75% of total billed charges,1.47,127.07,
PF XR OSSEOUS SURVEY COMPLETE,71800490P,CDM,972,RC,77075,HCPCS,Outpatient,,,270,202.5,,248.4,92,,,percent of total billed charges,92% of total billed charges,3.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,251.1,93,,,percent of total billed charges,93% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,261.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,261.9,97,,,percent of total billed charges,97% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,259.2,96,,,percent of total billed charges,96% of total billed charges,3.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,202.5,75,,,percent of total billed charges,75% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,3.08,261.9,
PF XR OSSEOUS SURVEY INFANT,71800492P,CDM,972,RC,77076,HCPCS,Outpatient,,,226,169.5,,207.92,92,,,percent of total billed charges,92% of total billed charges,3.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,210.18,93,,,percent of total billed charges,93% of total billed charges,203.4,90,,,percent of total billed charges,90% of total billed charges,203.4,90,,,percent of total billed charges,90% of total billed charges,219.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.22,97,,,percent of total billed charges,97% of total billed charges,169.5,75,,,percent of total billed charges,75% of total billed charges,216.96,96,,,percent of total billed charges,96% of total billed charges,3.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,169.5,75,,,percent of total billed charges,75% of total billed charges,169.5,75,,,percent of total billed charges,75% of total billed charges,3.11,219.22,
PF XR OSSEOUS SURVEY LIMITED,71800488P,CDM,972,RC,77074,HCPCS,Outpatient,,,177,132.75,,162.84,92,,,percent of total billed charges,92% of total billed charges,1.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.61,93,,,percent of total billed charges,93% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,171.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,171.69,97,,,percent of total billed charges,97% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,169.92,96,,,percent of total billed charges,96% of total billed charges,1.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.75,75,,,percent of total billed charges,75% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,1.81,171.69,
PF XR PELVIS 1 OR 2 VIEWS,71800131P,CDM,972,RC,72170,HCPCS,Outpatient,,,75,56.25,,69,92,,,percent of total billed charges,92% of total billed charges,0.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,93,,,percent of total billed charges,93% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,67.5,90,,,percent of total billed charges,90% of total billed charges,72.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72.75,97,,,percent of total billed charges,97% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,72,96,,,percent of total billed charges,96% of total billed charges,0.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.25,75,,,percent of total billed charges,75% of total billed charges,56.25,75,,,percent of total billed charges,75% of total billed charges,0.95,72.75,
PF XR PELVIS COMPLETE 3+ VIEWS,71800133P,CDM,972,RC,72190,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.02,93,,,percent of total billed charges,93% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,110.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.58,97,,,percent of total billed charges,97% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,109.44,96,,,percent of total billed charges,96% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.5,75,,,percent of total billed charges,75% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,1.32,110.58,
PF XR PERC TUBE/DRAINAGE CATH CHNG W/ CONT,71800417P,CDM,972,RC,75984,HCPCS,Outpatient,,,284,213,,261.28,92,,,percent of total billed charges,92% of total billed charges,2.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,264.12,93,,,percent of total billed charges,93% of total billed charges,255.6,90,,,percent of total billed charges,90% of total billed charges,255.6,90,,,percent of total billed charges,90% of total billed charges,275.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.48,97,,,percent of total billed charges,97% of total billed charges,213,75,,,percent of total billed charges,75% of total billed charges,272.64,96,,,percent of total billed charges,96% of total billed charges,2.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213,75,,,percent of total billed charges,75% of total billed charges,213,75,,,percent of total billed charges,75% of total billed charges,2.27,275.48,
PF XR RIBS 2 VIEWS LEFT,71800064P,CDM,972,RC,71100,HCPCS,Outpatient,,,100,75,,92,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93,93,,,percent of total billed charges,93% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97,97,,,percent of total billed charges,97% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,96,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75,75,,,percent of total billed charges,75% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,1.18,97,
PF XR RIBS 2 VIEWS RIGHT,71800064P,CDM,972,RC,71100,HCPCS,Outpatient,,,100,75,,92,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93,93,,,percent of total billed charges,93% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,90,90,,,percent of total billed charges,90% of total billed charges,97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97,97,,,percent of total billed charges,97% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,96,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75,75,,,percent of total billed charges,75% of total billed charges,75,75,,,percent of total billed charges,75% of total billed charges,1.18,97,
PF XR RIBS 3 VIEWS BILATERAL,71800068P,CDM,972,RC,71110,HCPCS,Outpatient,,,119,89.25,,109.48,92,,,percent of total billed charges,92% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.67,93,,,percent of total billed charges,93% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,115.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,115.43,97,,,percent of total billed charges,97% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,114.24,96,,,percent of total billed charges,96% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,89.25,75,,,percent of total billed charges,75% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,1.32,115.43,
PF XR RIBS W/ PA CHEST BILATERAL,71800070P,CDM,972,RC,71111,HCPCS,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges,1.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.06,93,,,percent of total billed charges,93% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,137.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,137.74,97,,,percent of total billed charges,97% of total billed charges,106.5,75,,,percent of total billed charges,75% of total billed charges,136.32,96,,,percent of total billed charges,96% of total billed charges,1.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.5,75,,,percent of total billed charges,75% of total billed charges,106.5,75,,,percent of total billed charges,75% of total billed charges,1.56,137.74,
PF XR RIBS W/ PA CHEST LEFT,71800066P,CDM,972,RC,71101,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.02,93,,,percent of total billed charges,93% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,110.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.58,97,,,percent of total billed charges,97% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,109.44,96,,,percent of total billed charges,96% of total billed charges,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.5,75,,,percent of total billed charges,75% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,1.29,110.58,
PF XR RIBS W/ PA CHEST RIGHT,71800066P,CDM,972,RC,71101,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.02,93,,,percent of total billed charges,93% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,110.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.58,97,,,percent of total billed charges,97% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,109.44,96,,,percent of total billed charges,96% of total billed charges,1.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.5,75,,,percent of total billed charges,75% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,1.29,110.58,
PF XR SACROILIAC JOINTS 1 OR 2 VIEWS,71800146P,CDM,972,RC,72202,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges,1.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,98.58,93,,,percent of total billed charges,93% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,102.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102.82,97,,,percent of total billed charges,97% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges,101.76,96,,,percent of total billed charges,96% of total billed charges,1.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.5,75,,,percent of total billed charges,75% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges,1.26,102.82,
PF XR SACROILIAC JOINTS 3+ VIEWS,71800144P,CDM,972,RC,72200,HCPCS,Outpatient,,,89,66.75,,81.88,92,,,percent of total billed charges,92% of total billed charges,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,82.77,93,,,percent of total billed charges,93% of total billed charges,80.1,90,,,percent of total billed charges,90% of total billed charges,80.1,90,,,percent of total billed charges,90% of total billed charges,86.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,86.33,97,,,percent of total billed charges,97% of total billed charges,66.75,75,,,percent of total billed charges,75% of total billed charges,85.44,96,,,percent of total billed charges,96% of total billed charges,1.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.75,75,,,percent of total billed charges,75% of total billed charges,66.75,75,,,percent of total billed charges,75% of total billed charges,1.15,86.33,
PF XR SACRUM/COCCYX 2+ VIEWS,71800148P,CDM,972,RC,72220,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.11,85.36,
PF XR SCAPULA COMPLETE BILATERAL,71800168P,CDM,972,RC,73010,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges,0.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.38,93,,,percent of total billed charges,93% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,64.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.02,97,,,percent of total billed charges,97% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,63.36,96,,,percent of total billed charges,96% of total billed charges,0.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.5,75,,,percent of total billed charges,75% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,0.8,64.02,
PF XR SCAPULA LEFT,71800166P,CDM,972,RC,73010,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges,0.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.38,93,,,percent of total billed charges,93% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,64.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.02,97,,,percent of total billed charges,97% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,63.36,96,,,percent of total billed charges,96% of total billed charges,0.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.5,75,,,percent of total billed charges,75% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,0.8,64.02,
PF XR SCAPULA RIGHT,71800166P,CDM,972,RC,73010,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges,0.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.38,93,,,percent of total billed charges,93% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,64.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.02,97,,,percent of total billed charges,97% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,63.36,96,,,percent of total billed charges,96% of total billed charges,0.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.5,75,,,percent of total billed charges,75% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,0.8,64.02,
PF XR SHOULDER 1 VIEW BILAT,71800172P,CDM,972,RC,73020,HCPCS,Outpatient,,,59,44.25,,54.28,92,,,percent of total billed charges,92% of total billed charges,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54.87,93,,,percent of total billed charges,93% of total billed charges,53.1,90,,,percent of total billed charges,90% of total billed charges,53.1,90,,,percent of total billed charges,90% of total billed charges,57.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.23,97,,,percent of total billed charges,97% of total billed charges,44.25,75,,,percent of total billed charges,75% of total billed charges,56.64,96,,,percent of total billed charges,96% of total billed charges,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,44.25,75,,,percent of total billed charges,75% of total billed charges,44.25,75,,,percent of total billed charges,75% of total billed charges,0.77,57.23,
PF XR SHOULDER 1 VIEW LEFT,71800170P,CDM,972,RC,73020,HCPCS,Outpatient,,,59,44.25,,54.28,92,,,percent of total billed charges,92% of total billed charges,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54.87,93,,,percent of total billed charges,93% of total billed charges,53.1,90,,,percent of total billed charges,90% of total billed charges,53.1,90,,,percent of total billed charges,90% of total billed charges,57.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.23,97,,,percent of total billed charges,97% of total billed charges,44.25,75,,,percent of total billed charges,75% of total billed charges,56.64,96,,,percent of total billed charges,96% of total billed charges,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,44.25,75,,,percent of total billed charges,75% of total billed charges,44.25,75,,,percent of total billed charges,75% of total billed charges,0.77,57.23,
PF XR SHOULDER 1 VIEW RIGHT,71800170P,CDM,972,RC,73020,HCPCS,Outpatient,,,59,44.25,,54.28,92,,,percent of total billed charges,92% of total billed charges,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54.87,93,,,percent of total billed charges,93% of total billed charges,53.1,90,,,percent of total billed charges,90% of total billed charges,53.1,90,,,percent of total billed charges,90% of total billed charges,57.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.23,97,,,percent of total billed charges,97% of total billed charges,44.25,75,,,percent of total billed charges,75% of total billed charges,56.64,96,,,percent of total billed charges,96% of total billed charges,0.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,44.25,75,,,percent of total billed charges,75% of total billed charges,44.25,75,,,percent of total billed charges,75% of total billed charges,0.77,57.23,
PF XR SHOULDER COMPLETE 2+ VIEWS BILAT,71800176P,CDM,972,RC,73030,HCPCS,Outpatient,,,93,69.75,,85.56,92,,,percent of total billed charges,92% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,86.49,93,,,percent of total billed charges,93% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,90.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90.21,97,,,percent of total billed charges,97% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,89.28,96,,,percent of total billed charges,96% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,75,,,percent of total billed charges,75% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,1.17,90.21,
PF XR SHOULDER COMPLETE 2+ VIEWS LEFT,71800174P,CDM,972,RC,73030,HCPCS,Outpatient,,,93,69.75,,85.56,92,,,percent of total billed charges,92% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,86.49,93,,,percent of total billed charges,93% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,90.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90.21,97,,,percent of total billed charges,97% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,89.28,96,,,percent of total billed charges,96% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,75,,,percent of total billed charges,75% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,1.17,90.21,
PF XR SHOULDER COMPLETE 2+ VIEWS RIGHT,71800174P,CDM,972,RC,73030,HCPCS,Outpatient,,,93,69.75,,85.56,92,,,percent of total billed charges,92% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,86.49,93,,,percent of total billed charges,93% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,83.7,90,,,percent of total billed charges,90% of total billed charges,90.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90.21,97,,,percent of total billed charges,97% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,89.28,96,,,percent of total billed charges,96% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.75,75,,,percent of total billed charges,75% of total billed charges,69.75,75,,,percent of total billed charges,75% of total billed charges,1.17,90.21,
PF XR SINUSES PARANASAL < 3 VIEWS,71800016P,CDM,972,RC,70210,HCPCS,Outpatient,,,88,66,,80.96,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.84,93,,,percent of total billed charges,93% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,79.2,90,,,percent of total billed charges,90% of total billed charges,85.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.36,97,,,percent of total billed charges,97% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,84.48,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66,75,,,percent of total billed charges,75% of total billed charges,66,75,,,percent of total billed charges,75% of total billed charges,1.1,85.36,
PF XR SINUSES PARANASAL COMPLETE,71800018P,CDM,972,RC,70220,HCPCS,Outpatient,,,102,76.5,,93.84,92,,,percent of total billed charges,92% of total billed charges,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,94.86,93,,,percent of total billed charges,93% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,98.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,98.94,97,,,percent of total billed charges,97% of total billed charges,76.5,75,,,percent of total billed charges,75% of total billed charges,97.92,96,,,percent of total billed charges,96% of total billed charges,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.5,75,,,percent of total billed charges,75% of total billed charges,76.5,75,,,percent of total billed charges,75% of total billed charges,1.21,98.94,
PF XR SKULL < 4 VIEWS,71800020P,CDM,972,RC,70250,HCPCS,Outpatient,,,97,72.75,,89.24,92,,,percent of total billed charges,92% of total billed charges,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90.21,93,,,percent of total billed charges,93% of total billed charges,87.3,90,,,percent of total billed charges,90% of total billed charges,87.3,90,,,percent of total billed charges,90% of total billed charges,94.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,94.09,97,,,percent of total billed charges,97% of total billed charges,72.75,75,,,percent of total billed charges,75% of total billed charges,93.12,96,,,percent of total billed charges,96% of total billed charges,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72.75,75,,,percent of total billed charges,75% of total billed charges,72.75,75,,,percent of total billed charges,75% of total billed charges,1.21,94.09,
PF XR SKULL COMPLETE,71800022P,CDM,972,RC,70260,HCPCS,Outpatient,,,121,90.75,,111.32,92,,,percent of total billed charges,92% of total billed charges,1.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,112.53,93,,,percent of total billed charges,93% of total billed charges,108.9,90,,,percent of total billed charges,90% of total billed charges,108.9,90,,,percent of total billed charges,90% of total billed charges,117.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117.37,97,,,percent of total billed charges,97% of total billed charges,90.75,75,,,percent of total billed charges,75% of total billed charges,116.16,96,,,percent of total billed charges,96% of total billed charges,1.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90.75,75,,,percent of total billed charges,75% of total billed charges,90.75,75,,,percent of total billed charges,75% of total billed charges,1.35,117.37,
PF XR SMALL BOWEL W/ MULTIPLE SERIES,71800377P,CDM,972,RC,74250,HCPCS,Outpatient,,,341,255.75,,313.72,92,,,percent of total billed charges,92% of total billed charges,3.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,317.13,93,,,percent of total billed charges,93% of total billed charges,306.9,90,,,percent of total billed charges,90% of total billed charges,306.9,90,,,percent of total billed charges,90% of total billed charges,330.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,330.77,97,,,percent of total billed charges,97% of total billed charges,255.75,75,,,percent of total billed charges,75% of total billed charges,327.36,96,,,percent of total billed charges,96% of total billed charges,3.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.75,75,,,percent of total billed charges,75% of total billed charges,255.75,75,,,percent of total billed charges,75% of total billed charges,3.17,330.77,
PF XR SPINE 1 VIEW SPECIFY LEVEL,71800087P,CDM,972,RC,72020,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.38,93,,,percent of total billed charges,93% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,64.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.02,97,,,percent of total billed charges,97% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,63.36,96,,,percent of total billed charges,96% of total billed charges,0.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.5,75,,,percent of total billed charges,75% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,0.85,64.02,
PF XR SPINE CERVICAL 2 OR 3 VIEWS,71800089P,CDM,972,RC,72040,HCPCS,Outpatient,,,107,80.25,,98.44,92,,,percent of total billed charges,92% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,99.51,93,,,percent of total billed charges,93% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,103.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.79,97,,,percent of total billed charges,97% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges,102.72,96,,,percent of total billed charges,96% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.25,75,,,percent of total billed charges,75% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges,1.27,103.79,
PF XR SPINE CERVICAL 4 OR 5 VIEWS,71800091P,CDM,972,RC,72050,HCPCS,Outpatient,,,144,108,,132.48,92,,,percent of total billed charges,92% of total billed charges,1.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,133.92,93,,,percent of total billed charges,93% of total billed charges,129.6,90,,,percent of total billed charges,90% of total billed charges,129.6,90,,,percent of total billed charges,90% of total billed charges,139.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,139.68,97,,,percent of total billed charges,97% of total billed charges,108,75,,,percent of total billed charges,75% of total billed charges,138.24,96,,,percent of total billed charges,96% of total billed charges,1.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,108,75,,,percent of total billed charges,75% of total billed charges,108,75,,,percent of total billed charges,75% of total billed charges,1.69,139.68,
PF XR SPINE CERVICAL 6 OR MORE VIEWS,71800093P,CDM,972,RC,72052,HCPCS,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges,1.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156.24,93,,,percent of total billed charges,93% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,162.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.96,97,,,percent of total billed charges,97% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,161.28,96,,,percent of total billed charges,96% of total billed charges,1.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126,75,,,percent of total billed charges,75% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,1.94,162.96,
PF XR SPINE LUMBOSACRAL 2/3 VIEWS,71800105P,CDM,972,RC,72100,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,1.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,1.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,1.28,104.76,
PF XR SPINE LUMBOSACRAL 4+ VIEWS,71800107P,CDM,972,RC,72110,HCPCS,Outpatient,,,139,104.25,,127.88,92,,,percent of total billed charges,92% of total billed charges,1.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,129.27,93,,,percent of total billed charges,93% of total billed charges,125.1,90,,,percent of total billed charges,90% of total billed charges,125.1,90,,,percent of total billed charges,90% of total billed charges,134.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,134.83,97,,,percent of total billed charges,97% of total billed charges,104.25,75,,,percent of total billed charges,75% of total billed charges,133.44,96,,,percent of total billed charges,96% of total billed charges,1.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.25,75,,,percent of total billed charges,75% of total billed charges,104.25,75,,,percent of total billed charges,75% of total billed charges,1.64,134.83,
PF XR SPINE LUMBOSACRAL BENDING 2-3 VIEWS,71800111P,CDM,972,RC,72120,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,1.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,1.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,1.31,107.67,
PF XR SPINE LUMBOSACRAL W/ BENDING 6+ VIEWS,71800109P,CDM,972,RC,72114,HCPCS,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges,1.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156.24,93,,,percent of total billed charges,93% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,162.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.96,97,,,percent of total billed charges,97% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,161.28,96,,,percent of total billed charges,96% of total billed charges,1.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126,75,,,percent of total billed charges,75% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,1.89,162.96,
PF XR SPINE SCOLIOSIS 2-3 VIEWS,71800103P,CDM,972,RC,72082,HCPCS,Outpatient,,,190,142.5,,174.8,92,,,percent of total billed charges,92% of total billed charges,2.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.7,93,,,percent of total billed charges,93% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,184.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.3,97,,,percent of total billed charges,97% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,182.4,96,,,percent of total billed charges,96% of total billed charges,2.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.5,75,,,percent of total billed charges,75% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,2.18,184.3,
PF XR SPINE THORACIC 2 VIEWS,71800095P,CDM,972,RC,72070,HCPCS,Outpatient,,,89,66.75,,81.88,92,,,percent of total billed charges,92% of total billed charges,1.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,82.77,93,,,percent of total billed charges,93% of total billed charges,80.1,90,,,percent of total billed charges,90% of total billed charges,80.1,90,,,percent of total billed charges,90% of total billed charges,86.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,86.33,97,,,percent of total billed charges,97% of total billed charges,66.75,75,,,percent of total billed charges,75% of total billed charges,85.44,96,,,percent of total billed charges,96% of total billed charges,1.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.75,75,,,percent of total billed charges,75% of total billed charges,66.75,75,,,percent of total billed charges,75% of total billed charges,1.08,86.33,
PF XR SPINE THORACIC 3 VIEWS,71800097P,CDM,972,RC,72072,HCPCS,Outpatient,,,160,120,,147.2,92,,,percent of total billed charges,92% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,148.8,93,,,percent of total billed charges,93% of total billed charges,144,90,,,percent of total billed charges,90% of total billed charges,144,90,,,percent of total billed charges,90% of total billed charges,155.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,155.2,97,,,percent of total billed charges,97% of total billed charges,120,75,,,percent of total billed charges,75% of total billed charges,153.6,96,,,percent of total billed charges,96% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,120,75,,,percent of total billed charges,75% of total billed charges,120,75,,,percent of total billed charges,75% of total billed charges,1.27,155.2,
PF XR SPINE THORACOLUMBAR 2+ VIEWS,71800099P,CDM,972,RC,72080,HCPCS,Outpatient,,,94,70.5,,86.48,92,,,percent of total billed charges,92% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,87.42,93,,,percent of total billed charges,93% of total billed charges,84.6,90,,,percent of total billed charges,90% of total billed charges,84.6,90,,,percent of total billed charges,90% of total billed charges,91.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,91.18,97,,,percent of total billed charges,97% of total billed charges,70.5,75,,,percent of total billed charges,75% of total billed charges,90.24,96,,,percent of total billed charges,96% of total billed charges,1.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.5,75,,,percent of total billed charges,75% of total billed charges,70.5,75,,,percent of total billed charges,75% of total billed charges,1.12,91.18,
PF XR STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,71800074P,CDM,972,RC,71130,HCPCS,Outpatient,,,418,313.5,,384.56,92,,,percent of total billed charges,92% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388.74,93,,,percent of total billed charges,93% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,405.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,405.46,97,,,percent of total billed charges,97% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,401.28,96,,,percent of total billed charges,96% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,313.5,75,,,percent of total billed charges,75% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,1.34,405.46,
PF XR STERNUM 2+ VIEWS,71800072P,CDM,972,RC,71120,HCPCS,Outpatient,,,91,68.25,,83.72,92,,,percent of total billed charges,92% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.63,93,,,percent of total billed charges,93% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,88.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,88.27,97,,,percent of total billed charges,97% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,87.36,96,,,percent of total billed charges,96% of total billed charges,1.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,68.25,75,,,percent of total billed charges,75% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,1.11,88.27,
PF XR TIBIA/FIBULA BILATERAL,71800293P,CDM,972,RC,73590,HCPCS,Outpatient,,,85,63.75,,78.2,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.05,93,,,percent of total billed charges,93% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,82.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,82.45,97,,,percent of total billed charges,97% of total billed charges,63.75,75,,,percent of total billed charges,75% of total billed charges,81.6,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63.75,75,,,percent of total billed charges,75% of total billed charges,63.75,75,,,percent of total billed charges,75% of total billed charges,1.1,82.45,
PF XR TIBIA/FIBULA LEFT,71800291P,CDM,972,RC,73590,HCPCS,Outpatient,,,85,63.75,,78.2,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.05,93,,,percent of total billed charges,93% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,82.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,82.45,97,,,percent of total billed charges,97% of total billed charges,63.75,75,,,percent of total billed charges,75% of total billed charges,81.6,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63.75,75,,,percent of total billed charges,75% of total billed charges,63.75,75,,,percent of total billed charges,75% of total billed charges,1.1,82.45,
PF XR TIBIA/FIBULA RIGHT,71800291P,CDM,972,RC,73590,HCPCS,Outpatient,,,85,63.75,,78.2,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.05,93,,,percent of total billed charges,93% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,76.5,90,,,percent of total billed charges,90% of total billed charges,82.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,82.45,97,,,percent of total billed charges,97% of total billed charges,63.75,75,,,percent of total billed charges,75% of total billed charges,81.6,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63.75,75,,,percent of total billed charges,75% of total billed charges,63.75,75,,,percent of total billed charges,75% of total billed charges,1.1,82.45,
PF XR TOE(S) 2+ VIEWS BILAT,71800323P,CDM,972,RC,73660,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.96,93,,,percent of total billed charges,93% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,69.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.84,97,,,percent of total billed charges,97% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,69.12,96,,,percent of total billed charges,96% of total billed charges,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54,75,,,percent of total billed charges,75% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,1.06,69.84,
PF XR TOE(S) 2+ VIEWS LEFT,71800323P,CDM,972,RC,73660,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.96,93,,,percent of total billed charges,93% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,69.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.84,97,,,percent of total billed charges,97% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,69.12,96,,,percent of total billed charges,96% of total billed charges,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54,75,,,percent of total billed charges,75% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,1.06,69.84,
PF XR TOE MINIMUM 2 VIEWS RT,71800323P,CDM,972,RC,73660,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.96,93,,,percent of total billed charges,93% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,69.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.84,97,,,percent of total billed charges,97% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,69.12,96,,,percent of total billed charges,96% of total billed charges,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54,75,,,percent of total billed charges,75% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,1.06,69.84,
PF XR TOE MINIMUM 2 VIEWS RT,71800323P,CDM,972,RC,73660,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.96,93,,,percent of total billed charges,93% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,69.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.84,97,,,percent of total billed charges,97% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,69.12,96,,,percent of total billed charges,96% of total billed charges,1.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54,75,,,percent of total billed charges,75% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,1.06,69.84,
PF XR UPPER EXTREMITY INFANT MINIMUM 2 VIEWS BIL,71800208P,CDM,972,RC,73092,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.98,93,,,percent of total billed charges,93% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,83.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.42,97,,,percent of total billed charges,97% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,82.56,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.5,75,,,percent of total billed charges,75% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,1.1,83.42,
PF XR UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,71800206P,CDM,972,RC,73092,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.98,93,,,percent of total billed charges,93% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,83.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.42,97,,,percent of total billed charges,97% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,82.56,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.5,75,,,percent of total billed charges,75% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,1.1,83.42,
PF XR UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,71800206P,CDM,972,RC,73092,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.98,93,,,percent of total billed charges,93% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,83.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.42,97,,,percent of total billed charges,97% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,82.56,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.5,75,,,percent of total billed charges,75% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,1.1,83.42,
PF XR UPPER GI TRC SINGLE CONTRAST STUDY,71800375P,CDM,972,RC,74240,HCPCS,Outpatient,,,342,256.5,,314.64,92,,,percent of total billed charges,92% of total billed charges,3.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,318.06,93,,,percent of total billed charges,93% of total billed charges,307.8,90,,,percent of total billed charges,90% of total billed charges,307.8,90,,,percent of total billed charges,90% of total billed charges,331.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,331.74,97,,,percent of total billed charges,97% of total billed charges,256.5,75,,,percent of total billed charges,75% of total billed charges,328.32,96,,,percent of total billed charges,96% of total billed charges,3.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,256.5,75,,,percent of total billed charges,75% of total billed charges,256.5,75,,,percent of total billed charges,75% of total billed charges,3.2,331.74,
PF XR UPPER GI TRC DOUBLE CONTRAST STUDY,71800517P,CDM,972,RC,74246,HCPCS,Outpatient,,,228,171,,209.76,92,,,percent of total billed charges,92% of total billed charges,3.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,212.04,93,,,percent of total billed charges,93% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,205.2,90,,,percent of total billed charges,90% of total billed charges,221.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,221.16,97,,,percent of total billed charges,97% of total billed charges,171,75,,,percent of total billed charges,75% of total billed charges,218.88,96,,,percent of total billed charges,96% of total billed charges,3.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,171,75,,,percent of total billed charges,75% of total billed charges,171,75,,,percent of total billed charges,75% of total billed charges,3.62,221.16,
PF XR URETHROCYSTOGRAPHY RETROGRADE RS and I,71800408P,CDM,972,RC,74450,HCPCS,Outpatient,,,133,99.75,,122.36,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,123.69,93,,,percent of total billed charges,93% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,119.7,90,,,percent of total billed charges,90% of total billed charges,129.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,129.01,97,,,percent of total billed charges,97% of total billed charges,99.75,75,,,percent of total billed charges,75% of total billed charges,127.68,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,99.75,75,,,percent of total billed charges,75% of total billed charges,99.75,75,,,percent of total billed charges,75% of total billed charges,99.75,129.01,
PF XR URETHROCYSTOGRAPHY VOIDING RS and I,71800410P,CDM,972,RC,74455,HCPCS,Outpatient,,,289,216.75,,265.88,92,,,percent of total billed charges,92% of total billed charges,3.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,268.77,93,,,percent of total billed charges,93% of total billed charges,260.1,90,,,percent of total billed charges,90% of total billed charges,260.1,90,,,percent of total billed charges,90% of total billed charges,280.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,280.33,97,,,percent of total billed charges,97% of total billed charges,216.75,75,,,percent of total billed charges,75% of total billed charges,277.44,96,,,percent of total billed charges,96% of total billed charges,3.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,216.75,75,,,percent of total billed charges,75% of total billed charges,216.75,75,,,percent of total billed charges,75% of total billed charges,3.33,280.33,
PF XR UROGRAPHY ANTEGRADE RS and I,71800402P,CDM,972,RC,74425,HCPCS,Outpatient,,,377,282.75,,346.84,92,,,percent of total billed charges,92% of total billed charges,4.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,350.61,93,,,percent of total billed charges,93% of total billed charges,339.3,90,,,percent of total billed charges,90% of total billed charges,339.3,90,,,percent of total billed charges,90% of total billed charges,365.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,365.69,97,,,percent of total billed charges,97% of total billed charges,282.75,75,,,percent of total billed charges,75% of total billed charges,361.92,96,,,percent of total billed charges,96% of total billed charges,4.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,282.75,75,,,percent of total billed charges,75% of total billed charges,282.75,75,,,percent of total billed charges,75% of total billed charges,4.15,365.69,
PF XR X-RAY URINARY TRACT EXAM WITH CONTRAST,71800400P,CDM,972,RC,74420,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,2.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,2.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,2.13,201.76,
PF XR WRIST 2 VIEWS BILATERAL,71800212P,CDM,972,RC,73100,HCPCS,Outpatient,,,91,68.25,,83.72,92,,,percent of total billed charges,92% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.63,93,,,percent of total billed charges,93% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,88.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,88.27,97,,,percent of total billed charges,97% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,87.36,96,,,percent of total billed charges,96% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,68.25,75,,,percent of total billed charges,75% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,1.17,88.27,
PF XR WRIST 2 VIEWS,71800210P,CDM,972,RC,73100,HCPCS,Outpatient,,,91,68.25,,83.72,92,,,percent of total billed charges,92% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.63,93,,,percent of total billed charges,93% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,88.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,88.27,97,,,percent of total billed charges,97% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,87.36,96,,,percent of total billed charges,96% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,68.25,75,,,percent of total billed charges,75% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,1.17,88.27,
PF XR WRIST 2 VIEWS,71800210P,CDM,972,RC,73100,HCPCS,Outpatient,,,91,68.25,,83.72,92,,,percent of total billed charges,92% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.63,93,,,percent of total billed charges,93% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,81.9,90,,,percent of total billed charges,90% of total billed charges,88.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,88.27,97,,,percent of total billed charges,97% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,87.36,96,,,percent of total billed charges,96% of total billed charges,1.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,68.25,75,,,percent of total billed charges,75% of total billed charges,68.25,75,,,percent of total billed charges,75% of total billed charges,1.17,88.27,
PF XR WRIST COMPLETE MINIMUM 3 VIEWS BILATERAL,71800216P,CDM,972,RC,73110,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,1.41,107.67,
PF XR WRIST COMPLETE MINIMUM 3 VIEWS,71800214P,CDM,972,RC,73110,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,1.41,107.67,
PF XR WRIST COMPLETE MINIMUM 3 VIEWS,71800214P,CDM,972,RC,73110,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,1.41,107.67,
PF ECHO RANSEOPHAGEAL 2D W/PROBE INTERP  and  REPORT,74000024P,CDM,985,RC,93312,HCPCS,Outpatient,,,270,202.5,,248.4,92,,,percent of total billed charges,92% of total billed charges,5.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,251.1,93,,,percent of total billed charges,93% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,261.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,261.9,97,,,percent of total billed charges,97% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,259.2,96,,,percent of total billed charges,96% of total billed charges,5.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,202.5,75,,,percent of total billed charges,75% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,5.36,261.9,
SLEEP STD AIRFLOW HRT RATE and O2 SAT EFFORT UNATT,74100002G,CDM,986,RC,95806,HCPCS,Outpatient,,,234,175.5,,215.28,92,,,percent of total billed charges,92% of total billed charges,2.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,217.62,93,,,percent of total billed charges,93% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,226.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,226.98,97,,,percent of total billed charges,97% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges,224.64,96,,,percent of total billed charges,96% of total billed charges,2.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.5,75,,,percent of total billed charges,75% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges,2.31,226.98,
POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND,74100003G,CDM,986,RC,95810,HCPCS,Outpatient,,,1553,1164.75,,1428.76,92,,,percent of total billed charges,92% of total billed charges,21.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1444.29,93,,,percent of total billed charges,93% of total billed charges,1397.7,90,,,percent of total billed charges,90% of total billed charges,1397.7,90,,,percent of total billed charges,90% of total billed charges,1506.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1506.41,97,,,percent of total billed charges,97% of total billed charges,1164.75,75,,,percent of total billed charges,75% of total billed charges,1490.88,96,,,percent of total billed charges,96% of total billed charges,21.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1164.75,75,,,percent of total billed charges,75% of total billed charges,1164.75,75,,,percent of total billed charges,75% of total billed charges,21.61,1506.41,
POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTD,74100004G,CDM,986,RC,95811,HCPCS,Outpatient,,,1623,1217.25,,1493.16,92,,,percent of total billed charges,92% of total billed charges,22.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1509.39,93,,,percent of total billed charges,93% of total billed charges,1460.7,90,,,percent of total billed charges,90% of total billed charges,1460.7,90,,,percent of total billed charges,90% of total billed charges,1574.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1574.31,97,,,percent of total billed charges,97% of total billed charges,1217.25,75,,,percent of total billed charges,75% of total billed charges,1558.08,96,,,percent of total billed charges,96% of total billed charges,22.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1217.25,75,,,percent of total billed charges,75% of total billed charges,1217.25,75,,,percent of total billed charges,75% of total billed charges,22.7,1574.31,
PF COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD,78001446P,CDM,975,RC,45378,HCPCS,Outpatient,,,2188,1641,,2012.96,92,,,percent of total billed charges,92% of total billed charges,17.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2034.84,93,,,percent of total billed charges,93% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,1969.2,90,,,percent of total billed charges,90% of total billed charges,2122.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2122.36,97,,,percent of total billed charges,97% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,2100.48,96,,,percent of total billed charges,96% of total billed charges,17.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1641,75,,,percent of total billed charges,75% of total billed charges,1641,75,,,percent of total billed charges,75% of total billed charges,17.67,2122.36,
PF HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS,78001466P,CDM,975,RC,46221,HCPCS,Outpatient,,,1341,1005.75,,1233.72,92,,,percent of total billed charges,92% of total billed charges,16.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1247.13,93,,,percent of total billed charges,93% of total billed charges,1206.9,90,,,percent of total billed charges,90% of total billed charges,1206.9,90,,,percent of total billed charges,90% of total billed charges,1300.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1300.77,97,,,percent of total billed charges,97% of total billed charges,1005.75,75,,,percent of total billed charges,75% of total billed charges,1287.36,96,,,percent of total billed charges,96% of total billed charges,16.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1005.75,75,,,percent of total billed charges,75% of total billed charges,1005.75,75,,,percent of total billed charges,75% of total billed charges,16.17,1300.77,
PF LAPAROSCOPY REPAIR RECURRENT INGUINAL HERNIA,78002882P,CDM,975,RC,49651,HCPCS,Outpatient,,,1121,840.75,,1031.32,92,,,percent of total billed charges,92% of total billed charges,77.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1042.53,93,,,percent of total billed charges,93% of total billed charges,1008.9,90,,,percent of total billed charges,90% of total billed charges,1008.9,90,,,percent of total billed charges,90% of total billed charges,1087.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,77.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1087.37,97,,,percent of total billed charges,97% of total billed charges,840.75,75,,,percent of total billed charges,75% of total billed charges,1076.16,96,,,percent of total billed charges,96% of total billed charges,77.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.75,75,,,percent of total billed charges,75% of total billed charges,840.75,75,,,percent of total billed charges,75% of total billed charges,77.49,1087.37,
WOUND CARE INCISION AND DRAINAGE ABSCESS SIMPLE/SINGLE,96000005G,CDM,960,RC,10060,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,7.23,289.06,
WOUND CARE INCISION AND DRAINAGE ABSCESS COMP/MULT,96000007G,CDM,960,RC,10061,HCPCS,Outpatient,,,712,534,,655.04,92,,,percent of total billed charges,92% of total billed charges,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,662.16,93,,,percent of total billed charges,93% of total billed charges,640.8,90,,,percent of total billed charges,90% of total billed charges,640.8,90,,,percent of total billed charges,90% of total billed charges,690.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,690.64,97,,,percent of total billed charges,97% of total billed charges,534,75,,,percent of total billed charges,75% of total billed charges,683.52,96,,,percent of total billed charges,96% of total billed charges,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534,75,,,percent of total billed charges,75% of total billed charges,534,75,,,percent of total billed charges,75% of total billed charges,15.08,690.64,
WOUND CARE DEBRIDE SUBCUTANEOUS TISSUE 20 SQ CM/<,96000032G,CDM,960,RC,11042,HCPCS,Outpatient,,,239,179.25,,219.88,92,,,percent of total billed charges,92% of total billed charges,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222.27,93,,,percent of total billed charges,93% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,231.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.83,97,,,percent of total billed charges,97% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,229.44,96,,,percent of total billed charges,96% of total billed charges,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.25,75,,,percent of total billed charges,75% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,5.61,231.83,
WOUND CARE DEBRIDE MUSCLE AND/OR FASCIA FIRST 20 SQCM OR,96000034G,CDM,960,RC,11043,HCPCS,Outpatient,,,608,456,,559.36,92,,,percent of total billed charges,92% of total billed charges,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,565.44,93,,,percent of total billed charges,93% of total billed charges,547.2,90,,,percent of total billed charges,90% of total billed charges,547.2,90,,,percent of total billed charges,90% of total billed charges,589.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,589.76,97,,,percent of total billed charges,97% of total billed charges,456,75,,,percent of total billed charges,75% of total billed charges,583.68,96,,,percent of total billed charges,96% of total billed charges,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,456,75,,,percent of total billed charges,75% of total billed charges,456,75,,,percent of total billed charges,75% of total billed charges,16.12,589.76,
WOUND CARE DEBRIDE BONE FIRST 20 SQ CM OR LESS,96000036G,CDM,960,RC,11044,HCPCS,Outpatient,,,893,669.75,,821.56,92,,,percent of total billed charges,92% of total billed charges,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,830.49,93,,,percent of total billed charges,93% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,866.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,866.21,97,,,percent of total billed charges,97% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,857.28,96,,,percent of total billed charges,96% of total billed charges,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,669.75,75,,,percent of total billed charges,75% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,25.64,866.21,
WOUND CARE DEBRIDE SUBCUT TISSUE EACH ADDL 20 SQ CM,96000038G,CDM,960,RC,11045,HCPCS,Outpatient,,,105,78.75,,96.6,92,,,percent of total billed charges,92% of total billed charges,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.65,93,,,percent of total billed charges,93% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,101.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.85,97,,,percent of total billed charges,97% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges,100.8,96,,,percent of total billed charges,96% of total billed charges,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.75,75,,,percent of total billed charges,75% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges,3.03,101.85,
WOUND CARE DEBRIDE MUSCLE AND/OR FASCIA EACH ADDL 20 SQ C,96000040G,CDM,960,RC,11046,HCPCS,Outpatient,,,219,164.25,,201.48,92,,,percent of total billed charges,92% of total billed charges,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.67,93,,,percent of total billed charges,93% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,212.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,212.43,97,,,percent of total billed charges,97% of total billed charges,164.25,75,,,percent of total billed charges,75% of total billed charges,210.24,96,,,percent of total billed charges,96% of total billed charges,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.25,75,,,percent of total billed charges,75% of total billed charges,164.25,75,,,percent of total billed charges,75% of total billed charges,7.03,212.43,
WOUND CARE DEBRIDE BONE EACH ADD'L 20 SQ CM,96000042G,CDM,960,RC,11047,HCPCS,Outpatient,,,387,290.25,,356.04,92,,,percent of total billed charges,92% of total billed charges,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,359.91,93,,,percent of total billed charges,93% of total billed charges,348.3,90,,,percent of total billed charges,90% of total billed charges,348.3,90,,,percent of total billed charges,90% of total billed charges,375.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375.39,97,,,percent of total billed charges,97% of total billed charges,290.25,75,,,percent of total billed charges,75% of total billed charges,371.52,96,,,percent of total billed charges,96% of total billed charges,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,290.25,75,,,percent of total billed charges,75% of total billed charges,290.25,75,,,percent of total billed charges,75% of total billed charges,12.81,375.39,
WOUND CARE PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,96000044G,CDM,960,RC,11055,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,39.06,93,,,percent of total billed charges,93% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,40.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,40.74,97,,,percent of total billed charges,97% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,40.32,96,,,percent of total billed charges,96% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,31.5,75,,,percent of total billed charges,75% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,1.34,40.74,
WOUND CARE PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,96000044G,CDM,960,RC,11056,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.94,93,,,percent of total billed charges,93% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,56.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.26,97,,,percent of total billed charges,97% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,55.68,96,,,percent of total billed charges,96% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.5,75,,,percent of total billed charges,75% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,1.83,56.26,
WOUND CARE PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,96000048G,CDM,960,RC,11057,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,2.33,73.72,
WOUND CARE TANGENTIAL BIOPSY SKIN SINGLE LESION,96000050G,CDM,960,RC,11102,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.15,93,,,percent of total billed charges,93% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,150.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.35,97,,,percent of total billed charges,97% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,148.8,96,,,percent of total billed charges,96% of total billed charges,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,75,,,percent of total billed charges,75% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,3.19,150.35,
WOUND CARE TANGENTIAL BIOPSY SKIN EA SEP/ADDL LESION,96000052G,CDM,960,RC,11103,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.61,93,,,percent of total billed charges,93% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,74.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.69,97,,,percent of total billed charges,97% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,73.92,96,,,percent of total billed charges,96% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.75,75,,,percent of total billed charges,75% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,1.83,74.69,
WOUND CARE PUNCH BIOPSY SKIN SINGLE LESION,96000054G,CDM,960,RC,11104,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.56,93,,,percent of total billed charges,93% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,186.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.24,97,,,percent of total billed charges,97% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,184.32,96,,,percent of total billed charges,96% of total billed charges,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144,75,,,percent of total billed charges,75% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,4.31,186.24,
WOUND CARE PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION,96000056G,CDM,960,RC,11105,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.7,93,,,percent of total billed charges,93% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,87.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,87.3,97,,,percent of total billed charges,97% of total billed charges,67.5,75,,,percent of total billed charges,75% of total billed charges,86.4,96,,,percent of total billed charges,96% of total billed charges,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,67.5,75,,,percent of total billed charges,75% of total billed charges,67.5,75,,,percent of total billed charges,75% of total billed charges,2.5,87.3,
WOUND CARE INCISIONAL BIOPSY SKIN SINGLE LESION,96000058G,CDM,960,RC,11106,HCPCS,Outpatient,,,238,178.5,,218.96,92,,,percent of total billed charges,92% of total billed charges,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,221.34,93,,,percent of total billed charges,93% of total billed charges,214.2,90,,,percent of total billed charges,90% of total billed charges,214.2,90,,,percent of total billed charges,90% of total billed charges,230.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,230.86,97,,,percent of total billed charges,97% of total billed charges,178.5,75,,,percent of total billed charges,75% of total billed charges,228.48,96,,,percent of total billed charges,96% of total billed charges,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.5,75,,,percent of total billed charges,75% of total billed charges,178.5,75,,,percent of total billed charges,75% of total billed charges,5.46,230.86,
WOUND CARE INCISIONAL BIOPSY SKIN EA SEP/ADD'L LESION,96000060G,CDM,960,RC,11107,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,2.95,104.76,
PF SHVG SKIN LESN 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,78002891P,CDM,961,RC,11302,HCPCS,Outpatient,,,204,153,,187.68,92,,,percent of total billed charges,92% of total billed charges,5.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.72,93,,,percent of total billed charges,93% of total billed charges,183.6,90,,,percent of total billed charges,90% of total billed charges,183.6,90,,,percent of total billed charges,90% of total billed charges,197.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.88,97,,,percent of total billed charges,97% of total billed charges,153,75,,,percent of total billed charges,75% of total billed charges,195.84,96,,,percent of total billed charges,96% of total billed charges,5.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,153,75,,,percent of total billed charges,75% of total billed charges,153,75,,,percent of total billed charges,75% of total billed charges,5.02,197.88,
WOUND CARE EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100CM,96000274G,CDM,960,RC,15116,HCPCS,Outpatient,,,392,294,,360.64,92,,,percent of total billed charges,92% of total billed charges,19.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,364.56,93,,,percent of total billed charges,93% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,380.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,380.24,97,,,percent of total billed charges,97% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,376.32,96,,,percent of total billed charges,96% of total billed charges,19.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,294,75,,,percent of total billed charges,75% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,19.65,380.24,
WOUND CARE SKIN GRAFT TRUNK ARM LEG UP TO 100SQCM 1ST 25S,96000282G,CDM,960,RC,15271,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges,8.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.6,93,,,percent of total billed charges,93% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,213.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.4,97,,,percent of total billed charges,97% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,211.2,96,,,percent of total billed charges,96% of total billed charges,8.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165,75,,,percent of total billed charges,75% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,8.85,213.4,
APPLY SKIN GRFT FACE NCK GENIT HAND FT TO 100SQCM 1ST 25SQCM,78000290G,CDM,983,RC,15275,HCPCS,Outpatient,,,246,184.5,,226.32,92,,,percent of total billed charges,92% of total billed charges,8.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.78,93,,,percent of total billed charges,93% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,238.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,238.62,97,,,percent of total billed charges,97% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges,236.16,96,,,percent of total billed charges,96% of total billed charges,8.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.5,75,,,percent of total billed charges,75% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges,8.34,238.62,
WOUND CARE DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE,96000304G,CDM,960,RC,16020,HCPCS,Outpatient,,,418,313.5,,384.56,92,,,percent of total billed charges,92% of total billed charges,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388.74,93,,,percent of total billed charges,93% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,405.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,405.46,97,,,percent of total billed charges,97% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,401.28,96,,,percent of total billed charges,96% of total billed charges,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,313.5,75,,,percent of total billed charges,75% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,5.19,405.46,
WOUND CARE DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/S,96000306G,CDM,960,RC,16025,HCPCS,Outpatient,,,434,325.5,,399.28,92,,,percent of total billed charges,92% of total billed charges,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.62,93,,,percent of total billed charges,93% of total billed charges,390.6,90,,,percent of total billed charges,90% of total billed charges,390.6,90,,,percent of total billed charges,90% of total billed charges,420.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,420.98,97,,,percent of total billed charges,97% of total billed charges,325.5,75,,,percent of total billed charges,75% of total billed charges,416.64,96,,,percent of total billed charges,96% of total billed charges,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,325.5,75,,,percent of total billed charges,75% of total billed charges,325.5,75,,,percent of total billed charges,75% of total billed charges,11.71,420.98,
WOUND CARE DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/S,96000308G,CDM,960,RC,16030,HCPCS,Outpatient,,,346,259.5,,318.32,92,,,percent of total billed charges,92% of total billed charges,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321.78,93,,,percent of total billed charges,93% of total billed charges,311.4,90,,,percent of total billed charges,90% of total billed charges,311.4,90,,,percent of total billed charges,90% of total billed charges,335.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,335.62,97,,,percent of total billed charges,97% of total billed charges,259.5,75,,,percent of total billed charges,75% of total billed charges,332.16,96,,,percent of total billed charges,96% of total billed charges,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,259.5,75,,,percent of total billed charges,75% of total billed charges,259.5,75,,,percent of total billed charges,75% of total billed charges,15.94,335.62,
WOUND CARE APPLICATION RIGID TOTAL CONTACT LEG CAST,96001182G,CDM,960,RC,29445,HCPCS,Outpatient,,,190,142.5,,174.8,92,,,percent of total billed charges,92% of total billed charges,8.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.7,93,,,percent of total billed charges,93% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,184.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.3,97,,,percent of total billed charges,97% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,182.4,96,,,percent of total billed charges,96% of total billed charges,8.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.5,75,,,percent of total billed charges,75% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,8.82,184.3,
WOUND CARE STRAPPING UNNA BOOT,96001196G,CDM,960,RC,29580,HCPCS,Outpatient,,,107,80.25,,98.44,92,,,percent of total billed charges,92% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,99.51,93,,,percent of total billed charges,93% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,103.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.79,97,,,percent of total billed charges,97% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges,102.72,96,,,percent of total billed charges,96% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.25,75,,,percent of total billed charges,75% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges,2.8,103.79,
WOUND CARE STRAPPING UNNA BOOT BIL,96002804G,CDM,960,RC,29580,HCPCS,Outpatient,,,160.5,120.38,,147.66,92,,,percent of total billed charges,92% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,149.27,93,,,percent of total billed charges,93% of total billed charges,144.45,90,,,percent of total billed charges,90% of total billed charges,144.45,90,,,percent of total billed charges,90% of total billed charges,155.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,155.69,97,,,percent of total billed charges,97% of total billed charges,120.38,75,,,percent of total billed charges,75% of total billed charges,154.08,96,,,percent of total billed charges,96% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,120.38,75,,,percent of total billed charges,75% of total billed charges,120.38,75,,,percent of total billed charges,75% of total billed charges,2.8,155.69,
WOUND CARE INJECT NONCMPND SCLEROSANT SINGLE INCMPTNT VEI,96001305G,CDM,960,RC,36465,HCPCS,Outpatient,,,308,231,,283.36,92,,,percent of total billed charges,92% of total billed charges,16.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,286.44,93,,,percent of total billed charges,93% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,298.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,298.76,97,,,percent of total billed charges,97% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,295.68,96,,,percent of total billed charges,96% of total billed charges,16.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231,75,,,percent of total billed charges,75% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,16.5,298.76,
WOUND CARE INJECT NONCMPND SCLEROSANT MULTIPLE INCMPTNT V,96001307G,CDM,960,RC,36466,HCPCS,Outpatient,,,401,300.75,,368.92,92,,,percent of total billed charges,92% of total billed charges,21.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,372.93,93,,,percent of total billed charges,93% of total billed charges,360.9,90,,,percent of total billed charges,90% of total billed charges,360.9,90,,,percent of total billed charges,90% of total billed charges,388.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388.97,97,,,percent of total billed charges,97% of total billed charges,300.75,75,,,percent of total billed charges,75% of total billed charges,384.96,96,,,percent of total billed charges,96% of total billed charges,21.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.75,75,,,percent of total billed charges,75% of total billed charges,300.75,75,,,percent of total billed charges,75% of total billed charges,21.13,388.97,
WOUND CARE ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,96001326G,CDM,960,RC,36478,HCPCS,Outpatient,,,722,541.5,,664.24,92,,,percent of total billed charges,92% of total billed charges,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,671.46,93,,,percent of total billed charges,93% of total billed charges,649.8,90,,,percent of total billed charges,90% of total billed charges,649.8,90,,,percent of total billed charges,90% of total billed charges,700.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,700.34,97,,,percent of total billed charges,97% of total billed charges,541.5,75,,,percent of total billed charges,75% of total billed charges,693.12,96,,,percent of total billed charges,96% of total billed charges,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,541.5,75,,,percent of total billed charges,75% of total billed charges,541.5,75,,,percent of total billed charges,75% of total billed charges,38.95,700.34,
WOUND CARE ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VNS,96001328G,CDM,960,RC,36479,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,19.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,19.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,19.5,343.38,
I&D PERIANAL ABSCESS SUPERFICIAL,78001459G,CDM,960,RC,46050,HCPCS,Outpatient,,,389,291.75,,357.88,92,,,percent of total billed charges,92% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,361.77,93,,,percent of total billed charges,93% of total billed charges,350.1,90,,,percent of total billed charges,90% of total billed charges,350.1,90,,,percent of total billed charges,90% of total billed charges,377.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,377.33,97,,,percent of total billed charges,97% of total billed charges,291.75,75,,,percent of total billed charges,75% of total billed charges,373.44,96,,,percent of total billed charges,96% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,291.75,75,,,percent of total billed charges,75% of total billed charges,291.75,75,,,percent of total billed charges,75% of total billed charges,10.04,377.33,
PF I&D PERIANAL ABSCESS SUPERFICIAL,78001459P,CDM,960,RC,46050,HCPCS,Outpatient,,,389,291.75,,357.88,92,,,percent of total billed charges,92% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,361.77,93,,,percent of total billed charges,93% of total billed charges,350.1,90,,,percent of total billed charges,90% of total billed charges,350.1,90,,,percent of total billed charges,90% of total billed charges,377.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,377.33,97,,,percent of total billed charges,97% of total billed charges,291.75,75,,,percent of total billed charges,75% of total billed charges,373.44,96,,,percent of total billed charges,96% of total billed charges,10.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,291.75,75,,,percent of total billed charges,75% of total billed charges,291.75,75,,,percent of total billed charges,75% of total billed charges,10.04,377.33,
WOUND CRE REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,96001820G,CDM,960,RC,69210,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,3.29,84.39,
WOUND CARE US UPPER/LWR PHYSILG STUDY OF ARTERIES 1-2 LVL,96000045G,CDM,960,RC,93922,HCPCS,Outpatient,,,222,166.5,,204.24,92,,,percent of total billed charges,92% of total billed charges,2.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,206.46,93,,,percent of total billed charges,93% of total billed charges,199.8,90,,,percent of total billed charges,90% of total billed charges,199.8,90,,,percent of total billed charges,90% of total billed charges,215.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,215.34,97,,,percent of total billed charges,97% of total billed charges,166.5,75,,,percent of total billed charges,75% of total billed charges,213.12,96,,,percent of total billed charges,96% of total billed charges,2.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,166.5,75,,,percent of total billed charges,75% of total billed charges,166.5,75,,,percent of total billed charges,75% of total billed charges,2.98,215.34,
WOUND CARE NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEV,96000047G,CDM,960,RC,93923,HCPCS,Outpatient,,,331,248.25,,304.52,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,307.83,93,,,percent of total billed charges,93% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,321.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321.07,97,,,percent of total billed charges,97% of total billed charges,248.25,75,,,percent of total billed charges,75% of total billed charges,317.76,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,248.25,75,,,percent of total billed charges,75% of total billed charges,248.25,75,,,percent of total billed charges,75% of total billed charges,4.57,321.07,
WOUND CARE US SCAN XTR VEINS COMPLETE BILATERAL STUDY,96000043G,CDM,960,RC,93970,HCPCS,Outpatient,,,492,369,,452.64,92,,,percent of total billed charges,92% of total billed charges,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,457.56,93,,,percent of total billed charges,93% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,477.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,477.24,97,,,percent of total billed charges,97% of total billed charges,369,75,,,percent of total billed charges,75% of total billed charges,472.32,96,,,percent of total billed charges,96% of total billed charges,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,369,75,,,percent of total billed charges,75% of total billed charges,369,75,,,percent of total billed charges,75% of total billed charges,6.15,477.24,
WOUND CARE US SCAN XTR VEINS UNIL/LIMITED STUDY,96000065G,CDM,960,RC,93971,HCPCS,Outpatient,,,190,142.5,,174.8,92,,,percent of total billed charges,92% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.7,93,,,percent of total billed charges,93% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,184.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.3,97,,,percent of total billed charges,97% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,182.4,96,,,percent of total billed charges,96% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.5,75,,,percent of total billed charges,75% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,3.94,184.3,
WOUND CARE DEBRIDEMENT OPEN WOUND 20 SQ CM/<,96001862G,CDM,960,RC,97597,HCPCS,Outpatient,,,198,148.5,,182.16,92,,,percent of total billed charges,92% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.14,93,,,percent of total billed charges,93% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,192.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,192.06,97,,,percent of total billed charges,97% of total billed charges,148.5,75,,,percent of total billed charges,75% of total billed charges,190.08,96,,,percent of total billed charges,96% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,148.5,75,,,percent of total billed charges,75% of total billed charges,148.5,75,,,percent of total billed charges,75% of total billed charges,2.84,192.06,
WOUND CARE DEBRIDEMENT OPEN WOUND EACH ADD'L 20SQCM,96001864G,CDM,960,RC,97598,HCPCS,Outpatient,,,316,237,,290.72,92,,,percent of total billed charges,92% of total billed charges,2.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,293.88,93,,,percent of total billed charges,93% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,306.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.52,97,,,percent of total billed charges,97% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,303.36,96,,,percent of total billed charges,96% of total billed charges,2.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237,75,,,percent of total billed charges,75% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,2.47,306.52,
WOUND CARE REMOVAL DEVITALIZD TISS N-SLCTV DBRDMT W/O ANE,96001866G,CDM,960,RC,97602,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,172.05,93,,,percent of total billed charges,93% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,179.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,179.45,97,,,percent of total billed charges,97% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,177.6,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,179.45,
WOUND CARE NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQC,96001867G,CDM,960,RC,97605,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.38,93,,,percent of total billed charges,93% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,64.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.02,97,,,percent of total billed charges,97% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,63.36,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.5,75,,,percent of total billed charges,75% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,1.1,64.02,
WOUND CARE NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM,96001869G,CDM,960,RC,97606,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.96,93,,,percent of total billed charges,93% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,69.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.84,97,,,percent of total billed charges,97% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,69.12,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54,75,,,percent of total billed charges,75% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,1.18,69.84,
WOUND CARE NEGATIVE PRESSURE WOUND THERAPY NON DME </= 50,96001871G,CDM,960,RC,97607,HCPCS,Outpatient,,,583,437.25,,536.36,92,,,percent of total billed charges,92% of total billed charges,2.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,542.19,93,,,percent of total billed charges,93% of total billed charges,524.7,90,,,percent of total billed charges,90% of total billed charges,524.7,90,,,percent of total billed charges,90% of total billed charges,565.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,565.51,97,,,percent of total billed charges,97% of total billed charges,437.25,75,,,percent of total billed charges,75% of total billed charges,559.68,96,,,percent of total billed charges,96% of total billed charges,2.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.25,75,,,percent of total billed charges,75% of total billed charges,437.25,75,,,percent of total billed charges,75% of total billed charges,2.35,565.51,
WOUND CARE NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM,96001873G,CDM,960,RC,97608,HCPCS,Outpatient,,,296,222,,272.32,92,,,percent of total billed charges,92% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.28,93,,,percent of total billed charges,93% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,287.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,287.12,97,,,percent of total billed charges,97% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,284.16,96,,,percent of total billed charges,96% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222,75,,,percent of total billed charges,75% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,3.29,287.12,
WOUND CARE NEW PATIENT VISIT LEVEL 2,96001891G,CDM,960,RC,99202,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,3.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,3.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,3.79,104.76,
WOUND CARE NEW PATIENT VISIT LEVEL 3,96001895G,CDM,960,RC,99203,HCPCS,Outpatient,,,146,109.5,,134.32,92,,,percent of total billed charges,92% of total billed charges,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.78,93,,,percent of total billed charges,93% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,141.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.62,97,,,percent of total billed charges,97% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,140.16,96,,,percent of total billed charges,96% of total billed charges,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,109.5,75,,,percent of total billed charges,75% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,7.15,141.62,
WOUND CARE NEW PATIENT VISIT LEVEL 4,96001899G,CDM,960,RC,99204,HCPCS,Outpatient,,,218,163.5,,200.56,92,,,percent of total billed charges,92% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,202.74,93,,,percent of total billed charges,93% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,211.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,211.46,97,,,percent of total billed charges,97% of total billed charges,163.5,75,,,percent of total billed charges,75% of total billed charges,209.28,96,,,percent of total billed charges,96% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.5,75,,,percent of total billed charges,75% of total billed charges,163.5,75,,,percent of total billed charges,75% of total billed charges,11.08,211.46,
WOUND CARE NEW PATIENT VISIT LEVEL 5,96001903G,CDM,960,RC,99205,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges,15.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,267.84,93,,,percent of total billed charges,93% of total billed charges,259.2,90,,,percent of total billed charges,90% of total billed charges,259.2,90,,,percent of total billed charges,90% of total billed charges,279.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,279.36,97,,,percent of total billed charges,97% of total billed charges,216,75,,,percent of total billed charges,75% of total billed charges,276.48,96,,,percent of total billed charges,96% of total billed charges,15.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,216,75,,,percent of total billed charges,75% of total billed charges,216,75,,,percent of total billed charges,75% of total billed charges,15.17,279.36,
WOUND CARE EST PATIENT VISIT LEVEL 1,96001907G,CDM,960,RC,99211,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,32.55,93,,,percent of total billed charges,93% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,33.95,97,,,percent of total billed charges,97% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,33.6,96,,,percent of total billed charges,96% of total billed charges,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,0.57,33.95,
WOUND CARE EST PATIENT VISIT LEVEL 2,96001911G,CDM,960,RC,99212,HCPCS,Outpatient,,,84,63,,77.28,92,,,percent of total billed charges,92% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.12,93,,,percent of total billed charges,93% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,81.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.48,97,,,percent of total billed charges,97% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,80.64,96,,,percent of total billed charges,96% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63,75,,,percent of total billed charges,75% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,2.84,81.48,
WOUND CARE EST PATIENT VISIT LEVEL 3,96001915G,CDM,960,RC,99213,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges,4.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.6,93,,,percent of total billed charges,93% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,116.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.4,97,,,percent of total billed charges,97% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,115.2,96,,,percent of total billed charges,96% of total billed charges,4.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90,75,,,percent of total billed charges,75% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,4.97,116.4,
WOUND CARE EST PATIENT VISIT LEVEL 4,96001919G,CDM,960,RC,99214,HCPCS,Outpatient,,,166,124.5,,152.72,92,,,percent of total billed charges,92% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.38,93,,,percent of total billed charges,93% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,161.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.02,97,,,percent of total billed charges,97% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,159.36,96,,,percent of total billed charges,96% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,124.5,75,,,percent of total billed charges,75% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,7.12,161.02,
WOUND CARE EST PATIENT VISIT LEVEL 5,96001923G,CDM,960,RC,99215,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.6,93,,,percent of total billed charges,93% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,213.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.4,97,,,percent of total billed charges,97% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,211.2,96,,,percent of total billed charges,96% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165,75,,,percent of total billed charges,75% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,10.9,213.4,
WOUND CARE HYPERBARIC OXYGEN FULL BODY CHAMBER EA 30MIN,96001889G,CDM,960,RC,,,Outpatient,,,430,322.5,,395.6,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,399.9,93,,,percent of total billed charges,93% of total billed charges,387,90,,,percent of total billed charges,90% of total billed charges,387,90,,,percent of total billed charges,90% of total billed charges,417.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,417.1,97,,,percent of total billed charges,97% of total billed charges,322.5,75,,,percent of total billed charges,75% of total billed charges,412.8,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,322.5,75,,,percent of total billed charges,75% of total billed charges,322.5,75,,,percent of total billed charges,75% of total billed charges,322.5,417.1,
PF CONSCIOUS SEDATION SAME MD EA ADDL 15 MIN,68500015P,CDM,964,RC,1996,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,39.06,93,,,percent of total billed charges,93% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,40.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.74,97,,,percent of total billed charges,97% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,40.32,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,31.5,75,,,percent of total billed charges,75% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,31.5,40.74,
PF MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAST,72900075P,CDM,972,RC,73220,HCPCS,Outpatient,,,3615,2711.25,,3325.8,92,,,percent of total billed charges,92% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3361.95,93,,,percent of total billed charges,93% of total billed charges,3253.5,90,,,percent of total billed charges,90% of total billed charges,3253.5,90,,,percent of total billed charges,90% of total billed charges,3506.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,3506.55,97,,,percent of total billed charges,97% of total billed charges,2711.25,75,,,percent of total billed charges,75% of total billed charges,3470.4,96,,,percent of total billed charges,96% of total billed charges,11.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2711.25,75,,,percent of total billed charges,75% of total billed charges,2711.25,75,,,percent of total billed charges,75% of total billed charges,11.89,3506.55,
PF XR ELBOW ARTHROGRAPHY RS&I,71800198P,CDM,972,RC,73040,HCPCS,Outpatient,,,309,231.75,,284.28,92,,,percent of total billed charges,92% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,287.37,93,,,percent of total billed charges,93% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,278.1,90,,,percent of total billed charges,90% of total billed charges,299.73,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,299.73,97,,,percent of total billed charges,97% of total billed charges,231.75,75,,,percent of total billed charges,75% of total billed charges,296.64,96,,,percent of total billed charges,96% of total billed charges,3.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.75,75,,,percent of total billed charges,75% of total billed charges,231.75,75,,,percent of total billed charges,75% of total billed charges,3.91,299.73,
PF OB CARE ANTEPARTUM VAGINAL DELIVERY  and  POSTPARTUM,78001670P,CDM,983,RC,59400,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,360.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,360.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,360.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,360.77,360.77,
PF OB ANTEPARTUM CARE CESAREAN DELIVERY  POSTPARTUM,78001686P,CDM,983,RC,59510,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,432.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,432.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,432.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,432.32,432.32,
PF ECG ROUTINE ECG W/LEAST 12 LDS IR ONLY,78001841P,CDM,985,RC,93010,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,0.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.55,0.55,
PF RHYTHM ECG 1-3 LEADS INTERPRETATION  and  RPRT ONLY,78001842P,CDM,985,RC,93042,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,0.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.5,0.5,
PF EXTERNAL ECG RECORDING FOR >48 HOURS UP TO 7 DAYS REVIEW,78002846P,CDM,985,RC,93244,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.32,1.32,
PF EXTERNAL ECG RECORDING FOR >7 DAYS UP TO 15 DAYS REVIEW  and,78002848P,CDM,985,RC,93248,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.41,1.41,
PF BRIEF EMOTIONAL BEHAVIORAL ASSESSMENT,78001861P,CDM,983,RC,96127,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,0.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.43,0.43,
PF SERVICES PROVIDED IN OFFICE AFTER HOURS,78002864P,CDM,983,RC,99050,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,32.55,93,,,percent of total billed charges,93% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.95,97,,,percent of total billed charges,97% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,33.6,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,33.95,
PF ATTEND  and  SUPERVISE HYPERBARIC OXYGEN THERAPY,78001890P,CDM,983,RC,99183,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,10.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.67,10.67,
PF CHRONIC CARE MANAGEMENT SERVICES 1ST 20 MIN,78002423P,CDM,983,RC,99490,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,3.61,
PF SPORTS PHYSICAL,78002033P,CDM,983,RC,99997,HCPCS,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,18.6,93,,,percent of total billed charges,93% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,19.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.4,97,,,percent of total billed charges,97% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,19.2,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,15,75,,,percent of total billed charges,75% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,15,19.4,
PF INITIAL PRENATAL CARE VISIT,78002105P,CDM,960,RC,0500F,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,195.3,93,,,percent of total billed charges,93% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,203.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,203.7,97,,,percent of total billed charges,97% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,201.6,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,157.5,75,,,percent of total billed charges,75% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,157.5,203.7,
PF OBSERVATION OR IP CARE 40 MIN PER DAY,78001940P,CDM,983,RC,99234,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,7.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.95,7.95,
PF HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES,78001963P,CDM,983,RC,99341,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.05,3.05,
PF HOME VISIT EST PT SELF LTD/MINOR 15 MIN,78001964P,CDM,983,RC,99347,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,2.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.91,2.91,
PF HOME VISIT EST PT LOW-MOD SEVERITY 25 MIN,78001965P,CDM,983,RC,99348,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,4.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.79,4.79,
PF HOME VISIT EST PT MOD-HI SEVERITY 40 MIN,78001966P,CDM,983,RC,99349,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,8.7,
PF PROLNG E/M SVC BEFORE and /AFTER DIR PT CARE 1ST HR,78001970P,CDM,983,RC,99358,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.99,5.99,
PF PROLNG E/M BEFORE and /AFTER DIR CARE EA 30 MINUTES,78001971P,CDM,983,RC,99359,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,2.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.61,2.61,
PF PREVENT MED COUNSEL/RISK FACTOR REDJ SPX 30 MIN,78002000P,CDM,983,RC,99402,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.26,3.26,
PF PROLONGED CLINICAL STAFF SVC OFFICE/O/P 1ST HR,78002005P,CDM,983,RC,99415,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,1.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.26,1.26,
PF PROLONGED CLINICAL STAFF SVC OFFICE/O/P EA ADDL,78002006P,CDM,983,RC,99416,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,0.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.6,0.6,
PF PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN,78002007P,CDM,983,RC,99417,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,2.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.11,2.11,
PF TELEPHONE E/M BY PHYSICIAN 5-10 MIN,78002008P,CDM,983,RC,99441,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,2.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.55,2.55,
PF TELEPHONE E/M BY PHYSICIAN 11-20 MIN,78002009P,CDM,983,RC,99442,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,4.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.69,4.69,
PF TELEPHONE E/M BY PHYSICIAN 21-30 MIN,78002010P,CDM,983,RC,99443,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,7.12,
CHRONIC CARE MANAGEMENT SERVICES 1ST 20 MIN,78002423,CDM,983,RC,99490,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,3.61,
PF CHRONIC CARE MGMT SVC AT LEAST 30 MIN PER MONTH,78002021P,CDM,983,RC,99491,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,5.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.29,5.29,
PF TRANSITIONAL CARE MANAGE SRVC 14 DAY DISCHARGE,78002022P,CDM,983,RC,99495,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,9.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.67,9.67,
PF TRANSITIONAL CARE MANAGE SRVC 7 DAY DISCHARGE,78002023P,CDM,983,RC,99496,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.01,13.01,
INITIAL PRVNT EXAM NEW BENEFICIARY 1ST 12 MONTH,78002076,CDM,983,RC,G0402,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,9.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.1,9.1,
ANNUAL WELLNESS VISIT INITIAL,78002079,CDM,983,RC,G0438,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,10.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.33,10.33,
ANNUAL WELLNESS VISIT SUBSEQUENT,78002081P,CDM,983,RC,G0439,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,8.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.02,8.02,
PF REMOTE EVALUATION RECORDED VIDEO/IMAGE EST PAT,78002097P,CDM,983,RC,G2010,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.58,0.58,
PF BRIEF VIRTUAL CHECK-IN BY PHYSICN OR OTHER QHP,78002100P,CDM,983,RC,G2012,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,0.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.98,0.98,
PF SPORTS PHYSICAL,78002033P,CDM,983,RC,99997,HCPCS,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,18.6,93,,,percent of total billed charges,93% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,19.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.4,97,,,percent of total billed charges,97% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,19.2,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,15,75,,,percent of total billed charges,75% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,15,19.4,
PF SPORTS PHYSICAL,78002033P,CDM,983,RC,99997,HCPCS,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,18.6,93,,,percent of total billed charges,93% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,19.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.4,97,,,percent of total billed charges,97% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,19.2,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,15,75,,,percent of total billed charges,75% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,15,19.4,
INJECTION(S) PLATELET RICH PLASMA,78002892G,CDM,983,RC,0232T,HCPCS,Outpatient,,,113,84.75,,103.96,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,105.09,93,,,percent of total billed charges,93% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,101.7,90,,,percent of total billed charges,90% of total billed charges,109.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,109.61,97,,,percent of total billed charges,97% of total billed charges,84.75,75,,,percent of total billed charges,75% of total billed charges,108.48,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,84.75,75,,,percent of total billed charges,75% of total billed charges,84.75,75,,,percent of total billed charges,75% of total billed charges,84.75,109.61,
FINE NEEDLE ASPIRATION BIOPSY W/US GUIDE FIRST LESION,78000001G,CDM,983,RC,10005,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,6.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,6.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,6.83,201.76,
FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESN,78000003G,CDM,983,RC,10021,HCPCS,Outpatient,,,642,481.5,,590.64,92,,,percent of total billed charges,92% of total billed charges,5.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,597.06,93,,,percent of total billed charges,93% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,577.8,90,,,percent of total billed charges,90% of total billed charges,622.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,622.74,97,,,percent of total billed charges,97% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,616.32,96,,,percent of total billed charges,96% of total billed charges,5.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,481.5,75,,,percent of total billed charges,75% of total billed charges,481.5,75,,,percent of total billed charges,75% of total billed charges,5.67,622.74,
INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE,78000005G,CDM,983,RC,10060,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,7.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,7.23,289.06,
INCISION  DRAINAGE ABSCESS COMPLICATED/MULT,78000007G,CDM,983,RC,10061,HCPCS,Outpatient,,,712,534,,655.04,92,,,percent of total billed charges,92% of total billed charges,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,662.16,93,,,percent of total billed charges,93% of total billed charges,640.8,90,,,percent of total billed charges,90% of total billed charges,640.8,90,,,percent of total billed charges,90% of total billed charges,690.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,690.64,97,,,percent of total billed charges,97% of total billed charges,534,75,,,percent of total billed charges,75% of total billed charges,683.52,96,,,percent of total billed charges,96% of total billed charges,15.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,534,75,,,percent of total billed charges,75% of total billed charges,534,75,,,percent of total billed charges,75% of total billed charges,15.08,690.64,
INCISION  DRAINAGE PILONIDAL CYST SIMPLE,78000009G,CDM,983,RC,10080,HCPCS,Outpatient,,,403,302.25,,370.76,92,,,percent of total billed charges,92% of total billed charges,9.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,374.79,93,,,percent of total billed charges,93% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,390.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,390.91,97,,,percent of total billed charges,97% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,386.88,96,,,percent of total billed charges,96% of total billed charges,9.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,302.25,75,,,percent of total billed charges,75% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,9.08,390.91,
INCISION  DRAINAGE PILONIDAL CYST COMPLICATED,78000011G,CDM,983,RC,10081,HCPCS,Outpatient,,,453,339.75,,416.76,92,,,percent of total billed charges,92% of total billed charges,18.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,421.29,93,,,percent of total billed charges,93% of total billed charges,407.7,90,,,percent of total billed charges,90% of total billed charges,407.7,90,,,percent of total billed charges,90% of total billed charges,439.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,439.41,97,,,percent of total billed charges,97% of total billed charges,339.75,75,,,percent of total billed charges,75% of total billed charges,434.88,96,,,percent of total billed charges,96% of total billed charges,18.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,339.75,75,,,percent of total billed charges,75% of total billed charges,339.75,75,,,percent of total billed charges,75% of total billed charges,18.68,439.41,
INCISION  REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,78000013G,CDM,983,RC,10120,HCPCS,Outpatient,,,403,302.25,,370.76,92,,,percent of total billed charges,92% of total billed charges,7.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,374.79,93,,,percent of total billed charges,93% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,362.7,90,,,percent of total billed charges,90% of total billed charges,390.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,390.91,97,,,percent of total billed charges,97% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,386.88,96,,,percent of total billed charges,96% of total billed charges,7.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,302.25,75,,,percent of total billed charges,75% of total billed charges,302.25,75,,,percent of total billed charges,75% of total billed charges,7.74,390.91,
INCISION  REMOVAL FOREIGN BODY SUBQ TISS COMPLETE,78000015G,CDM,983,RC,10121,HCPCS,Outpatient,,,728,546,,669.76,92,,,percent of total billed charges,92% of total billed charges,17.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,677.04,93,,,percent of total billed charges,93% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,706.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,706.16,97,,,percent of total billed charges,97% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,698.88,96,,,percent of total billed charges,96% of total billed charges,17.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546,75,,,percent of total billed charges,75% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,17.2,706.16,
ID HEMATOMA SEROMA/FLUID COLLECTION,78000017G,CDM,983,RC,10140,HCPCS,Outpatient,,,410,307.5,,377.2,92,,,percent of total billed charges,92% of total billed charges,9.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,381.3,93,,,percent of total billed charges,93% of total billed charges,369,90,,,percent of total billed charges,90% of total billed charges,369,90,,,percent of total billed charges,90% of total billed charges,397.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,397.7,97,,,percent of total billed charges,97% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges,393.6,96,,,percent of total billed charges,96% of total billed charges,9.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,307.5,75,,,percent of total billed charges,75% of total billed charges,307.5,75,,,percent of total billed charges,75% of total billed charges,9.8,397.7,
INCISION  DRAIN POST OP WOUND INFECTION COMPLEX,78000021G,CDM,983,RC,10180,HCPCS,Outpatient,,,907,680.25,,834.44,92,,,percent of total billed charges,92% of total billed charges,20.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,843.51,93,,,percent of total billed charges,93% of total billed charges,816.3,90,,,percent of total billed charges,90% of total billed charges,816.3,90,,,percent of total billed charges,90% of total billed charges,879.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,879.79,97,,,percent of total billed charges,97% of total billed charges,680.25,75,,,percent of total billed charges,75% of total billed charges,870.72,96,,,percent of total billed charges,96% of total billed charges,20.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,680.25,75,,,percent of total billed charges,75% of total billed charges,680.25,75,,,percent of total billed charges,75% of total billed charges,20.04,879.79,
DEBRIDE W/FOREIGN BODY REMOVAL SKIN & SUBC TISS,78000026G,CDM,983,RC,11010,HCPCS,Outpatient,,,728,546,,669.76,92,,,percent of total billed charges,92% of total billed charges,29.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,677.04,93,,,percent of total billed charges,93% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,706.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,706.16,97,,,percent of total billed charges,97% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,698.88,96,,,percent of total billed charges,96% of total billed charges,29.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546,75,,,percent of total billed charges,75% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,29.58,706.16,
DEBRIDE W/FOREIGN BODY RMVL SKIN SUBQ TISS MUSC,78000028G,CDM,983,RC,11011,HCPCS,Outpatient,,,752,564,,691.84,92,,,percent of total billed charges,92% of total billed charges,36.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,699.36,93,,,percent of total billed charges,93% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,676.8,90,,,percent of total billed charges,90% of total billed charges,729.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,36.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,729.44,97,,,percent of total billed charges,97% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,721.92,96,,,percent of total billed charges,96% of total billed charges,36.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564,75,,,percent of total billed charges,75% of total billed charges,564,75,,,percent of total billed charges,75% of total billed charges,36.54,729.44,
DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,78000032G,CDM,983,RC,11042,HCPCS,Outpatient,,,239,179.25,,219.88,92,,,percent of total billed charges,92% of total billed charges,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222.27,93,,,percent of total billed charges,93% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,231.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.83,97,,,percent of total billed charges,97% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,229.44,96,,,percent of total billed charges,96% of total billed charges,5.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.25,75,,,percent of total billed charges,75% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,5.61,231.83,
DEBRIDE MUSCLE AND/OR FASCIA FIRST 20 SQCM OR <,78000034G,CDM,983,RC,11043,HCPCS,Outpatient,,,608,456,,559.36,92,,,percent of total billed charges,92% of total billed charges,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,565.44,93,,,percent of total billed charges,93% of total billed charges,547.2,90,,,percent of total billed charges,90% of total billed charges,547.2,90,,,percent of total billed charges,90% of total billed charges,589.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,589.76,97,,,percent of total billed charges,97% of total billed charges,456,75,,,percent of total billed charges,75% of total billed charges,583.68,96,,,percent of total billed charges,96% of total billed charges,16.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,456,75,,,percent of total billed charges,75% of total billed charges,456,75,,,percent of total billed charges,75% of total billed charges,16.12,589.76,
DEBRIDEMENT BONE FIRST 20 SQ CM OR LESS,78000036G,CDM,983,RC,11044,HCPCS,Outpatient,,,893,669.75,,821.56,92,,,percent of total billed charges,92% of total billed charges,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,830.49,93,,,percent of total billed charges,93% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,803.7,90,,,percent of total billed charges,90% of total billed charges,866.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,866.21,97,,,percent of total billed charges,97% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,857.28,96,,,percent of total billed charges,96% of total billed charges,25.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,669.75,75,,,percent of total billed charges,75% of total billed charges,669.75,75,,,percent of total billed charges,75% of total billed charges,25.64,866.21,
DEBRIDE SUBCUTANEOUS TISSUE EACH ADDL 20 SQ CM,78000038G,CDM,983,RC,11045,HCPCS,Outpatient,,,105,78.75,,96.6,92,,,percent of total billed charges,92% of total billed charges,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.65,93,,,percent of total billed charges,93% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,94.5,90,,,percent of total billed charges,90% of total billed charges,101.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.85,97,,,percent of total billed charges,97% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges,100.8,96,,,percent of total billed charges,96% of total billed charges,3.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.75,75,,,percent of total billed charges,75% of total billed charges,78.75,75,,,percent of total billed charges,75% of total billed charges,3.03,101.85,
DEBRIDE MUSCLE AND/OR FASCIA EACH ADDL 20 SQ CM,78000040G,CDM,983,RC,11046,HCPCS,Outpatient,,,219,164.25,,201.48,92,,,percent of total billed charges,92% of total billed charges,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.67,93,,,percent of total billed charges,93% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,197.1,90,,,percent of total billed charges,90% of total billed charges,212.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,212.43,97,,,percent of total billed charges,97% of total billed charges,164.25,75,,,percent of total billed charges,75% of total billed charges,210.24,96,,,percent of total billed charges,96% of total billed charges,7.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.25,75,,,percent of total billed charges,75% of total billed charges,164.25,75,,,percent of total billed charges,75% of total billed charges,7.03,212.43,
DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM,78000042G,CDM,983,RC,11047,HCPCS,Outpatient,,,387,290.25,,356.04,92,,,percent of total billed charges,92% of total billed charges,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,359.91,93,,,percent of total billed charges,93% of total billed charges,348.3,90,,,percent of total billed charges,90% of total billed charges,348.3,90,,,percent of total billed charges,90% of total billed charges,375.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375.39,97,,,percent of total billed charges,97% of total billed charges,290.25,75,,,percent of total billed charges,75% of total billed charges,371.52,96,,,percent of total billed charges,96% of total billed charges,12.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,290.25,75,,,percent of total billed charges,75% of total billed charges,290.25,75,,,percent of total billed charges,75% of total billed charges,12.81,375.39,
PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,78000044G,CDM,983,RC,11055,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,39.06,93,,,percent of total billed charges,93% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,40.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,40.74,97,,,percent of total billed charges,97% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,40.32,96,,,percent of total billed charges,96% of total billed charges,1.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,31.5,75,,,percent of total billed charges,75% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,1.34,40.74,
PARING/CUTTING BENIGN HYPERKERATOTC LESIONS 2-4,78000046G,CDM,983,RC,11056,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.94,93,,,percent of total billed charges,93% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,56.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.26,97,,,percent of total billed charges,97% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,55.68,96,,,percent of total billed charges,96% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.5,75,,,percent of total billed charges,75% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,1.83,56.26,
PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,78000048G,CDM,983,RC,11057,HCPCS,Outpatient,,,76,57,,69.92,92,,,percent of total billed charges,92% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.68,93,,,percent of total billed charges,93% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,68.4,90,,,percent of total billed charges,90% of total billed charges,73.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,73.72,97,,,percent of total billed charges,97% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,72.96,96,,,percent of total billed charges,96% of total billed charges,2.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57,75,,,percent of total billed charges,75% of total billed charges,57,75,,,percent of total billed charges,75% of total billed charges,2.33,73.72,
"11102 Tangential biopsy of skin (eg, shave, scoop, saucerize",78000050G,CDM,983,RC,11102,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.15,93,,,percent of total billed charges,93% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,150.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.35,97,,,percent of total billed charges,97% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,148.8,96,,,percent of total billed charges,96% of total billed charges,3.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,75,,,percent of total billed charges,75% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,3.19,150.35,
TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000052G,CDM,983,RC,11103,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.61,93,,,percent of total billed charges,93% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,74.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.69,97,,,percent of total billed charges,97% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,73.92,96,,,percent of total billed charges,96% of total billed charges,1.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.75,75,,,percent of total billed charges,75% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,1.83,74.69,
PUNCH BIOPSY SKIN SINGLE LESION,78000054G,CDM,983,RC,11104,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.56,93,,,percent of total billed charges,93% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,186.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.24,97,,,percent of total billed charges,97% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,184.32,96,,,percent of total billed charges,96% of total billed charges,4.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144,75,,,percent of total billed charges,75% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,4.31,186.24,
PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000056G,CDM,983,RC,11105,HCPCS,Outpatient,,,90,67.5,,82.8,92,,,percent of total billed charges,92% of total billed charges,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.7,93,,,percent of total billed charges,93% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,81,90,,,percent of total billed charges,90% of total billed charges,87.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,87.3,97,,,percent of total billed charges,97% of total billed charges,67.5,75,,,percent of total billed charges,75% of total billed charges,86.4,96,,,percent of total billed charges,96% of total billed charges,2.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,67.5,75,,,percent of total billed charges,75% of total billed charges,67.5,75,,,percent of total billed charges,75% of total billed charges,2.5,87.3,
INCISIONAL BIOPSY SKIN SINGLE LESION,78000058G,CDM,983,RC,11106,HCPCS,Outpatient,,,238,178.5,,218.96,92,,,percent of total billed charges,92% of total billed charges,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,221.34,93,,,percent of total billed charges,93% of total billed charges,214.2,90,,,percent of total billed charges,90% of total billed charges,214.2,90,,,percent of total billed charges,90% of total billed charges,230.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,230.86,97,,,percent of total billed charges,97% of total billed charges,178.5,75,,,percent of total billed charges,75% of total billed charges,228.48,96,,,percent of total billed charges,96% of total billed charges,5.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.5,75,,,percent of total billed charges,75% of total billed charges,178.5,75,,,percent of total billed charges,75% of total billed charges,5.46,230.86,
INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION,78000060G,CDM,983,RC,11107,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,2.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,2.95,104.76,
REMOVAL OF UP TO AND INCLUDING 15 SKIN TAGS,78000062G,CDM,983,RC,11200,HCPCS,Outpatient,,,135,101.25,,124.2,92,,,percent of total billed charges,92% of total billed charges,5.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.55,93,,,percent of total billed charges,93% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,121.5,90,,,percent of total billed charges,90% of total billed charges,130.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.95,97,,,percent of total billed charges,97% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,129.6,96,,,percent of total billed charges,96% of total billed charges,5.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,101.25,75,,,percent of total billed charges,75% of total billed charges,101.25,75,,,percent of total billed charges,75% of total billed charges,5.1,130.95,
REMOVAL OF SKIN TAGS ANY AREA EACH ADD 10 LESIONS,78000064G,CDM,983,RC,11201,HCPCS,Outpatient,,,43,32.25,,39.56,92,,,percent of total billed charges,92% of total billed charges,1.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,39.99,93,,,percent of total billed charges,93% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,38.7,90,,,percent of total billed charges,90% of total billed charges,41.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,41.71,97,,,percent of total billed charges,97% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,41.28,96,,,percent of total billed charges,96% of total billed charges,1.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,32.25,75,,,percent of total billed charges,75% of total billed charges,32.25,75,,,percent of total billed charges,75% of total billed charges,1.37,41.71,
SHAVING SKIN LESN 1 TRUNK/ARM/LEG DIAM 0.5CM/<,78000066G,CDM,983,RC,11300,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges,3.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.15,93,,,percent of total billed charges,93% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,150.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.35,97,,,percent of total billed charges,97% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,148.8,96,,,percent of total billed charges,96% of total billed charges,3.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,75,,,percent of total billed charges,75% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,3.06,150.35,
SHAVING SKIN LESION TRUNK/ARM/LEG DIAM 0.6-1.0 CM,78000068G,CDM,983,RC,11301,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges,4.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.05,93,,,percent of total billed charges,93% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,179.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.45,97,,,percent of total billed charges,97% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,177.6,96,,,percent of total billed charges,96% of total billed charges,4.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,4.46,179.45,
SHAVING OF 0.5 CENTIMETERS OR LESS SKIN GROWTH OF FACE EARS,78000072G,CDM,983,RC,11310,HCPCS,Outpatient,,,177,132.75,,162.84,92,,,percent of total billed charges,92% of total billed charges,4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.61,93,,,percent of total billed charges,93% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,171.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,171.69,97,,,percent of total billed charges,97% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,169.92,96,,,percent of total billed charges,96% of total billed charges,4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.75,75,,,percent of total billed charges,75% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,4,171.69,
SHAVING OF 0.6 CENTIMETERS TO 1.0 CENTIMETERS SKIN GROWTH OF,78000074G,CDM,983,RC,11311,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,5.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,5.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,5.4,201.76,
EXCISE BENIGN LESION MARGIN XCP SK TG T/A/L 0.5 CM/<,78000076G,CDM,983,RC,11400,HCPCS,Outpatient,,,221,165.75,,203.32,92,,,percent of total billed charges,92% of total billed charges,6.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,205.53,93,,,percent of total billed charges,93% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,214.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.37,97,,,percent of total billed charges,97% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,212.16,96,,,percent of total billed charges,96% of total billed charges,6.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.75,75,,,percent of total billed charges,75% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,6.19,214.37,
REMOVAL OF GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE TRUNK ARMS,78000078G,CDM,983,RC,11401,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.48,93,,,percent of total billed charges,93% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,228.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.92,97,,,percent of total billed charges,97% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,226.56,96,,,percent of total billed charges,96% of total billed charges,8.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177,75,,,percent of total billed charges,75% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,8.01,228.92,
EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 1.1-2.0 CM,78000080G,CDM,983,RC,11402,HCPCS,Outpatient,,,260,195,,239.2,92,,,percent of total billed charges,92% of total billed charges,9.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,241.8,93,,,percent of total billed charges,93% of total billed charges,234,90,,,percent of total billed charges,90% of total billed charges,234,90,,,percent of total billed charges,90% of total billed charges,252.2,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,252.2,97,,,percent of total billed charges,97% of total billed charges,195,75,,,percent of total billed charges,75% of total billed charges,249.6,96,,,percent of total billed charges,96% of total billed charges,9.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195,75,,,percent of total billed charges,75% of total billed charges,195,75,,,percent of total billed charges,75% of total billed charges,9.17,252.2,
EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 2.1-3.0 CM,78000082G,CDM,983,RC,11403,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,12.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,12.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,12.53,289.06,
EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS 3.1-4.0 CM,78000084G,CDM,983,RC,11404,HCPCS,Outpatient,,,338,253.5,,310.96,92,,,percent of total billed charges,92% of total billed charges,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,314.34,93,,,percent of total billed charges,93% of total billed charges,304.2,90,,,percent of total billed charges,90% of total billed charges,304.2,90,,,percent of total billed charges,90% of total billed charges,327.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,327.86,97,,,percent of total billed charges,97% of total billed charges,253.5,75,,,percent of total billed charges,75% of total billed charges,324.48,96,,,percent of total billed charges,96% of total billed charges,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,253.5,75,,,percent of total billed charges,75% of total billed charges,253.5,75,,,percent of total billed charges,75% of total billed charges,15.21,327.86,
EXCISE BENIGN LESION MARGIN TRUNK ARMS LEGS >4.0 CM,78000086G,CDM,983,RC,11406,HCPCS,Outpatient,,,479,359.25,,440.68,92,,,percent of total billed charges,92% of total billed charges,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,445.47,93,,,percent of total billed charges,93% of total billed charges,431.1,90,,,percent of total billed charges,90% of total billed charges,431.1,90,,,percent of total billed charges,90% of total billed charges,464.63,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,464.63,97,,,percent of total billed charges,97% of total billed charges,359.25,75,,,percent of total billed charges,75% of total billed charges,459.84,96,,,percent of total billed charges,96% of total billed charges,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,359.25,75,,,percent of total billed charges,75% of total billed charges,359.25,75,,,percent of total billed charges,75% of total billed charges,26.53,464.63,
EXCISE BENIGN LESN MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM,78000092G,CDM,983,RC,11422,HCPCS,Outpatient,,,270,202.5,,248.4,92,,,percent of total billed charges,92% of total billed charges,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,251.1,93,,,percent of total billed charges,93% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,243,90,,,percent of total billed charges,90% of total billed charges,261.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,261.9,97,,,percent of total billed charges,97% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,259.2,96,,,percent of total billed charges,96% of total billed charges,10.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,202.5,75,,,percent of total billed charges,75% of total billed charges,202.5,75,,,percent of total billed charges,75% of total billed charges,10.41,261.9,
EXCISE BENIGN LESION MGN XCP SK TG S/N/H/F/G 2.1-3.0CM,78000094G,CDM,983,RC,11423,HCPCS,Outpatient,,,308,231,,283.36,92,,,percent of total billed charges,92% of total billed charges,12.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,286.44,93,,,percent of total billed charges,93% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,298.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,298.76,97,,,percent of total billed charges,97% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,295.68,96,,,percent of total billed charges,96% of total billed charges,12.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231,75,,,percent of total billed charges,75% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,12.78,298.76,
EXCISE BENIGN LESION MGN XCP SK TG S/N/H/F/G 3.1-4.0CM,78000096G,CDM,983,RC,11424,HCPCS,Outpatient,,,353,264.75,,324.76,92,,,percent of total billed charges,92% of total billed charges,16.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,328.29,93,,,percent of total billed charges,93% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,342.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,342.41,97,,,percent of total billed charges,97% of total billed charges,264.75,75,,,percent of total billed charges,75% of total billed charges,338.88,96,,,percent of total billed charges,96% of total billed charges,16.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,264.75,75,,,percent of total billed charges,75% of total billed charges,264.75,75,,,percent of total billed charges,75% of total billed charges,16.32,342.41,
EXCISE BENIGN LESION SCALP NECK HANDS FEET GENITALS > 4.0CM,78000098G,CDM,983,RC,11426,HCPCS,Outpatient,,,499,374.25,,459.08,92,,,percent of total billed charges,92% of total billed charges,26.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,464.07,93,,,percent of total billed charges,93% of total billed charges,449.1,90,,,percent of total billed charges,90% of total billed charges,449.1,90,,,percent of total billed charges,90% of total billed charges,484.03,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,484.03,97,,,percent of total billed charges,97% of total billed charges,374.25,75,,,percent of total billed charges,75% of total billed charges,479.04,96,,,percent of total billed charges,96% of total billed charges,26.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,374.25,75,,,percent of total billed charges,75% of total billed charges,374.25,75,,,percent of total billed charges,75% of total billed charges,26.37,484.03,
EXCISE BENIGN LESION FACE EARS EYELIDS NOSE LIPS MOUTH 0.5CM,78000100G,CDM,983,RC,11440,HCPCS,Outpatient,,,217,162.75,,199.64,92,,,percent of total billed charges,92% of total billed charges,6.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.81,93,,,percent of total billed charges,93% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,195.3,90,,,percent of total billed charges,90% of total billed charges,210.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,210.49,97,,,percent of total billed charges,97% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,208.32,96,,,percent of total billed charges,96% of total billed charges,6.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.75,75,,,percent of total billed charges,75% of total billed charges,162.75,75,,,percent of total billed charges,75% of total billed charges,6.71,210.49,
EXCISE BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM,78000102G,CDM,983,RC,11441,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,10.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,10.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,10.06,255.11,
EXCISION MALIGNAT LESION TRUNK ARMS LEGS 0.5 CM/<,78000108G,CDM,983,RC,11600,HCPCS,Outpatient,,,322,241.5,,296.24,92,,,percent of total billed charges,92% of total billed charges,10.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,299.46,93,,,percent of total billed charges,93% of total billed charges,289.8,90,,,percent of total billed charges,90% of total billed charges,289.8,90,,,percent of total billed charges,90% of total billed charges,312.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312.34,97,,,percent of total billed charges,97% of total billed charges,241.5,75,,,percent of total billed charges,75% of total billed charges,309.12,96,,,percent of total billed charges,96% of total billed charges,10.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,241.5,75,,,percent of total billed charges,75% of total billed charges,241.5,75,,,percent of total billed charges,75% of total billed charges,10.2,312.34,
EXCISION MALIGNANT LESION TRUNK ARMS LEGS 0.6-1.0CM,78000110G,CDM,983,RC,11601,HCPCS,Outpatient,,,344,258,,316.48,92,,,percent of total billed charges,92% of total billed charges,11.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,319.92,93,,,percent of total billed charges,93% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,309.6,90,,,percent of total billed charges,90% of total billed charges,333.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333.68,97,,,percent of total billed charges,97% of total billed charges,258,75,,,percent of total billed charges,75% of total billed charges,330.24,96,,,percent of total billed charges,96% of total billed charges,11.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,258,75,,,percent of total billed charges,75% of total billed charges,258,75,,,percent of total billed charges,75% of total billed charges,11.9,333.68,
EXCISION MALIGNANT LESION TRUNK ARMS LEGS 1.1-2.0CM,78000112G,CDM,983,RC,11602,HCPCS,Outpatient,,,367,275.25,,337.64,92,,,percent of total billed charges,92% of total billed charges,12.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,341.31,93,,,percent of total billed charges,93% of total billed charges,330.3,90,,,percent of total billed charges,90% of total billed charges,330.3,90,,,percent of total billed charges,90% of total billed charges,355.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,355.99,97,,,percent of total billed charges,97% of total billed charges,275.25,75,,,percent of total billed charges,75% of total billed charges,352.32,96,,,percent of total billed charges,96% of total billed charges,12.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.25,75,,,percent of total billed charges,75% of total billed charges,275.25,75,,,percent of total billed charges,75% of total billed charges,12.34,355.99,
EXCISION MALIGNANT LESION TRUNK ARMS LEGS 2.1-3.0CM,78000114G,CDM,983,RC,11603,HCPCS,Outpatient,,,507,380.25,,466.44,92,,,percent of total billed charges,92% of total billed charges,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,471.51,93,,,percent of total billed charges,93% of total billed charges,456.3,90,,,percent of total billed charges,90% of total billed charges,456.3,90,,,percent of total billed charges,90% of total billed charges,491.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,491.79,97,,,percent of total billed charges,97% of total billed charges,380.25,75,,,percent of total billed charges,75% of total billed charges,486.72,96,,,percent of total billed charges,96% of total billed charges,15.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,380.25,75,,,percent of total billed charges,75% of total billed charges,380.25,75,,,percent of total billed charges,75% of total billed charges,15.86,491.79,
EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT 0.6-1.0CM,78000118G,CDM,983,RC,11621,HCPCS,Outpatient,,,624,468,,574.08,92,,,percent of total billed charges,92% of total billed charges,12.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,580.32,93,,,percent of total billed charges,93% of total billed charges,561.6,90,,,percent of total billed charges,90% of total billed charges,561.6,90,,,percent of total billed charges,90% of total billed charges,605.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,605.28,97,,,percent of total billed charges,97% of total billed charges,468,75,,,percent of total billed charges,75% of total billed charges,599.04,96,,,percent of total billed charges,96% of total billed charges,12.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,468,75,,,percent of total billed charges,75% of total billed charges,468,75,,,percent of total billed charges,75% of total billed charges,12.2,605.28,
EXCISE MALIG LESION SCALP NECK HANDS FEET GENIT 1.1-2.0CM,78000120G,CDM,983,RC,11622,HCPCS,Outpatient,,,444,333,,408.48,92,,,percent of total billed charges,92% of total billed charges,13.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,412.92,93,,,percent of total billed charges,93% of total billed charges,399.6,90,,,percent of total billed charges,90% of total billed charges,399.6,90,,,percent of total billed charges,90% of total billed charges,430.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,430.68,97,,,percent of total billed charges,97% of total billed charges,333,75,,,percent of total billed charges,75% of total billed charges,426.24,96,,,percent of total billed charges,96% of total billed charges,13.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333,75,,,percent of total billed charges,75% of total billed charges,333,75,,,percent of total billed charges,75% of total billed charges,13.7,430.68,
EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM,78000122G,CDM,983,RC,11623,HCPCS,Outpatient,,,549,411.75,,505.08,92,,,percent of total billed charges,92% of total billed charges,18.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,510.57,93,,,percent of total billed charges,93% of total billed charges,494.1,90,,,percent of total billed charges,90% of total billed charges,494.1,90,,,percent of total billed charges,90% of total billed charges,532.53,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,532.53,97,,,percent of total billed charges,97% of total billed charges,411.75,75,,,percent of total billed charges,75% of total billed charges,527.04,96,,,percent of total billed charges,96% of total billed charges,18.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.75,75,,,percent of total billed charges,75% of total billed charges,411.75,75,,,percent of total billed charges,75% of total billed charges,18.04,532.53,
EXCISE MALIGNANT LESION FACE EARS EYELIDS NOSE LIPS 0.5CM/<,78000126G,CDM,983,RC,11640,HCPCS,Outpatient,,,333,249.75,,306.36,92,,,percent of total billed charges,92% of total billed charges,10.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,309.69,93,,,percent of total billed charges,93% of total billed charges,299.7,90,,,percent of total billed charges,90% of total billed charges,299.7,90,,,percent of total billed charges,90% of total billed charges,323.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,323.01,97,,,percent of total billed charges,97% of total billed charges,249.75,75,,,percent of total billed charges,75% of total billed charges,319.68,96,,,percent of total billed charges,96% of total billed charges,10.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,249.75,75,,,percent of total billed charges,75% of total billed charges,249.75,75,,,percent of total billed charges,75% of total billed charges,10.08,323.01,
EXCISE MALIGNANT LESN FACE EARS EYELIDS NOSE LIPS 0.6-1.0CM,78000128G,CDM,983,RC,11641,HCPCS,Outpatient,,,408,306,,375.36,92,,,percent of total billed charges,92% of total billed charges,12.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,379.44,93,,,percent of total billed charges,93% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,367.2,90,,,percent of total billed charges,90% of total billed charges,395.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,395.76,97,,,percent of total billed charges,97% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,391.68,96,,,percent of total billed charges,96% of total billed charges,12.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306,75,,,percent of total billed charges,75% of total billed charges,306,75,,,percent of total billed charges,75% of total billed charges,12.69,395.76,
EXCISE MALIGNANT LESN FACE EARS EYELIDS NOSE LIPS 1.1-2.0CM,78000130G,CDM,983,RC,11642,HCPCS,Outpatient,,,478,358.5,,439.76,92,,,percent of total billed charges,92% of total billed charges,15.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,444.54,93,,,percent of total billed charges,93% of total billed charges,430.2,90,,,percent of total billed charges,90% of total billed charges,430.2,90,,,percent of total billed charges,90% of total billed charges,463.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,463.66,97,,,percent of total billed charges,97% of total billed charges,358.5,75,,,percent of total billed charges,75% of total billed charges,458.88,96,,,percent of total billed charges,96% of total billed charges,15.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,358.5,75,,,percent of total billed charges,75% of total billed charges,358.5,75,,,percent of total billed charges,75% of total billed charges,15.49,463.66,
DEBRIDEMENT NAIL ANY METHOD 1-5,78000138G,CDM,983,RC,11720,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges,1.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.94,93,,,percent of total billed charges,93% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,56.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.26,97,,,percent of total billed charges,97% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,55.68,96,,,percent of total billed charges,96% of total billed charges,1.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.5,75,,,percent of total billed charges,75% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,1.3,56.26,
AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE,78000142G,CDM,983,RC,11730,HCPCS,Outpatient,,,215,161.25,,197.8,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,199.95,93,,,percent of total billed charges,93% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,193.5,90,,,percent of total billed charges,90% of total billed charges,208.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,208.55,97,,,percent of total billed charges,97% of total billed charges,161.25,75,,,percent of total billed charges,75% of total billed charges,206.4,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.25,75,,,percent of total billed charges,75% of total billed charges,161.25,75,,,percent of total billed charges,75% of total billed charges,4.28,208.55,
AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL,78000144G,CDM,983,RC,11732,HCPCS,Outpatient,,,69,51.75,,63.48,92,,,percent of total billed charges,92% of total billed charges,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.17,93,,,percent of total billed charges,93% of total billed charges,62.1,90,,,percent of total billed charges,90% of total billed charges,62.1,90,,,percent of total billed charges,90% of total billed charges,66.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.93,97,,,percent of total billed charges,97% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges,66.24,96,,,percent of total billed charges,96% of total billed charges,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,51.75,75,,,percent of total billed charges,75% of total billed charges,51.75,75,,,percent of total billed charges,75% of total billed charges,1.39,66.93,
EVACUATION SUBUNGUAL HEMATOMA,78000146G,CDM,983,RC,11740,HCPCS,Outpatient,,,124,93,,114.08,92,,,percent of total billed charges,92% of total billed charges,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,115.32,93,,,percent of total billed charges,93% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,111.6,90,,,percent of total billed charges,90% of total billed charges,120.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,120.28,97,,,percent of total billed charges,97% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,119.04,96,,,percent of total billed charges,96% of total billed charges,1.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93,75,,,percent of total billed charges,75% of total billed charges,93,75,,,percent of total billed charges,75% of total billed charges,1.93,120.28,
WEDGE EXCISION SKIN NAIL FOLD,78000152G,CDM,983,RC,11765,HCPCS,Outpatient,,,251,188.25,,230.92,92,,,percent of total billed charges,92% of total billed charges,5.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.43,93,,,percent of total billed charges,93% of total billed charges,225.9,90,,,percent of total billed charges,90% of total billed charges,225.9,90,,,percent of total billed charges,90% of total billed charges,243.47,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,243.47,97,,,percent of total billed charges,97% of total billed charges,188.25,75,,,percent of total billed charges,75% of total billed charges,240.96,96,,,percent of total billed charges,96% of total billed charges,5.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,188.25,75,,,percent of total billed charges,75% of total billed charges,188.25,75,,,percent of total billed charges,75% of total billed charges,5.93,243.47,
INJECTION INTRALESIONAL UP TO  and  INCLUD 7 LESION,78000156G,CDM,983,RC,11900,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.61,93,,,percent of total billed charges,93% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,74.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.69,97,,,percent of total billed charges,97% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,73.92,96,,,percent of total billed charges,96% of total billed charges,2.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.75,75,,,percent of total billed charges,75% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,2.65,74.69,
SUBCUTANEOUS HORMONE PELLET IMPLANTATION,78002110G,CDM,983,RC,11980,HCPCS,Outpatient,,,138,103.5,,126.96,92,,,percent of total billed charges,92% of total billed charges,5.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,128.34,93,,,percent of total billed charges,93% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,124.2,90,,,percent of total billed charges,90% of total billed charges,133.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,133.86,97,,,percent of total billed charges,97% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges,132.48,96,,,percent of total billed charges,96% of total billed charges,5.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.5,75,,,percent of total billed charges,75% of total billed charges,103.5,75,,,percent of total billed charges,75% of total billed charges,5.97,133.86,
INSERT NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,78000160G,CDM,983,RC,11981,HCPCS,Outpatient,,,167,125.25,,153.64,92,,,percent of total billed charges,92% of total billed charges,7.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,155.31,93,,,percent of total billed charges,93% of total billed charges,150.3,90,,,percent of total billed charges,90% of total billed charges,150.3,90,,,percent of total billed charges,90% of total billed charges,161.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.99,97,,,percent of total billed charges,97% of total billed charges,125.25,75,,,percent of total billed charges,75% of total billed charges,160.32,96,,,percent of total billed charges,96% of total billed charges,7.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,125.25,75,,,percent of total billed charges,75% of total billed charges,125.25,75,,,percent of total billed charges,75% of total billed charges,7.85,161.99,
REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,78000162G,CDM,983,RC,11982,HCPCS,Outpatient,,,195,146.25,,179.4,92,,,percent of total billed charges,92% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.35,93,,,percent of total billed charges,93% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,175.5,90,,,percent of total billed charges,90% of total billed charges,189.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.15,97,,,percent of total billed charges,97% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,187.2,96,,,percent of total billed charges,96% of total billed charges,9.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.25,75,,,percent of total billed charges,75% of total billed charges,146.25,75,,,percent of total billed charges,75% of total billed charges,9.02,189.15,
REMOVAL W/REINSERT NON-BIODEGRADABLE DRUG DELIVERY IMPLT,78000164G,CDM,983,RC,11983,HCPCS,Outpatient,,,272,204,,250.24,92,,,percent of total billed charges,92% of total billed charges,12.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,252.96,93,,,percent of total billed charges,93% of total billed charges,244.8,90,,,percent of total billed charges,90% of total billed charges,244.8,90,,,percent of total billed charges,90% of total billed charges,263.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,263.84,97,,,percent of total billed charges,97% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges,261.12,96,,,percent of total billed charges,96% of total billed charges,12.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204,75,,,percent of total billed charges,75% of total billed charges,204,75,,,percent of total billed charges,75% of total billed charges,12.77,263.84,
SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 2.5CM/<,78000166G,CDM,983,RC,12001,HCPCS,Outpatient,,,176,132,,161.92,92,,,percent of total billed charges,92% of total billed charges,5.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.68,93,,,percent of total billed charges,93% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,170.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,170.72,97,,,percent of total billed charges,97% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,168.96,96,,,percent of total billed charges,96% of total billed charges,5.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132,75,,,percent of total billed charges,75% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,5.88,170.72,
SIMPLE REPAIR SCALP NECK UNDERARM TRUNK ARM LEG 2.6-7.5CM,78000168G,CDM,983,RC,12002,HCPCS,Outpatient,,,235,176.25,,216.2,92,,,percent of total billed charges,92% of total billed charges,7.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.55,93,,,percent of total billed charges,93% of total billed charges,211.5,90,,,percent of total billed charges,90% of total billed charges,211.5,90,,,percent of total billed charges,90% of total billed charges,227.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,227.95,97,,,percent of total billed charges,97% of total billed charges,176.25,75,,,percent of total billed charges,75% of total billed charges,225.6,96,,,percent of total billed charges,96% of total billed charges,7.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.25,75,,,percent of total billed charges,75% of total billed charges,176.25,75,,,percent of total billed charges,75% of total billed charges,7.99,227.95,
SIMPLE REPAIR EAR EYELID NOSE LIP MUCOUS MEMBRANE 2.5CM/<,78000178G,CDM,983,RC,12011,HCPCS,Outpatient,,,221,165.75,,203.32,92,,,percent of total billed charges,92% of total billed charges,7.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,205.53,93,,,percent of total billed charges,93% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,214.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.37,97,,,percent of total billed charges,97% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,212.16,96,,,percent of total billed charges,96% of total billed charges,7.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.75,75,,,percent of total billed charges,75% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,7.61,214.37,
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM,78000180G,CDM,983,RC,12013,HCPCS,Outpatient,,,233,174.75,,214.36,92,,,percent of total billed charges,92% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,216.69,93,,,percent of total billed charges,93% of total billed charges,209.7,90,,,percent of total billed charges,90% of total billed charges,209.7,90,,,percent of total billed charges,90% of total billed charges,226.01,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,226.01,97,,,percent of total billed charges,97% of total billed charges,174.75,75,,,percent of total billed charges,75% of total billed charges,223.68,96,,,percent of total billed charges,96% of total billed charges,8.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,174.75,75,,,percent of total billed charges,75% of total billed charges,174.75,75,,,percent of total billed charges,75% of total billed charges,8.5,226.01,
REPAIR INTERMEDIATE SCALP UNDERARMS TRUNK ARM LEG 2.5 CM/<,78000194G,CDM,983,RC,12031,HCPCS,Outpatient,,,565,423.75,,519.8,92,,,percent of total billed charges,92% of total billed charges,12.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,525.45,93,,,percent of total billed charges,93% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,508.5,90,,,percent of total billed charges,90% of total billed charges,548.05,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,548.05,97,,,percent of total billed charges,97% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,542.4,96,,,percent of total billed charges,96% of total billed charges,12.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,423.75,75,,,percent of total billed charges,75% of total billed charges,423.75,75,,,percent of total billed charges,75% of total billed charges,12.01,548.05,
REPAIR INTERMEDIATE SCALP UNDERARMS TRUNK ARM LEG 2.6-7.5CM,78000196G,CDM,983,RC,12032,HCPCS,Outpatient,,,748,561,,688.16,92,,,percent of total billed charges,92% of total billed charges,14.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,695.64,93,,,percent of total billed charges,93% of total billed charges,673.2,90,,,percent of total billed charges,90% of total billed charges,673.2,90,,,percent of total billed charges,90% of total billed charges,725.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,725.56,97,,,percent of total billed charges,97% of total billed charges,561,75,,,percent of total billed charges,75% of total billed charges,718.08,96,,,percent of total billed charges,96% of total billed charges,14.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,561,75,,,percent of total billed charges,75% of total billed charges,561,75,,,percent of total billed charges,75% of total billed charges,14.43,725.56,
REPAIR INTERMEDIATE NECK HAND FEET GENITALS 2.5CM/<,78000206G,CDM,983,RC,12041,HCPCS,Outpatient,,,576,432,,529.92,92,,,percent of total billed charges,92% of total billed charges,12.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,535.68,93,,,percent of total billed charges,93% of total billed charges,518.4,90,,,percent of total billed charges,90% of total billed charges,518.4,90,,,percent of total billed charges,90% of total billed charges,558.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,558.72,97,,,percent of total billed charges,97% of total billed charges,432,75,,,percent of total billed charges,75% of total billed charges,552.96,96,,,percent of total billed charges,96% of total billed charges,12.06,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,432,75,,,percent of total billed charges,75% of total billed charges,432,75,,,percent of total billed charges,75% of total billed charges,12.06,558.72,
REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<,78000218G,CDM,983,RC,12051,HCPCS,Outpatient,,,445,333.75,,409.4,92,,,percent of total billed charges,92% of total billed charges,14.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.85,93,,,percent of total billed charges,93% of total billed charges,400.5,90,,,percent of total billed charges,90% of total billed charges,400.5,90,,,percent of total billed charges,90% of total billed charges,431.65,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,431.65,97,,,percent of total billed charges,97% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges,427.2,96,,,percent of total billed charges,96% of total billed charges,14.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,333.75,75,,,percent of total billed charges,75% of total billed charges,333.75,75,,,percent of total billed charges,75% of total billed charges,14.26,431.65,
REPAIR COMPLEX WOUND TRUNK 1.1-2.5 CM,78000232G,CDM,983,RC,13100,HCPCS,Outpatient,,,795,596.25,,731.4,92,,,percent of total billed charges,92% of total billed charges,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,739.35,93,,,percent of total billed charges,93% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,771.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,771.15,97,,,percent of total billed charges,97% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,763.2,96,,,percent of total billed charges,96% of total billed charges,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,596.25,75,,,percent of total billed charges,75% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,17.19,771.15,
REPAIR COMPLEX WOUND TRUNK 2.6-7.5 CM,78000234G,CDM,983,RC,13101,HCPCS,Outpatient,,,978,733.5,,899.76,92,,,percent of total billed charges,92% of total billed charges,19.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,909.54,93,,,percent of total billed charges,93% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,880.2,90,,,percent of total billed charges,90% of total billed charges,948.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,948.66,97,,,percent of total billed charges,97% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,938.88,96,,,percent of total billed charges,96% of total billed charges,19.86,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,733.5,75,,,percent of total billed charges,75% of total billed charges,733.5,75,,,percent of total billed charges,75% of total billed charges,19.86,948.66,
REPAIR COMPLEX WOUND SCALP ARM LEG 1.1-2.5 CM,78000238G,CDM,983,RC,13120,HCPCS,Outpatient,,,914,685.5,,840.88,92,,,percent of total billed charges,92% of total billed charges,18.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,850.02,93,,,percent of total billed charges,93% of total billed charges,822.6,90,,,percent of total billed charges,90% of total billed charges,822.6,90,,,percent of total billed charges,90% of total billed charges,886.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,886.58,97,,,percent of total billed charges,97% of total billed charges,685.5,75,,,percent of total billed charges,75% of total billed charges,877.44,96,,,percent of total billed charges,96% of total billed charges,18.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,685.5,75,,,percent of total billed charges,75% of total billed charges,685.5,75,,,percent of total billed charges,75% of total billed charges,18.8,886.58,
REPAIR COMPLEX WOUND SCALP ARM LEG 2.6-7.5 CM,78000240G,CDM,983,RC,13121,HCPCS,Outpatient,,,675,506.25,,621,92,,,percent of total billed charges,92% of total billed charges,21.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,627.75,93,,,percent of total billed charges,93% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,607.5,90,,,percent of total billed charges,90% of total billed charges,654.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,654.75,97,,,percent of total billed charges,97% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,648,96,,,percent of total billed charges,96% of total billed charges,21.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,506.25,75,,,percent of total billed charges,75% of total billed charges,506.25,75,,,percent of total billed charges,75% of total billed charges,21.59,654.75,
REPAIR COMPLEX WOUND SCALP ARM LEG EACH ADDL 5 CM/<,78000242G,CDM,983,RC,13122,HCPCS,Outpatient,,,330,247.5,,303.6,92,,,percent of total billed charges,92% of total billed charges,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.9,93,,,percent of total billed charges,93% of total billed charges,297,90,,,percent of total billed charges,90% of total billed charges,297,90,,,percent of total billed charges,90% of total billed charges,320.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,320.1,97,,,percent of total billed charges,97% of total billed charges,247.5,75,,,percent of total billed charges,75% of total billed charges,316.8,96,,,percent of total billed charges,96% of total billed charges,8.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,247.5,75,,,percent of total billed charges,75% of total billed charges,247.5,75,,,percent of total billed charges,75% of total billed charges,8.79,320.1,
REPAIR COMP FOREHEAD CHEEK CHIN MOUTH NECK HAND 2.6-7.5CM,78000246G,CDM,983,RC,13132,HCPCS,Outpatient,,,795,596.25,,731.4,92,,,percent of total billed charges,92% of total billed charges,25.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,739.35,93,,,percent of total billed charges,93% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,715.5,90,,,percent of total billed charges,90% of total billed charges,771.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,771.15,97,,,percent of total billed charges,97% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,763.2,96,,,percent of total billed charges,96% of total billed charges,25.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,596.25,75,,,percent of total billed charges,75% of total billed charges,596.25,75,,,percent of total billed charges,75% of total billed charges,25.28,771.15,
EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM,78000274G,CDM,983,RC,15116,HCPCS,Outpatient,,,392,294,,360.64,92,,,percent of total billed charges,92% of total billed charges,19.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,364.56,93,,,percent of total billed charges,93% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,380.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,380.24,97,,,percent of total billed charges,97% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,376.32,96,,,percent of total billed charges,96% of total billed charges,19.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,294,75,,,percent of total billed charges,75% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,19.65,380.24,
SKIN GRAFT TRUNK ARM LEG UP TO 100SQCM 1ST 25 SQ CM,78000282G,CDM,983,RC,15271,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges,8.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.6,93,,,percent of total billed charges,93% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,213.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.4,97,,,percent of total billed charges,97% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,211.2,96,,,percent of total billed charges,96% of total billed charges,8.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165,75,,,percent of total billed charges,75% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,8.85,213.4,
DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE (LESS THAN 5%,78000304G,CDM,983,RC,16020,HCPCS,Outpatient,,,418,313.5,,384.56,92,,,percent of total billed charges,92% of total billed charges,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388.74,93,,,percent of total billed charges,93% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,376.2,90,,,percent of total billed charges,90% of total billed charges,405.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,405.46,97,,,percent of total billed charges,97% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,401.28,96,,,percent of total billed charges,96% of total billed charges,5.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,313.5,75,,,percent of total billed charges,75% of total billed charges,313.5,75,,,percent of total billed charges,75% of total billed charges,5.19,405.46,
DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/SBSQ MEDIUM,78000306G,CDM,983,RC,16025,HCPCS,Outpatient,,,434,325.5,,399.28,92,,,percent of total billed charges,92% of total billed charges,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,403.62,93,,,percent of total billed charges,93% of total billed charges,390.6,90,,,percent of total billed charges,90% of total billed charges,390.6,90,,,percent of total billed charges,90% of total billed charges,420.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,420.98,97,,,percent of total billed charges,97% of total billed charges,325.5,75,,,percent of total billed charges,75% of total billed charges,416.64,96,,,percent of total billed charges,96% of total billed charges,11.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,325.5,75,,,percent of total billed charges,75% of total billed charges,325.5,75,,,percent of total billed charges,75% of total billed charges,11.71,420.98,
DRESSING DEBRIDE PARTIAL-THICKNESS BURNS 1ST/SBSQ LARGE,78000308G,CDM,983,RC,16030,HCPCS,Outpatient,,,346,259.5,,318.32,92,,,percent of total billed charges,92% of total billed charges,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321.78,93,,,percent of total billed charges,93% of total billed charges,311.4,90,,,percent of total billed charges,90% of total billed charges,311.4,90,,,percent of total billed charges,90% of total billed charges,335.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,335.62,97,,,percent of total billed charges,97% of total billed charges,259.5,75,,,percent of total billed charges,75% of total billed charges,332.16,96,,,percent of total billed charges,96% of total billed charges,15.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,259.5,75,,,percent of total billed charges,75% of total billed charges,259.5,75,,,percent of total billed charges,75% of total billed charges,15.94,335.62,
DESTRUCTION PREMALIGNANT LESION 1ST,78000310G,CDM,983,RC,17000,HCPCS,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,3.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,3.54,97.97,
DESTRUCTION PREMALIGNANT LESION 2 TO 14,78000312G,CDM,983,RC,17003,HCPCS,Outpatient,,,7,5.25,,6.44,92,,,percent of total billed charges,92% of total billed charges,0.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6.51,93,,,percent of total billed charges,93% of total billed charges,6.3,90,,,percent of total billed charges,90% of total billed charges,6.3,90,,,percent of total billed charges,90% of total billed charges,6.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6.79,97,,,percent of total billed charges,97% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges,6.72,96,,,percent of total billed charges,96% of total billed charges,0.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5.25,75,,,percent of total billed charges,75% of total billed charges,5.25,75,,,percent of total billed charges,75% of total billed charges,0.07,6.79,
DESTRUCTION PREMALIGNANT LESION 15/>,78000314G,CDM,983,RC,17004,HCPCS,Outpatient,,,253,189.75,,232.76,92,,,percent of total billed charges,92% of total billed charges,7.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,235.29,93,,,percent of total billed charges,93% of total billed charges,227.7,90,,,percent of total billed charges,90% of total billed charges,227.7,90,,,percent of total billed charges,90% of total billed charges,245.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.41,97,,,percent of total billed charges,97% of total billed charges,189.75,75,,,percent of total billed charges,75% of total billed charges,242.88,96,,,percent of total billed charges,96% of total billed charges,7.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,189.75,75,,,percent of total billed charges,75% of total billed charges,189.75,75,,,percent of total billed charges,75% of total billed charges,7.46,245.41,
DESTRUCTION BENIGN LESIONS 15/>,78000318G,CDM,983,RC,17111,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges,5.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186,93,,,percent of total billed charges,93% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,194,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194,97,,,percent of total billed charges,97% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,192,96,,,percent of total billed charges,96% of total billed charges,5.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150,75,,,percent of total billed charges,75% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,5.6,194,
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE,78000320G,CDM,983,RC,17250,HCPCS,Outpatient,,,136,102,,125.12,92,,,percent of total billed charges,92% of total billed charges,3.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126.48,93,,,percent of total billed charges,93% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,122.4,90,,,percent of total billed charges,90% of total billed charges,131.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.92,97,,,percent of total billed charges,97% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,130.56,96,,,percent of total billed charges,96% of total billed charges,3.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102,75,,,percent of total billed charges,75% of total billed charges,102,75,,,percent of total billed charges,75% of total billed charges,3.47,131.92,
PUNCTURE ASPIRATION OF CYST OF BREAST,78002193G,CDM,983,RC,19000,HCPCS,Outpatient,,,112,84,,103.04,92,,,percent of total billed charges,92% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.16,93,,,percent of total billed charges,93% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,100.8,90,,,percent of total billed charges,90% of total billed charges,108.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,108.64,97,,,percent of total billed charges,97% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,107.52,96,,,percent of total billed charges,96% of total billed charges,4.42,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84,75,,,percent of total billed charges,75% of total billed charges,84,75,,,percent of total billed charges,75% of total billed charges,4.42,108.64,
BIOPSY MUSCLE PERCUTANEOUS NEEDLE,78000336G,CDM,983,RC,20206,HCPCS,Outpatient,,,350,262.5,,322,92,,,percent of total billed charges,92% of total billed charges,4.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,325.5,93,,,percent of total billed charges,93% of total billed charges,315,90,,,percent of total billed charges,90% of total billed charges,315,90,,,percent of total billed charges,90% of total billed charges,339.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,339.5,97,,,percent of total billed charges,97% of total billed charges,262.5,75,,,percent of total billed charges,75% of total billed charges,336,96,,,percent of total billed charges,96% of total billed charges,4.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,262.5,75,,,percent of total billed charges,75% of total billed charges,262.5,75,,,percent of total billed charges,75% of total billed charges,4.66,339.5,
INJECTION SINGLE TENDON ORIGIN/INSERTION,78000350G,CDM,983,RC,20551,HCPCS,Outpatient,,,158,118.5,,145.36,92,,,percent of total billed charges,92% of total billed charges,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,146.94,93,,,percent of total billed charges,93% of total billed charges,142.2,90,,,percent of total billed charges,90% of total billed charges,142.2,90,,,percent of total billed charges,90% of total billed charges,153.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,153.26,97,,,percent of total billed charges,97% of total billed charges,118.5,75,,,percent of total billed charges,75% of total billed charges,151.68,96,,,percent of total billed charges,96% of total billed charges,3.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,118.5,75,,,percent of total billed charges,75% of total billed charges,118.5,75,,,percent of total billed charges,75% of total billed charges,3.77,153.26,
INJECTIONS OF TRIGGER POINTS IN 1 OR 2 MUSCLES,78000352G,CDM,983,RC,20552,HCPCS,Outpatient,,,152,114,,139.84,92,,,percent of total billed charges,92% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.36,93,,,percent of total billed charges,93% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,136.8,90,,,percent of total billed charges,90% of total billed charges,147.44,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.44,97,,,percent of total billed charges,97% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,145.92,96,,,percent of total billed charges,96% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,114,75,,,percent of total billed charges,75% of total billed charges,114,75,,,percent of total billed charges,75% of total billed charges,3.44,147.44,
INJECTIONS OF TRIGGER POINTS IN 3 OR MORE MUSCLES,78000354G,CDM,983,RC,20553,HCPCS,Outpatient,,,170,127.5,,156.4,92,,,percent of total billed charges,92% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.1,93,,,percent of total billed charges,93% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,164.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.9,97,,,percent of total billed charges,97% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,163.2,96,,,percent of total billed charges,96% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.5,75,,,percent of total billed charges,75% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,3.88,164.9,
ARTHROCNT ASPIR/INJ SML JT/BURSAW/US REC RPRT,78000360G,CDM,983,RC,20604,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.33,93,,,percent of total billed charges,93% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,175.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.57,97,,,percent of total billed charges,97% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,173.76,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.75,75,,,percent of total billed charges,75% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,4.28,175.57,
ARTHROCENTESIS ASPIR/INJ INTERM JT/BURS W/US,78000366G,CDM,983,RC,20606,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,5.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,5.31,201.76,
ARTHROCENTESIS ASPIRATION INJECTION MAJOR JT/BURSA W/O US,78000368G,CDM,983,RC,20610,HCPCS,Outpatient,,,181,135.75,,166.52,92,,,percent of total billed charges,92% of total billed charges,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.33,93,,,percent of total billed charges,93% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,162.9,90,,,percent of total billed charges,90% of total billed charges,175.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.57,97,,,percent of total billed charges,97% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,173.76,96,,,percent of total billed charges,96% of total billed charges,5.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.75,75,,,percent of total billed charges,75% of total billed charges,135.75,75,,,percent of total billed charges,75% of total billed charges,5.09,175.57,
ARTHROCENTESIS ASPIR/INJ MAJOR JT/BURSA W/US,78000372G,CDM,983,RC,20611,HCPCS,Outpatient,,,236,177,,217.12,92,,,percent of total billed charges,92% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,219.48,93,,,percent of total billed charges,93% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,212.4,90,,,percent of total billed charges,90% of total billed charges,228.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.92,97,,,percent of total billed charges,97% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,226.56,96,,,percent of total billed charges,96% of total billed charges,6.09,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177,75,,,percent of total billed charges,75% of total billed charges,177,75,,,percent of total billed charges,75% of total billed charges,6.09,228.92,
ASPIRATION INJECTION GANGLION CYST ANY LOCATION,78000374G,CDM,983,RC,20612,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,4.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,4.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,4.13,104.76,
INCISION  DRAIN DEEP ABSC/HEMATOMA SOFT TISS NECK THORAX,78000394G,CDM,983,RC,21501,HCPCS,Outpatient,,,1335,1001.25,,1228.2,92,,,percent of total billed charges,92% of total billed charges,34.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1241.55,93,,,percent of total billed charges,93% of total billed charges,1201.5,90,,,percent of total billed charges,90% of total billed charges,1201.5,90,,,percent of total billed charges,90% of total billed charges,1294.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,34.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1294.95,97,,,percent of total billed charges,97% of total billed charges,1001.25,75,,,percent of total billed charges,75% of total billed charges,1281.6,96,,,percent of total billed charges,96% of total billed charges,34.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1001.25,75,,,percent of total billed charges,75% of total billed charges,1001.25,75,,,percent of total billed charges,75% of total billed charges,34.04,1294.95,
EXCISION TUMOR SOFT TISSUE NECK ANTERIOR THORAX SUBQ <3CM,78000396G,CDM,983,RC,21555,HCPCS,Outpatient,,,1578,1183.5,,1451.76,92,,,percent of total billed charges,92% of total billed charges,32.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1467.54,93,,,percent of total billed charges,93% of total billed charges,1420.2,90,,,percent of total billed charges,90% of total billed charges,1420.2,90,,,percent of total billed charges,90% of total billed charges,1530.66,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,32.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1530.66,97,,,percent of total billed charges,97% of total billed charges,1183.5,75,,,percent of total billed charges,75% of total billed charges,1514.88,96,,,percent of total billed charges,96% of total billed charges,32.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1183.5,75,,,percent of total billed charges,75% of total billed charges,1183.5,75,,,percent of total billed charges,75% of total billed charges,32.72,1530.66,
CLOSED TX VERT BODY FX W/O MANIP REQUIRES CASTING OR BRACING,78000406G,CDM,983,RC,22310,HCPCS,Outpatient,,,792,594,,728.64,92,,,percent of total billed charges,92% of total billed charges,31.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,736.56,93,,,percent of total billed charges,93% of total billed charges,712.8,90,,,percent of total billed charges,90% of total billed charges,712.8,90,,,percent of total billed charges,90% of total billed charges,768.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,31.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,768.24,97,,,percent of total billed charges,97% of total billed charges,594,75,,,percent of total billed charges,75% of total billed charges,760.32,96,,,percent of total billed charges,96% of total billed charges,31.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,594,75,,,percent of total billed charges,75% of total billed charges,594,75,,,percent of total billed charges,75% of total billed charges,31.36,768.24,
CLOSED TX CLAVICULAR FRACTURE W/O MANIPULATION,78000449G,CDM,983,RC,23500,HCPCS,Outpatient,,,614,460.5,,564.88,92,,,percent of total billed charges,92% of total billed charges,20.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,571.02,93,,,percent of total billed charges,93% of total billed charges,552.6,90,,,percent of total billed charges,90% of total billed charges,552.6,90,,,percent of total billed charges,90% of total billed charges,595.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,20.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,595.58,97,,,percent of total billed charges,97% of total billed charges,460.5,75,,,percent of total billed charges,75% of total billed charges,589.44,96,,,percent of total billed charges,96% of total billed charges,20.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,460.5,75,,,percent of total billed charges,75% of total billed charges,460.5,75,,,percent of total billed charges,75% of total billed charges,20.2,595.58,
CLOSED TX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION,78000466G,CDM,983,RC,23600,HCPCS,Outpatient,,,1220,915,,1122.4,92,,,percent of total billed charges,92% of total billed charges,27.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1134.6,93,,,percent of total billed charges,93% of total billed charges,1098,90,,,percent of total billed charges,90% of total billed charges,1098,90,,,percent of total billed charges,90% of total billed charges,1183.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1183.4,97,,,percent of total billed charges,97% of total billed charges,915,75,,,percent of total billed charges,75% of total billed charges,1171.2,96,,,percent of total billed charges,96% of total billed charges,27.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,915,75,,,percent of total billed charges,75% of total billed charges,915,75,,,percent of total billed charges,75% of total billed charges,27.41,1183.4,
CLOSED TX GREATER HUMERAL TUBEROSITY FX W/O MANIP,78000472G,CDM,983,RC,23620,HCPCS,Outpatient,,,705,528.75,,648.6,92,,,percent of total billed charges,92% of total billed charges,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,655.65,93,,,percent of total billed charges,93% of total billed charges,634.5,90,,,percent of total billed charges,90% of total billed charges,634.5,90,,,percent of total billed charges,90% of total billed charges,683.85,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,683.85,97,,,percent of total billed charges,97% of total billed charges,528.75,75,,,percent of total billed charges,75% of total billed charges,676.8,96,,,percent of total billed charges,96% of total billed charges,22.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,528.75,75,,,percent of total billed charges,75% of total billed charges,528.75,75,,,percent of total billed charges,75% of total billed charges,22.94,683.85,
CLOSED TX HUMERAL SHAFT FRACTURE W/O MANIPULATION,78000516G,CDM,983,RC,24500,HCPCS,Outpatient,,,1293,969.75,,1189.56,92,,,percent of total billed charges,92% of total billed charges,30.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1202.49,93,,,percent of total billed charges,93% of total billed charges,1163.7,90,,,percent of total billed charges,90% of total billed charges,1163.7,90,,,percent of total billed charges,90% of total billed charges,1254.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,30.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1254.21,97,,,percent of total billed charges,97% of total billed charges,969.75,75,,,percent of total billed charges,75% of total billed charges,1241.28,96,,,percent of total billed charges,96% of total billed charges,30.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,969.75,75,,,percent of total billed charges,75% of total billed charges,969.75,75,,,percent of total billed charges,75% of total billed charges,30.78,1254.21,
CLOSED TX RADIAL HEAD SUBLXTJ CHLD NURSEMAID ELBOW W/MANIP,78000548G,CDM,983,RC,24640,HCPCS,Outpatient,,,310,232.5,,285.2,92,,,percent of total billed charges,92% of total billed charges,5.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.3,93,,,percent of total billed charges,93% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,279,90,,,percent of total billed charges,90% of total billed charges,300.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.7,97,,,percent of total billed charges,97% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,297.6,96,,,percent of total billed charges,96% of total billed charges,5.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,232.5,75,,,percent of total billed charges,75% of total billed charges,232.5,75,,,percent of total billed charges,75% of total billed charges,5.23,300.7,
CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANIP,78000556G,CDM,983,RC,24670,HCPCS,Outpatient,,,1041,780.75,,957.72,92,,,percent of total billed charges,92% of total billed charges,24.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,968.13,93,,,percent of total billed charges,93% of total billed charges,936.9,90,,,percent of total billed charges,90% of total billed charges,936.9,90,,,percent of total billed charges,90% of total billed charges,1009.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1009.77,97,,,percent of total billed charges,97% of total billed charges,780.75,75,,,percent of total billed charges,75% of total billed charges,999.36,96,,,percent of total billed charges,96% of total billed charges,24.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,780.75,75,,,percent of total billed charges,75% of total billed charges,780.75,75,,,percent of total billed charges,75% of total billed charges,24.04,1009.77,
CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION,78000601G,CDM,983,RC,25500,HCPCS,Outpatient,,,990,742.5,,910.8,92,,,percent of total billed charges,92% of total billed charges,22.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,920.7,93,,,percent of total billed charges,93% of total billed charges,891,90,,,percent of total billed charges,90% of total billed charges,891,90,,,percent of total billed charges,90% of total billed charges,960.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,22.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,960.3,97,,,percent of total billed charges,97% of total billed charges,742.5,75,,,percent of total billed charges,75% of total billed charges,950.4,96,,,percent of total billed charges,96% of total billed charges,22.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,742.5,75,,,percent of total billed charges,75% of total billed charges,742.5,75,,,percent of total billed charges,75% of total billed charges,22.9,960.3,
CLOSED TX DISTAL RADIAL FX/EPIPHYSL SEP W/O MANIP,78000624G,CDM,983,RC,25600,HCPCS,Outpatient,,,402,301.5,,369.84,92,,,percent of total billed charges,92% of total billed charges,26.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,373.86,93,,,percent of total billed charges,93% of total billed charges,361.8,90,,,percent of total billed charges,90% of total billed charges,361.8,90,,,percent of total billed charges,90% of total billed charges,389.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,389.94,97,,,percent of total billed charges,97% of total billed charges,301.5,75,,,percent of total billed charges,75% of total billed charges,385.92,96,,,percent of total billed charges,96% of total billed charges,26.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,301.5,75,,,percent of total billed charges,75% of total billed charges,301.5,75,,,percent of total billed charges,75% of total billed charges,26.36,389.94,
CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANIP,78000635G,CDM,983,RC,25622,HCPCS,Outpatient,,,467,350.25,,429.64,92,,,percent of total billed charges,92% of total billed charges,24.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,434.31,93,,,percent of total billed charges,93% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,452.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,452.99,97,,,percent of total billed charges,97% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,448.32,96,,,percent of total billed charges,96% of total billed charges,24.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,350.25,75,,,percent of total billed charges,75% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,24.64,452.99,
CLOSED TREATMENT ULNAR STYLOID FRACTURE,78000639G,CDM,983,RC,25650,HCPCS,Outpatient,,,470,352.5,,432.4,92,,,percent of total billed charges,92% of total billed charges,28.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.1,93,,,percent of total billed charges,93% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,423,90,,,percent of total billed charges,90% of total billed charges,455.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,28.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,455.9,97,,,percent of total billed charges,97% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,451.2,96,,,percent of total billed charges,96% of total billed charges,28.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.5,75,,,percent of total billed charges,75% of total billed charges,352.5,75,,,percent of total billed charges,75% of total billed charges,28.11,455.9,
CLOSED TX METACARPAL FX W/O MANIPULATION EACH BONE,78000702G,CDM,983,RC,26600,HCPCS,Outpatient,,,1103,827.25,,1014.76,92,,,percent of total billed charges,92% of total billed charges,23.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1025.79,93,,,percent of total billed charges,93% of total billed charges,992.7,90,,,percent of total billed charges,90% of total billed charges,992.7,90,,,percent of total billed charges,90% of total billed charges,1069.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1069.91,97,,,percent of total billed charges,97% of total billed charges,827.25,75,,,percent of total billed charges,75% of total billed charges,1058.88,96,,,percent of total billed charges,96% of total billed charges,23.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,827.25,75,,,percent of total billed charges,75% of total billed charges,827.25,75,,,percent of total billed charges,75% of total billed charges,23.94,1069.91,
CLOSED TX METACARPAL FX W/MANIP W/XTRNL FIXATION EACH BONE,78000706G,CDM,983,RC,26607,HCPCS,Outpatient,,,772,579,,710.24,92,,,percent of total billed charges,92% of total billed charges,49.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,717.96,93,,,percent of total billed charges,93% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,694.8,90,,,percent of total billed charges,90% of total billed charges,748.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,49.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,748.84,97,,,percent of total billed charges,97% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,741.12,96,,,percent of total billed charges,96% of total billed charges,49.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,579,75,,,percent of total billed charges,75% of total billed charges,579,75,,,percent of total billed charges,75% of total billed charges,49.13,748.84,
CLOSED TX PHALANGEAL FX PROX/MIDDLE FINGER THUMB W/O MANP EA,78000726G,CDM,983,RC,26720,HCPCS,Outpatient,,,728,546,,669.76,92,,,percent of total billed charges,92% of total billed charges,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,677.04,93,,,percent of total billed charges,93% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,655.2,90,,,percent of total billed charges,90% of total billed charges,706.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,706.16,97,,,percent of total billed charges,97% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,698.88,96,,,percent of total billed charges,96% of total billed charges,16.36,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,546,75,,,percent of total billed charges,75% of total billed charges,546,75,,,percent of total billed charges,75% of total billed charges,16.36,706.16,
CLOSED TX DISTAL PHLNGL FX FINGR OR THUMB W/O MANIP EACH,78000736G,CDM,983,RC,26750,HCPCS,Outpatient,,,732,549,,673.44,92,,,percent of total billed charges,92% of total billed charges,16.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,680.76,93,,,percent of total billed charges,93% of total billed charges,658.8,90,,,percent of total billed charges,90% of total billed charges,658.8,90,,,percent of total billed charges,90% of total billed charges,710.04,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,710.04,97,,,percent of total billed charges,97% of total billed charges,549,75,,,percent of total billed charges,75% of total billed charges,702.72,96,,,percent of total billed charges,96% of total billed charges,16.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,549,75,,,percent of total billed charges,75% of total billed charges,549,75,,,percent of total billed charges,75% of total billed charges,16.4,710.04,
CLOSED TX DISTAL PHALANGEAL FX FINGER THUMB W/MANIP EA,78000738G,CDM,983,RC,26755,HCPCS,Outpatient,,,1073,804.75,,987.16,92,,,percent of total billed charges,92% of total billed charges,27.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,997.89,93,,,percent of total billed charges,93% of total billed charges,965.7,90,,,percent of total billed charges,90% of total billed charges,965.7,90,,,percent of total billed charges,90% of total billed charges,1040.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,27.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1040.81,97,,,percent of total billed charges,97% of total billed charges,804.75,75,,,percent of total billed charges,75% of total billed charges,1030.08,96,,,percent of total billed charges,96% of total billed charges,27.22,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,804.75,75,,,percent of total billed charges,75% of total billed charges,804.75,75,,,percent of total billed charges,75% of total billed charges,27.22,1040.81,
INJECT SACROLIAC JOINT FOR ANESTH/STEROID,78000764G,CDM,983,RC,27096,HCPCS,Outpatient,,,246,184.5,,226.32,92,,,percent of total billed charges,92% of total billed charges,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,228.78,93,,,percent of total billed charges,93% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,221.4,90,,,percent of total billed charges,90% of total billed charges,238.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,238.62,97,,,percent of total billed charges,97% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges,236.16,96,,,percent of total billed charges,96% of total billed charges,6.64,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.5,75,,,percent of total billed charges,75% of total billed charges,184.5,75,,,percent of total billed charges,75% of total billed charges,6.64,238.62,
CLOSED TREATMENT COCCYGEAL FRACTURE,78000774G,CDM,983,RC,27200,HCPCS,Outpatient,,,426,319.5,,391.92,92,,,percent of total billed charges,92% of total billed charges,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,396.18,93,,,percent of total billed charges,93% of total billed charges,383.4,90,,,percent of total billed charges,90% of total billed charges,383.4,90,,,percent of total billed charges,90% of total billed charges,413.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,413.22,97,,,percent of total billed charges,97% of total billed charges,319.5,75,,,percent of total billed charges,75% of total billed charges,408.96,96,,,percent of total billed charges,96% of total billed charges,17.19,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,319.5,75,,,percent of total billed charges,75% of total billed charges,319.5,75,,,percent of total billed charges,75% of total billed charges,17.19,413.22,
CLOSED TX GREATER TROCHANTERIC FX W/O MANIP,78000791G,CDM,983,RC,27246,HCPCS,Outpatient,,,1036,777,,953.12,92,,,percent of total billed charges,92% of total billed charges,40.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,963.48,93,,,percent of total billed charges,93% of total billed charges,932.4,90,,,percent of total billed charges,90% of total billed charges,932.4,90,,,percent of total billed charges,90% of total billed charges,1004.92,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,40.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1004.92,97,,,percent of total billed charges,97% of total billed charges,777,75,,,percent of total billed charges,75% of total billed charges,994.56,96,,,percent of total billed charges,96% of total billed charges,40.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,777,75,,,percent of total billed charges,75% of total billed charges,777,75,,,percent of total billed charges,75% of total billed charges,40.58,1004.92,
ClOSED TX TIBIAL FX PROXIMAL W/O MANIPULATION,78000896G,CDM,983,RC,27530,HCPCS,Outpatient,,,468,351,,430.56,92,,,percent of total billed charges,92% of total billed charges,24.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,435.24,93,,,percent of total billed charges,93% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,453.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,453.96,97,,,percent of total billed charges,97% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,449.28,96,,,percent of total billed charges,96% of total billed charges,24.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,351,75,,,percent of total billed charges,75% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,24.53,453.96,
CLOSED TX TIBIAL SHAFT FX W/O MANIPULATION,78000963G,CDM,983,RC,27750,HCPCS,Outpatient,,,526,394.5,,483.92,92,,,percent of total billed charges,92% of total billed charges,29.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,489.18,93,,,percent of total billed charges,93% of total billed charges,473.4,90,,,percent of total billed charges,90% of total billed charges,473.4,90,,,percent of total billed charges,90% of total billed charges,510.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,29.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,510.22,97,,,percent of total billed charges,97% of total billed charges,394.5,75,,,percent of total billed charges,75% of total billed charges,504.96,96,,,percent of total billed charges,96% of total billed charges,29.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,394.5,75,,,percent of total billed charges,75% of total billed charges,394.5,75,,,percent of total billed charges,75% of total billed charges,29.8,510.22,
CLOSED TX MEDIAL MALLEOLUS FX W/O MANIPULATION,78000974G,CDM,983,RC,27760,HCPCS,Outpatient,,,1204,903,,1107.68,92,,,percent of total billed charges,92% of total billed charges,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1119.72,93,,,percent of total billed charges,93% of total billed charges,1083.6,90,,,percent of total billed charges,90% of total billed charges,1083.6,90,,,percent of total billed charges,90% of total billed charges,1167.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1167.88,97,,,percent of total billed charges,97% of total billed charges,903,75,,,percent of total billed charges,75% of total billed charges,1155.84,96,,,percent of total billed charges,96% of total billed charges,26.53,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,903,75,,,percent of total billed charges,75% of total billed charges,903,75,,,percent of total billed charges,75% of total billed charges,26.53,1167.88,
CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP,78000979G,CDM,983,RC,27767,HCPCS,Outpatient,,,1121,840.75,,1031.32,92,,,percent of total billed charges,92% of total billed charges,23.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1042.53,93,,,percent of total billed charges,93% of total billed charges,1008.9,90,,,percent of total billed charges,90% of total billed charges,1008.9,90,,,percent of total billed charges,90% of total billed charges,1087.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1087.37,97,,,percent of total billed charges,97% of total billed charges,840.75,75,,,percent of total billed charges,75% of total billed charges,1076.16,96,,,percent of total billed charges,96% of total billed charges,23.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,840.75,75,,,percent of total billed charges,75% of total billed charges,840.75,75,,,percent of total billed charges,75% of total billed charges,23.45,1087.37,
CLOSED TX DISTAL FIBULAR FX LATERAL MALLS W/O MANIP,78000989G,CDM,983,RC,27786,HCPCS,Outpatient,,,1128,846,,1037.76,92,,,percent of total billed charges,92% of total billed charges,24.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1049.04,93,,,percent of total billed charges,93% of total billed charges,1015.2,90,,,percent of total billed charges,90% of total billed charges,1015.2,90,,,percent of total billed charges,90% of total billed charges,1094.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,24.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1094.16,97,,,percent of total billed charges,97% of total billed charges,846,75,,,percent of total billed charges,75% of total billed charges,1082.88,96,,,percent of total billed charges,96% of total billed charges,24.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,846,75,,,percent of total billed charges,75% of total billed charges,846,75,,,percent of total billed charges,75% of total billed charges,24.97,1094.16,
CLOSED TX TALUS FRACTURE W/O MANIPULATION,78001099G,CDM,983,RC,28430,HCPCS,Outpatient,,,363,272.25,,333.96,92,,,percent of total billed charges,92% of total billed charges,17.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,337.59,93,,,percent of total billed charges,93% of total billed charges,326.7,90,,,percent of total billed charges,90% of total billed charges,326.7,90,,,percent of total billed charges,90% of total billed charges,352.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,352.11,97,,,percent of total billed charges,97% of total billed charges,272.25,75,,,percent of total billed charges,75% of total billed charges,348.48,96,,,percent of total billed charges,96% of total billed charges,17.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,272.25,75,,,percent of total billed charges,75% of total billed charges,272.25,75,,,percent of total billed charges,75% of total billed charges,17.3,352.11,
CLOSED TX METATARSAL FRACTURE W/O MANIPULATION,78001106G,CDM,983,RC,28470,HCPCS,Outpatient,,,801,600.75,,736.92,92,,,percent of total billed charges,92% of total billed charges,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,744.93,93,,,percent of total billed charges,93% of total billed charges,720.9,90,,,percent of total billed charges,90% of total billed charges,720.9,90,,,percent of total billed charges,90% of total billed charges,776.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,776.97,97,,,percent of total billed charges,97% of total billed charges,600.75,75,,,percent of total billed charges,75% of total billed charges,768.96,96,,,percent of total billed charges,96% of total billed charges,15.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,600.75,75,,,percent of total billed charges,75% of total billed charges,600.75,75,,,percent of total billed charges,75% of total billed charges,15.21,776.97,
CLOSED TX FX GREAT TOE PHLX/PHLG W/MANIP,78001114G,CDM,983,RC,28495,HCPCS,Outpatient,,,582,436.5,,535.44,92,,,percent of total billed charges,92% of total billed charges,10.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,541.26,93,,,percent of total billed charges,93% of total billed charges,523.8,90,,,percent of total billed charges,90% of total billed charges,523.8,90,,,percent of total billed charges,90% of total billed charges,564.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,564.54,97,,,percent of total billed charges,97% of total billed charges,436.5,75,,,percent of total billed charges,75% of total billed charges,558.72,96,,,percent of total billed charges,96% of total billed charges,10.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,436.5,75,,,percent of total billed charges,75% of total billed charges,436.5,75,,,percent of total billed charges,75% of total billed charges,10.47,564.54,
CLOSED TX FX PHALANX OR PHALANGES NOT GREAT TOE W/O MANIP,78001118G,CDM,983,RC,28510,HCPCS,Outpatient,,,467,350.25,,429.64,92,,,percent of total billed charges,92% of total billed charges,8.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,434.31,93,,,percent of total billed charges,93% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,420.3,90,,,percent of total billed charges,90% of total billed charges,452.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,452.99,97,,,percent of total billed charges,97% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,448.32,96,,,percent of total billed charges,96% of total billed charges,8.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,350.25,75,,,percent of total billed charges,75% of total billed charges,350.25,75,,,percent of total billed charges,75% of total billed charges,8.11,452.99,
APPLICATION CAST SHOULDER HAND LONG ARM,78001148G,CDM,983,RC,29065,HCPCS,Outpatient,,,266,199.5,,244.72,92,,,percent of total billed charges,92% of total billed charges,6.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,247.38,93,,,percent of total billed charges,93% of total billed charges,239.4,90,,,percent of total billed charges,90% of total billed charges,239.4,90,,,percent of total billed charges,90% of total billed charges,258.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,258.02,97,,,percent of total billed charges,97% of total billed charges,199.5,75,,,percent of total billed charges,75% of total billed charges,255.36,96,,,percent of total billed charges,96% of total billed charges,6.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,199.5,75,,,percent of total billed charges,75% of total billed charges,199.5,75,,,percent of total billed charges,75% of total billed charges,6.98,258.02,
APPLICATION OF CAST ELBOW TO FINGER (SHORT ARM),78001150G,CDM,983,RC,29075,HCPCS,Outpatient,,,240,180,,220.8,92,,,percent of total billed charges,92% of total billed charges,6.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.2,93,,,percent of total billed charges,93% of total billed charges,216,90,,,percent of total billed charges,90% of total billed charges,216,90,,,percent of total billed charges,90% of total billed charges,232.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,232.8,97,,,percent of total billed charges,97% of total billed charges,180,75,,,percent of total billed charges,75% of total billed charges,230.4,96,,,percent of total billed charges,96% of total billed charges,6.24,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180,75,,,percent of total billed charges,75% of total billed charges,180,75,,,percent of total billed charges,75% of total billed charges,6.24,232.8,
APPLICATION CAST HAND  LOWER FOREARM GAUNTLET,78001152G,CDM,983,RC,29085,HCPCS,Outpatient,,,263,197.25,,241.96,92,,,percent of total billed charges,92% of total billed charges,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,244.59,93,,,percent of total billed charges,93% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,236.7,90,,,percent of total billed charges,90% of total billed charges,255.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,255.11,97,,,percent of total billed charges,97% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,252.48,96,,,percent of total billed charges,96% of total billed charges,6.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,197.25,75,,,percent of total billed charges,75% of total billed charges,197.25,75,,,percent of total billed charges,75% of total billed charges,6.69,255.11,
APPLICATION LONG ARM SPLINT SHOULDER HAND,78001156G,CDM,983,RC,29105,HCPCS,Outpatient,,,255,191.25,,234.6,92,,,percent of total billed charges,92% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237.15,93,,,percent of total billed charges,93% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,247.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,247.35,97,,,percent of total billed charges,97% of total billed charges,191.25,75,,,percent of total billed charges,75% of total billed charges,244.8,96,,,percent of total billed charges,96% of total billed charges,5.78,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.25,75,,,percent of total billed charges,75% of total billed charges,191.25,75,,,percent of total billed charges,75% of total billed charges,5.78,247.35,
29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STA,78001158P,CDM,983,RC,29125,HCPCS,Outpatient,,,255,191.25,,234.6,92,,,percent of total billed charges,92% of total billed charges,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237.15,93,,,percent of total billed charges,93% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,247.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,247.35,97,,,percent of total billed charges,97% of total billed charges,191.25,75,,,percent of total billed charges,75% of total billed charges,244.8,96,,,percent of total billed charges,96% of total billed charges,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.25,75,,,percent of total billed charges,75% of total billed charges,191.25,75,,,percent of total billed charges,75% of total billed charges,3.85,247.35,
APPLY SHORT ARM SPLINT FOREARM-HAND STATIC,78001158G,CDM,983,RC,29125,HCPCS,Outpatient,,,255,191.25,,234.6,92,,,percent of total billed charges,92% of total billed charges,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237.15,93,,,percent of total billed charges,93% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,229.5,90,,,percent of total billed charges,90% of total billed charges,247.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,247.35,97,,,percent of total billed charges,97% of total billed charges,191.25,75,,,percent of total billed charges,75% of total billed charges,244.8,96,,,percent of total billed charges,96% of total billed charges,3.85,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.25,75,,,percent of total billed charges,75% of total billed charges,191.25,75,,,percent of total billed charges,75% of total billed charges,3.85,247.35,
APPLICATION FINGER SPLINT STATIC,78001160G,CDM,983,RC,29130,HCPCS,Outpatient,,,116,87,,106.72,92,,,percent of total billed charges,92% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.88,93,,,percent of total billed charges,93% of total billed charges,104.4,90,,,percent of total billed charges,90% of total billed charges,104.4,90,,,percent of total billed charges,90% of total billed charges,112.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,112.52,97,,,percent of total billed charges,97% of total billed charges,87,75,,,percent of total billed charges,75% of total billed charges,111.36,96,,,percent of total billed charges,96% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,87,75,,,percent of total billed charges,75% of total billed charges,87,75,,,percent of total billed charges,75% of total billed charges,3.44,112.52,
APPLICATION LONG LEG CAST THIGH-TOE,78001174G,CDM,983,RC,29345,HCPCS,Outpatient,,,261,195.75,,240.12,92,,,percent of total billed charges,92% of total billed charges,10.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,242.73,93,,,percent of total billed charges,93% of total billed charges,234.9,90,,,percent of total billed charges,90% of total billed charges,234.9,90,,,percent of total billed charges,90% of total billed charges,253.17,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,253.17,97,,,percent of total billed charges,97% of total billed charges,195.75,75,,,percent of total billed charges,75% of total billed charges,250.56,96,,,percent of total billed charges,96% of total billed charges,10.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.75,75,,,percent of total billed charges,75% of total billed charges,195.75,75,,,percent of total billed charges,75% of total billed charges,10.48,253.17,
APPLICATION SHORT LEG CAST BELOW KNEE-TOE,78001176G,CDM,983,RC,29405,HCPCS,Outpatient,,,230,172.5,,211.6,92,,,percent of total billed charges,92% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.9,93,,,percent of total billed charges,93% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,207,90,,,percent of total billed charges,90% of total billed charges,223.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.1,97,,,percent of total billed charges,97% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,220.8,96,,,percent of total billed charges,96% of total billed charges,5.56,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.5,75,,,percent of total billed charges,75% of total billed charges,172.5,75,,,percent of total billed charges,75% of total billed charges,5.56,223.1,
APPLICATION SHORT LEG CAST WALKING/AMBULATORY,78001178G,CDM,983,RC,29425,HCPCS,Outpatient,,,392,294,,360.64,92,,,percent of total billed charges,92% of total billed charges,4.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,364.56,93,,,percent of total billed charges,93% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,352.8,90,,,percent of total billed charges,90% of total billed charges,380.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,380.24,97,,,percent of total billed charges,97% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,376.32,96,,,percent of total billed charges,96% of total billed charges,4.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,294,75,,,percent of total billed charges,75% of total billed charges,294,75,,,percent of total billed charges,75% of total billed charges,4.59,380.24,
APPLICATION RIGID TOTAL CONTACT LEG CAST,78001182G,CDM,983,RC,29445,HCPCS,Outpatient,,,190,142.5,,174.8,92,,,percent of total billed charges,92% of total billed charges,8.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.7,93,,,percent of total billed charges,93% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,184.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.3,97,,,percent of total billed charges,97% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,182.4,96,,,percent of total billed charges,96% of total billed charges,8.82,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.5,75,,,percent of total billed charges,75% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,8.82,184.3,
STRAPPING UNNA BOOT,78001196G,CDM,983,RC,29580,HCPCS,Outpatient,,,107,80.25,,98.44,92,,,percent of total billed charges,92% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,99.51,93,,,percent of total billed charges,93% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,96.3,90,,,percent of total billed charges,90% of total billed charges,103.79,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.79,97,,,percent of total billed charges,97% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges,102.72,96,,,percent of total billed charges,96% of total billed charges,2.8,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.25,75,,,percent of total billed charges,75% of total billed charges,80.25,75,,,percent of total billed charges,75% of total billed charges,2.8,103.79,
REMOVAL FOREIGN BODY INTRANASAL,78001249G,CDM,983,RC,30300,HCPCS,Outpatient,,,443,332.25,,407.56,92,,,percent of total billed charges,92% of total billed charges,8.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.99,93,,,percent of total billed charges,93% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,398.7,90,,,percent of total billed charges,90% of total billed charges,429.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,429.71,97,,,percent of total billed charges,97% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,425.28,96,,,percent of total billed charges,96% of total billed charges,8.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,332.25,75,,,percent of total billed charges,75% of total billed charges,332.25,75,,,percent of total billed charges,75% of total billed charges,8.62,429.71,
CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE UNILATERAL,78001251G,CDM,983,RC,30901,HCPCS,Outpatient,,,241,180.75,,221.72,92,,,percent of total billed charges,92% of total billed charges,7.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,224.13,93,,,percent of total billed charges,93% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,233.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.77,97,,,percent of total billed charges,97% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,231.36,96,,,percent of total billed charges,96% of total billed charges,7.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.75,75,,,percent of total billed charges,75% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,7.1,233.77,
PERCUTANEOUS DRAINAGE PLEURA INSERT CATH W/O IMAGING,78001282G,CDM,983,RC,32556,HCPCS,Outpatient,,,1286,964.5,,1183.12,92,,,percent of total billed charges,92% of total billed charges,14.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1195.98,93,,,percent of total billed charges,93% of total billed charges,1157.4,90,,,percent of total billed charges,90% of total billed charges,1157.4,90,,,percent of total billed charges,90% of total billed charges,1247.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1247.42,97,,,percent of total billed charges,97% of total billed charges,964.5,75,,,percent of total billed charges,75% of total billed charges,1234.56,96,,,percent of total billed charges,96% of total billed charges,14.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,964.5,75,,,percent of total billed charges,75% of total billed charges,964.5,75,,,percent of total billed charges,75% of total billed charges,14.25,1247.42,
INJECTION NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN,78001305G,CDM,983,RC,36465,HCPCS,Outpatient,,,308,231,,283.36,92,,,percent of total billed charges,92% of total billed charges,16.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,286.44,93,,,percent of total billed charges,93% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,277.2,90,,,percent of total billed charges,90% of total billed charges,298.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,16.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,298.76,97,,,percent of total billed charges,97% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,295.68,96,,,percent of total billed charges,96% of total billed charges,16.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231,75,,,percent of total billed charges,75% of total billed charges,231,75,,,percent of total billed charges,75% of total billed charges,16.5,298.76,
INJECTION NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS,78001307G,CDM,983,RC,36466,HCPCS,Outpatient,,,401,300.75,,368.92,92,,,percent of total billed charges,92% of total billed charges,21.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,372.93,93,,,percent of total billed charges,93% of total billed charges,360.9,90,,,percent of total billed charges,90% of total billed charges,360.9,90,,,percent of total billed charges,90% of total billed charges,388.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,388.97,97,,,percent of total billed charges,97% of total billed charges,300.75,75,,,percent of total billed charges,75% of total billed charges,384.96,96,,,percent of total billed charges,96% of total billed charges,21.13,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,300.75,75,,,percent of total billed charges,75% of total billed charges,300.75,75,,,percent of total billed charges,75% of total billed charges,21.13,388.97,
ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,78001326G,CDM,983,RC,36478,HCPCS,Outpatient,,,722,541.5,,664.24,92,,,percent of total billed charges,92% of total billed charges,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,671.46,93,,,percent of total billed charges,93% of total billed charges,649.8,90,,,percent of total billed charges,90% of total billed charges,649.8,90,,,percent of total billed charges,90% of total billed charges,700.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,700.34,97,,,percent of total billed charges,97% of total billed charges,541.5,75,,,percent of total billed charges,75% of total billed charges,693.12,96,,,percent of total billed charges,96% of total billed charges,38.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,541.5,75,,,percent of total billed charges,75% of total billed charges,541.5,75,,,percent of total billed charges,75% of total billed charges,38.95,700.34,
ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VNS,78001328G,CDM,983,RC,36479,HCPCS,Outpatient,,,354,265.5,,325.68,92,,,percent of total billed charges,92% of total billed charges,19.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,329.22,93,,,percent of total billed charges,93% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,318.6,90,,,percent of total billed charges,90% of total billed charges,343.38,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,343.38,97,,,percent of total billed charges,97% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,339.84,96,,,percent of total billed charges,96% of total billed charges,19.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,265.5,75,,,percent of total billed charges,75% of total billed charges,265.5,75,,,percent of total billed charges,75% of total billed charges,19.5,343.38,
REMOVE TUNNELED CTR VAD W/SUBQ PORT/PUMP,78001332G,CDM,983,RC,36590,HCPCS,Outpatient,,,1113,834.75,,1023.96,92,,,percent of total billed charges,92% of total billed charges,21.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1035.09,93,,,percent of total billed charges,93% of total billed charges,1001.7,90,,,percent of total billed charges,90% of total billed charges,1001.7,90,,,percent of total billed charges,90% of total billed charges,1079.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,21.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1079.61,97,,,percent of total billed charges,97% of total billed charges,834.75,75,,,percent of total billed charges,75% of total billed charges,1068.48,96,,,percent of total billed charges,96% of total billed charges,21.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,834.75,75,,,percent of total billed charges,75% of total billed charges,834.75,75,,,percent of total billed charges,75% of total billed charges,21.12,1079.61,
BIOPSY OF LIP,78001362G,CDM,983,RC,40490,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.05,93,,,percent of total billed charges,93% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,179.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.45,97,,,percent of total billed charges,97% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,177.6,96,,,percent of total billed charges,96% of total billed charges,5.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,5.9,179.45,
INCISION THROMBOSED HEMORRHOID EXTERNAL,78001462G,CDM,983,RC,46083,HCPCS,Outpatient,,,321,240.75,,295.32,92,,,percent of total billed charges,92% of total billed charges,11.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,298.53,93,,,percent of total billed charges,93% of total billed charges,288.9,90,,,percent of total billed charges,90% of total billed charges,288.9,90,,,percent of total billed charges,90% of total billed charges,311.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,311.37,97,,,percent of total billed charges,97% of total billed charges,240.75,75,,,percent of total billed charges,75% of total billed charges,308.16,96,,,percent of total billed charges,96% of total billed charges,11.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,240.75,75,,,percent of total billed charges,75% of total billed charges,240.75,75,,,percent of total billed charges,75% of total billed charges,11.16,311.37,
EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS,78001464G,CDM,983,RC,46220,HCPCS,Outpatient,,,385,288.75,,354.2,92,,,percent of total billed charges,92% of total billed charges,12.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,358.05,93,,,percent of total billed charges,93% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,346.5,90,,,percent of total billed charges,90% of total billed charges,373.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,373.45,97,,,percent of total billed charges,97% of total billed charges,288.75,75,,,percent of total billed charges,75% of total billed charges,369.6,96,,,percent of total billed charges,96% of total billed charges,12.37,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,288.75,75,,,percent of total billed charges,75% of total billed charges,288.75,75,,,percent of total billed charges,75% of total billed charges,12.37,373.45,
INSERT NON-INDWELLING BLADDER CATHETER,78001532G,CDM,983,RC,51701,HCPCS,Outpatient,,,68,51,,62.56,92,,,percent of total billed charges,92% of total billed charges,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63.24,93,,,percent of total billed charges,93% of total billed charges,61.2,90,,,percent of total billed charges,90% of total billed charges,61.2,90,,,percent of total billed charges,90% of total billed charges,65.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.96,97,,,percent of total billed charges,97% of total billed charges,51,75,,,percent of total billed charges,75% of total billed charges,65.28,96,,,percent of total billed charges,96% of total billed charges,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,51,75,,,percent of total billed charges,75% of total billed charges,51,75,,,percent of total billed charges,75% of total billed charges,2.77,65.96,
INSERT TEMP INDWELLING BLADDER CATHETER SIMPLE,78001534G,CDM,983,RC,51702,HCPCS,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,2.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,2.49,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,2.49,97.97,
CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK,78001546G,CDM,983,RC,54150,HCPCS,Outpatient,,,863,647.25,,793.96,92,,,percent of total billed charges,92% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,802.59,93,,,percent of total billed charges,93% of total billed charges,776.7,90,,,percent of total billed charges,90% of total billed charges,776.7,90,,,percent of total billed charges,90% of total billed charges,837.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,837.11,97,,,percent of total billed charges,97% of total billed charges,647.25,75,,,percent of total billed charges,75% of total billed charges,828.48,96,,,percent of total billed charges,96% of total billed charges,9.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,647.25,75,,,percent of total billed charges,75% of total billed charges,647.25,75,,,percent of total billed charges,75% of total billed charges,9.79,837.11,
CIRCUMCISION AGE >28 DAYS,78001548G,CDM,983,RC,54161,HCPCS,Outpatient,,,1243,932.25,,1143.56,92,,,percent of total billed charges,92% of total billed charges,17.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1155.99,93,,,percent of total billed charges,93% of total billed charges,1118.7,90,,,percent of total billed charges,90% of total billed charges,1118.7,90,,,percent of total billed charges,90% of total billed charges,1205.71,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1205.71,97,,,percent of total billed charges,97% of total billed charges,932.25,75,,,percent of total billed charges,75% of total billed charges,1193.28,96,,,percent of total billed charges,96% of total billed charges,17.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,932.25,75,,,percent of total billed charges,75% of total billed charges,932.25,75,,,percent of total billed charges,75% of total billed charges,17.66,1205.71,
VASECTOMY W/POSTOP SEMEN EXAMS,78001556G,CDM,983,RC,55250,HCPCS,Outpatient,,,603,452.25,,554.76,92,,,percent of total billed charges,92% of total billed charges,18.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,560.79,93,,,percent of total billed charges,93% of total billed charges,542.7,90,,,percent of total billed charges,90% of total billed charges,542.7,90,,,percent of total billed charges,90% of total billed charges,584.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,584.91,97,,,percent of total billed charges,97% of total billed charges,452.25,75,,,percent of total billed charges,75% of total billed charges,578.88,96,,,percent of total billed charges,96% of total billed charges,18.83,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,452.25,75,,,percent of total billed charges,75% of total billed charges,452.25,75,,,percent of total billed charges,75% of total billed charges,18.83,584.91,
DESTRUCTION LESIONS VULVA SIMPLE,78001563G,CDM,983,RC,56501,HCPCS,Outpatient,,,442,331.5,,406.64,92,,,percent of total billed charges,92% of total billed charges,11.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,411.06,93,,,percent of total billed charges,93% of total billed charges,397.8,90,,,percent of total billed charges,90% of total billed charges,397.8,90,,,percent of total billed charges,90% of total billed charges,428.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,428.74,97,,,percent of total billed charges,97% of total billed charges,331.5,75,,,percent of total billed charges,75% of total billed charges,424.32,96,,,percent of total billed charges,96% of total billed charges,11.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,331.5,75,,,percent of total billed charges,75% of total billed charges,331.5,75,,,percent of total billed charges,75% of total billed charges,11.17,428.74,
BIOPSY VULVA/PERINEUM 1 LESION,78001567G,CDM,983,RC,56605,HCPCS,Outpatient,,,156,117,,143.52,92,,,percent of total billed charges,92% of total billed charges,6.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,145.08,93,,,percent of total billed charges,93% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,151.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,151.32,97,,,percent of total billed charges,97% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,149.76,96,,,percent of total billed charges,96% of total billed charges,6.92,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117,75,,,percent of total billed charges,75% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,6.92,151.32,
BIOPSY VULVA/PERINEUM EACH ADDL LESION,78001569G,CDM,983,RC,56606,HCPCS,Outpatient,,,77,57.75,,70.84,92,,,percent of total billed charges,92% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,71.61,93,,,percent of total billed charges,93% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,69.3,90,,,percent of total billed charges,90% of total billed charges,74.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,74.69,97,,,percent of total billed charges,97% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,73.92,96,,,percent of total billed charges,96% of total billed charges,3.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,57.75,75,,,percent of total billed charges,75% of total billed charges,57.75,75,,,percent of total billed charges,75% of total billed charges,3.44,74.69,
FIT AND INSERTION OF VAGINAL SUPPORT DEVICE,78001578G,CDM,983,RC,57160,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges,5.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.6,93,,,percent of total billed charges,93% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,116.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.4,97,,,percent of total billed charges,97% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,115.2,96,,,percent of total billed charges,96% of total billed charges,5.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90,75,,,percent of total billed charges,75% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,5.38,116.4,
DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS,78001580G,CDM,983,RC,57170,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges,5.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,93,,,percent of total billed charges,93% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,121.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,121.25,97,,,percent of total billed charges,97% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,120,96,,,percent of total billed charges,96% of total billed charges,5.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.75,75,,,percent of total billed charges,75% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,5.69,121.25,
COMBINED ANTEROPOSTERIOR COLPORRHAPHY,78001585G,CDM,983,RC,57260,HCPCS,Outpatient,,,2077,1557.75,,1910.84,92,,,percent of total billed charges,92% of total billed charges,85.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1931.61,93,,,percent of total billed charges,93% of total billed charges,1869.3,90,,,percent of total billed charges,90% of total billed charges,1869.3,90,,,percent of total billed charges,90% of total billed charges,2014.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,85.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,2014.69,97,,,percent of total billed charges,97% of total billed charges,1557.75,75,,,percent of total billed charges,75% of total billed charges,1993.92,96,,,percent of total billed charges,96% of total billed charges,85.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1557.75,75,,,percent of total billed charges,75% of total billed charges,1557.75,75,,,percent of total billed charges,75% of total billed charges,85.34,2014.69,
COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX,78001588G,CDM,983,RC,57421,HCPCS,Outpatient,,,320,240,,294.4,92,,,percent of total billed charges,92% of total billed charges,14.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,297.6,93,,,percent of total billed charges,93% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,288,90,,,percent of total billed charges,90% of total billed charges,310.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,310.4,97,,,percent of total billed charges,97% of total billed charges,240,75,,,percent of total billed charges,75% of total billed charges,307.2,96,,,percent of total billed charges,96% of total billed charges,14.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,240,75,,,percent of total billed charges,75% of total billed charges,240,75,,,percent of total billed charges,75% of total billed charges,14.51,310.4,
COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA,78001590G,CDM,983,RC,57452,HCPCS,Outpatient,,,239,179.25,,219.88,92,,,percent of total billed charges,92% of total billed charges,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222.27,93,,,percent of total billed charges,93% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,231.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.83,97,,,percent of total billed charges,97% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,229.44,96,,,percent of total billed charges,96% of total billed charges,9.65,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.25,75,,,percent of total billed charges,75% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,9.65,231.83,
COLPOSCOPY CERVIX BX CERVIX  and  ENDO CURRETAGE,78001592G,CDM,983,RC,57454,HCPCS,Outpatient,,,353,264.75,,324.76,92,,,percent of total billed charges,92% of total billed charges,15.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,328.29,93,,,percent of total billed charges,93% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,317.7,90,,,percent of total billed charges,90% of total billed charges,342.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,342.41,97,,,percent of total billed charges,97% of total billed charges,264.75,75,,,percent of total billed charges,75% of total billed charges,338.88,96,,,percent of total billed charges,96% of total billed charges,15.2,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,264.75,75,,,percent of total billed charges,75% of total billed charges,264.75,75,,,percent of total billed charges,75% of total billed charges,15.2,342.41,
COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX,78001594G,CDM,983,RC,57460,HCPCS,Outpatient,,,483,362.25,,444.36,92,,,percent of total billed charges,92% of total billed charges,18.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,449.19,93,,,percent of total billed charges,93% of total billed charges,434.7,90,,,percent of total billed charges,90% of total billed charges,434.7,90,,,percent of total billed charges,90% of total billed charges,468.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,18.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,468.51,97,,,percent of total billed charges,97% of total billed charges,362.25,75,,,percent of total billed charges,75% of total billed charges,463.68,96,,,percent of total billed charges,96% of total billed charges,18.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,362.25,75,,,percent of total billed charges,75% of total billed charges,362.25,75,,,percent of total billed charges,75% of total billed charges,18.25,468.51,
BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESN SPX,78001596G,CDM,983,RC,57500,HCPCS,Outpatient,,,237,177.75,,218.04,92,,,percent of total billed charges,92% of total billed charges,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,220.41,93,,,percent of total billed charges,93% of total billed charges,213.3,90,,,percent of total billed charges,90% of total billed charges,213.3,90,,,percent of total billed charges,90% of total billed charges,229.89,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,229.89,97,,,percent of total billed charges,97% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges,227.52,96,,,percent of total billed charges,96% of total billed charges,8.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,177.75,75,,,percent of total billed charges,75% of total billed charges,177.75,75,,,percent of total billed charges,75% of total billed charges,8.03,229.89,
CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT,78001598G,CDM,983,RC,57511,HCPCS,Outpatient,,,395,296.25,,363.4,92,,,percent of total billed charges,92% of total billed charges,14.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,367.35,93,,,percent of total billed charges,93% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,355.5,90,,,percent of total billed charges,90% of total billed charges,383.15,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,14.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,383.15,97,,,percent of total billed charges,97% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,379.2,96,,,percent of total billed charges,96% of total billed charges,14.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.25,75,,,percent of total billed charges,75% of total billed charges,296.25,75,,,percent of total billed charges,75% of total billed charges,14.1,383.15,
CONIZATION CERVIX W/WO D and C REPAIR ELTRD EXC,78001601G,CDM,983,RC,57522,HCPCS,Outpatient,,,459,344.25,,422.28,92,,,percent of total billed charges,92% of total billed charges,25.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,426.87,93,,,percent of total billed charges,93% of total billed charges,413.1,90,,,percent of total billed charges,90% of total billed charges,413.1,90,,,percent of total billed charges,90% of total billed charges,445.23,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,25.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,445.23,97,,,percent of total billed charges,97% of total billed charges,344.25,75,,,percent of total billed charges,75% of total billed charges,440.64,96,,,percent of total billed charges,96% of total billed charges,25.46,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,344.25,75,,,percent of total billed charges,75% of total billed charges,344.25,75,,,percent of total billed charges,75% of total billed charges,25.46,445.23,
ENDOMETRIAL SAMPLING W/O CERVICAL DILATION,78001604G,CDM,983,RC,58100,HCPCS,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges,7.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156.24,93,,,percent of total billed charges,93% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,162.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.96,97,,,percent of total billed charges,97% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,161.28,96,,,percent of total billed charges,96% of total billed charges,7.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126,75,,,percent of total billed charges,75% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,7.6,162.96,
ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY,78001606G,CDM,983,RC,58110,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges,4.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,98.58,93,,,percent of total billed charges,93% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,102.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102.82,97,,,percent of total billed charges,97% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges,101.76,96,,,percent of total billed charges,96% of total billed charges,4.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.5,75,,,percent of total billed charges,75% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges,4.91,102.82,
INSERTION INTRAUTERINE DEVICE IUD,78001619G,CDM,983,RC,58300,HCPCS,Outpatient,,,170,127.5,,156.4,92,,,percent of total billed charges,92% of total billed charges,4.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.1,93,,,percent of total billed charges,93% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,164.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.9,97,,,percent of total billed charges,97% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,163.2,96,,,percent of total billed charges,96% of total billed charges,4.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.5,75,,,percent of total billed charges,75% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,4.44,164.9,
REMOVAL INTRAUTERINE DEVICE IUD,78001621G,CDM,983,RC,58301,HCPCS,Outpatient,,,175,131.25,,161,92,,,percent of total billed charges,92% of total billed charges,7.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.75,93,,,percent of total billed charges,93% of total billed charges,157.5,90,,,percent of total billed charges,90% of total billed charges,157.5,90,,,percent of total billed charges,90% of total billed charges,169.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,169.75,97,,,percent of total billed charges,97% of total billed charges,131.25,75,,,percent of total billed charges,75% of total billed charges,168,96,,,percent of total billed charges,96% of total billed charges,7.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.25,75,,,percent of total billed charges,75% of total billed charges,131.25,75,,,percent of total billed charges,75% of total billed charges,7.98,169.75,
FETAL CONTRACTION STRESS TEST,78001658G,CDM,983,RC,59020,HCPCS,Outpatient,,,186,139.5,,171.12,92,,,percent of total billed charges,92% of total billed charges,1.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.98,93,,,percent of total billed charges,93% of total billed charges,167.4,90,,,percent of total billed charges,90% of total billed charges,167.4,90,,,percent of total billed charges,90% of total billed charges,180.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.42,97,,,percent of total billed charges,97% of total billed charges,139.5,75,,,percent of total billed charges,75% of total billed charges,178.56,96,,,percent of total billed charges,96% of total billed charges,1.48,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,139.5,75,,,percent of total billed charges,75% of total billed charges,139.5,75,,,percent of total billed charges,75% of total billed charges,1.48,180.42,
FETAL NONSTRESS TEST,78001660G,CDM,983,RC,59025,HCPCS,Outpatient,,,127,95.25,,116.84,92,,,percent of total billed charges,92% of total billed charges,0.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,118.11,93,,,percent of total billed charges,93% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,114.3,90,,,percent of total billed charges,90% of total billed charges,123.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,123.19,97,,,percent of total billed charges,97% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,121.92,96,,,percent of total billed charges,96% of total billed charges,0.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,95.25,75,,,percent of total billed charges,75% of total billed charges,95.25,75,,,percent of total billed charges,75% of total billed charges,0.97,123.19,
PF OB CARE ANTEPARTUM VAGINAL DELIVERY  and  POSTPARTUM,78001670P,CDM,983,RC,59400,HCPCS,Outpatient,,,5785,4338.75,,5322.2,92,,,percent of total billed charges,92% of total billed charges,360.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5380.05,93,,,percent of total billed charges,93% of total billed charges,5206.5,90,,,percent of total billed charges,90% of total billed charges,5206.5,90,,,percent of total billed charges,90% of total billed charges,5611.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,360.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,5611.45,97,,,percent of total billed charges,97% of total billed charges,4338.75,75,,,percent of total billed charges,75% of total billed charges,5553.6,96,,,percent of total billed charges,96% of total billed charges,360.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4338.75,75,,,percent of total billed charges,75% of total billed charges,4338.75,75,,,percent of total billed charges,75% of total billed charges,360.77,5611.45,
ANTEPARTUM CARE ONLY 4-6 VISITS,78001680G,CDM,983,RC,59425,HCPCS,Outpatient,,,829,621.75,,762.68,92,,,percent of total billed charges,92% of total billed charges,73.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,770.97,93,,,percent of total billed charges,93% of total billed charges,746.1,90,,,percent of total billed charges,90% of total billed charges,746.1,90,,,percent of total billed charges,90% of total billed charges,804.13,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,73.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,804.13,97,,,percent of total billed charges,97% of total billed charges,621.75,75,,,percent of total billed charges,75% of total billed charges,795.84,96,,,percent of total billed charges,96% of total billed charges,73.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,621.75,75,,,percent of total billed charges,75% of total billed charges,621.75,75,,,percent of total billed charges,75% of total billed charges,73.32,804.13,
ANTEPARTUM CARE ONLY 7/> VISITS,78001682G,CDM,983,RC,59426,HCPCS,Outpatient,,,1515,1136.25,,1393.8,92,,,percent of total billed charges,92% of total billed charges,135.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1408.95,93,,,percent of total billed charges,93% of total billed charges,1363.5,90,,,percent of total billed charges,90% of total billed charges,1363.5,90,,,percent of total billed charges,90% of total billed charges,1469.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,135.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1469.55,97,,,percent of total billed charges,97% of total billed charges,1136.25,75,,,percent of total billed charges,75% of total billed charges,1454.4,96,,,percent of total billed charges,96% of total billed charges,135.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,1136.25,75,,,percent of total billed charges,75% of total billed charges,1136.25,75,,,percent of total billed charges,75% of total billed charges,135.51,1469.55,
PF OB ANTEPARTUM CARE CESAREAN DELIVERY  POSTPARTUM,78001686P,CDM,983,RC,59510,HCPCS,Outpatient,,,6463,4847.25,,5945.96,92,,,percent of total billed charges,92% of total billed charges,432.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6010.59,93,,,percent of total billed charges,93% of total billed charges,5816.7,90,,,percent of total billed charges,90% of total billed charges,5816.7,90,,,percent of total billed charges,90% of total billed charges,6269.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,432.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,6269.11,97,,,percent of total billed charges,97% of total billed charges,4847.25,75,,,percent of total billed charges,75% of total billed charges,6204.48,96,,,percent of total billed charges,96% of total billed charges,432.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,4847.25,75,,,percent of total billed charges,75% of total billed charges,4847.25,75,,,percent of total billed charges,75% of total billed charges,432.32,6269.11,
INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NERVE,78001722G,CDM,983,RC,64405,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,195.3,93,,,percent of total billed charges,93% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,203.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,203.7,97,,,percent of total billed charges,97% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,201.6,96,,,percent of total billed charges,96% of total billed charges,7.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,157.5,75,,,percent of total billed charges,75% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,7.79,203.7,
INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE,78001736G,CDM,983,RC,64445,HCPCS,Outpatient,,,141,105.75,,129.72,92,,,percent of total billed charges,92% of total billed charges,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,131.13,93,,,percent of total billed charges,93% of total billed charges,126.9,90,,,percent of total billed charges,90% of total billed charges,126.9,90,,,percent of total billed charges,90% of total billed charges,136.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,136.77,97,,,percent of total billed charges,97% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges,135.36,96,,,percent of total billed charges,96% of total billed charges,6.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,105.75,75,,,percent of total billed charges,75% of total billed charges,105.75,75,,,percent of total billed charges,75% of total billed charges,6.26,136.77,
INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,78001738G,CDM,983,RC,64450,HCPCS,Outpatient,,,168,126,,154.56,92,,,percent of total billed charges,92% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156.24,93,,,percent of total billed charges,93% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,151.2,90,,,percent of total billed charges,90% of total billed charges,162.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,162.96,97,,,percent of total billed charges,97% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,161.28,96,,,percent of total billed charges,96% of total billed charges,3.88,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126,75,,,percent of total billed charges,75% of total billed charges,126,75,,,percent of total billed charges,75% of total billed charges,3.88,162.96,
INCISIONAL BIOPSY EYELID SKIN  and  LID MARGIN,78001809G,CDM,983,RC,67810,HCPCS,Outpatient,,,281,210.75,,258.52,92,,,percent of total billed charges,92% of total billed charges,5.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,261.33,93,,,percent of total billed charges,93% of total billed charges,252.9,90,,,percent of total billed charges,90% of total billed charges,252.9,90,,,percent of total billed charges,90% of total billed charges,272.57,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,272.57,97,,,percent of total billed charges,97% of total billed charges,210.75,75,,,percent of total billed charges,75% of total billed charges,269.76,96,,,percent of total billed charges,96% of total billed charges,5.3,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,210.75,75,,,percent of total billed charges,75% of total billed charges,210.75,75,,,percent of total billed charges,75% of total billed charges,5.3,272.57,
DRAINAGE EXTERNAL EAR ABSCESS SIMPLE,78002850G,CDM,983,RC,69000,HCPCS,Outpatient,,,568,426,,522.56,92,,,percent of total billed charges,92% of total billed charges,10.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,528.24,93,,,percent of total billed charges,93% of total billed charges,511.2,90,,,percent of total billed charges,90% of total billed charges,511.2,90,,,percent of total billed charges,90% of total billed charges,550.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,550.96,97,,,percent of total billed charges,97% of total billed charges,426,75,,,percent of total billed charges,75% of total billed charges,545.28,96,,,percent of total billed charges,96% of total billed charges,10.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,426,75,,,percent of total billed charges,75% of total billed charges,426,75,,,percent of total billed charges,75% of total billed charges,10.61,550.96,
REMOVAL FB EXTERNAL AUDITORY CANAL W/O ANES,78001817G,CDM,983,RC,69200,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges,4.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.05,93,,,percent of total billed charges,93% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,179.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.45,97,,,percent of total billed charges,97% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,177.6,96,,,percent of total billed charges,96% of total billed charges,4.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,4.62,179.45,
REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,78001820G,CDM,983,RC,69210,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,3.29,84.39,
REMOVAL IMPACTED CERUMEN INSTRUMENTATION BILATERAL,78002890G,CDM,983,RC,69210,HCPCS,Outpatient,,,130,97.5,,119.6,92,,,percent of total billed charges,92% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,120.9,93,,,percent of total billed charges,93% of total billed charges,117,90,,,percent of total billed charges,90% of total billed charges,117,90,,,percent of total billed charges,90% of total billed charges,126.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126.1,97,,,percent of total billed charges,97% of total billed charges,97.5,75,,,percent of total billed charges,75% of total billed charges,124.8,96,,,percent of total billed charges,96% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.5,75,,,percent of total billed charges,75% of total billed charges,97.5,75,,,percent of total billed charges,75% of total billed charges,3.29,126.1,
"Removal impacted cerumen requiring instrumentation, unilater",78001820G,CDM,983,RC,69210,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,3.29,84.39,
ECG ROUTINE ECG W/LEAST 12 LDS W/I and R,78001838G,CDM,985,RC,93000,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges,1.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,109.74,93,,,percent of total billed charges,93% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,114.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,114.46,97,,,percent of total billed charges,97% of total billed charges,88.5,75,,,percent of total billed charges,75% of total billed charges,113.28,96,,,percent of total billed charges,96% of total billed charges,1.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,88.5,75,,,percent of total billed charges,75% of total billed charges,88.5,75,,,percent of total billed charges,75% of total billed charges,1.04,114.46,
PF ECG ROUTINE ECG W/LEAST 12 LDS IR ONLY,78001841P,CDM,985,RC,93010,HCPCS,Outpatient,,,197,147.75,,181.24,92,,,percent of total billed charges,92% of total billed charges,0.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,183.21,93,,,percent of total billed charges,93% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,191.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.09,97,,,percent of total billed charges,97% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,189.12,96,,,percent of total billed charges,96% of total billed charges,0.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.75,75,,,percent of total billed charges,75% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,0.55,191.09,
PF RHYTHM ECG 1-3 LEADS INTERPRETATION  and  RPRT ONLY,78001842P,CDM,985,RC,93042,HCPCS,Outpatient,,,86,64.5,,79.12,92,,,percent of total billed charges,92% of total billed charges,0.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.98,93,,,percent of total billed charges,93% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,77.4,90,,,percent of total billed charges,90% of total billed charges,83.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.42,97,,,percent of total billed charges,97% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,82.56,96,,,percent of total billed charges,96% of total billed charges,0.5,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.5,75,,,percent of total billed charges,75% of total billed charges,64.5,75,,,percent of total billed charges,75% of total billed charges,0.5,83.42,
PF EXTERNAL ECG RECORDING FOR >48 HOURS UP TO 7 DAYS REVIEW,78002846P,CDM,985,RC,93244,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.94,93,,,percent of total billed charges,93% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,56.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.26,97,,,percent of total billed charges,97% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,55.68,96,,,percent of total billed charges,96% of total billed charges,1.32,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.5,75,,,percent of total billed charges,75% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,1.32,56.26,
PF EXTERNAL ECG RECORDING FOR >7 DAYS UP TO 15 DAYS REVIEW  and,78002848P,CDM,985,RC,93248,HCPCS,Outpatient,,,64,48,,58.88,92,,,percent of total billed charges,92% of total billed charges,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,59.52,93,,,percent of total billed charges,93% of total billed charges,57.6,90,,,percent of total billed charges,90% of total billed charges,57.6,90,,,percent of total billed charges,90% of total billed charges,62.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,62.08,97,,,percent of total billed charges,97% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges,61.44,96,,,percent of total billed charges,96% of total billed charges,1.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,48,75,,,percent of total billed charges,75% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges,1.41,62.08,
UPPER/LWR PHYSILGC STUDIES OF ARTERIES 1-2 LVLS,72600040G,CDM,960,RC,93922,HCPCS,Outpatient,,,222,166.5,,204.24,92,,,percent of total billed charges,92% of total billed charges,2.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,206.46,93,,,percent of total billed charges,93% of total billed charges,199.8,90,,,percent of total billed charges,90% of total billed charges,199.8,90,,,percent of total billed charges,90% of total billed charges,215.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,215.34,97,,,percent of total billed charges,97% of total billed charges,166.5,75,,,percent of total billed charges,75% of total billed charges,213.12,96,,,percent of total billed charges,96% of total billed charges,2.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,166.5,75,,,percent of total billed charges,75% of total billed charges,166.5,75,,,percent of total billed charges,75% of total billed charges,2.98,215.34,
NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVELS,72600047G,CDM,960,RC,93923,HCPCS,Outpatient,,,331,248.25,,304.52,92,,,percent of total billed charges,92% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,307.83,93,,,percent of total billed charges,93% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,297.9,90,,,percent of total billed charges,90% of total billed charges,321.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,321.07,97,,,percent of total billed charges,97% of total billed charges,248.25,75,,,percent of total billed charges,75% of total billed charges,317.76,96,,,percent of total billed charges,96% of total billed charges,4.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,248.25,75,,,percent of total billed charges,75% of total billed charges,248.25,75,,,percent of total billed charges,75% of total billed charges,4.57,321.07,
US SCAN XTR VEINS COMPLETE BILATERAL STUDY,72600043G,CDM,960,RC,93970,HCPCS,Outpatient,,,492,369,,452.64,92,,,percent of total billed charges,92% of total billed charges,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,457.56,93,,,percent of total billed charges,93% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,442.8,90,,,percent of total billed charges,90% of total billed charges,477.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,477.24,97,,,percent of total billed charges,97% of total billed charges,369,75,,,percent of total billed charges,75% of total billed charges,472.32,96,,,percent of total billed charges,96% of total billed charges,6.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,369,75,,,percent of total billed charges,75% of total billed charges,369,75,,,percent of total billed charges,75% of total billed charges,6.15,477.24,
US SCAN XTR VEINS UNILATERAL/LIMITED STUDY,72600044G,CDM,960,RC,93971,HCPCS,Outpatient,,,190,142.5,,174.8,92,,,percent of total billed charges,92% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,176.7,93,,,percent of total billed charges,93% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,171,90,,,percent of total billed charges,90% of total billed charges,184.3,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.3,97,,,percent of total billed charges,97% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,182.4,96,,,percent of total billed charges,96% of total billed charges,3.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.5,75,,,percent of total billed charges,75% of total billed charges,142.5,75,,,percent of total billed charges,75% of total billed charges,3.94,184.3,
SPIROMETRY W/VITAL CAPACITY EXPIRATORY FLO W/WO MXML VOL,78001844G,CDM,983,RC,94010,HCPCS,Outpatient,,,71,53.25,,65.32,92,,,percent of total billed charges,92% of total billed charges,0.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.03,93,,,percent of total billed charges,93% of total billed charges,63.9,90,,,percent of total billed charges,90% of total billed charges,63.9,90,,,percent of total billed charges,90% of total billed charges,68.87,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,68.87,97,,,percent of total billed charges,97% of total billed charges,53.25,75,,,percent of total billed charges,75% of total billed charges,68.16,96,,,percent of total billed charges,96% of total billed charges,0.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.25,75,,,percent of total billed charges,75% of total billed charges,53.25,75,,,percent of total billed charges,75% of total billed charges,0.94,68.87,
BRONCHO DILATOR RESPONSE SPIROMETRY PRE  and  POST,78001846G,CDM,983,RC,94060,HCPCS,Outpatient,,,102,76.5,,93.84,92,,,percent of total billed charges,92% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,94.86,93,,,percent of total billed charges,93% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,98.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,98.94,97,,,percent of total billed charges,97% of total billed charges,76.5,75,,,percent of total billed charges,75% of total billed charges,97.92,96,,,percent of total billed charges,96% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.5,75,,,percent of total billed charges,75% of total billed charges,76.5,75,,,percent of total billed charges,75% of total billed charges,1.27,98.94,
PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS,78001848G,CDM,983,RC,95004,HCPCS,Outpatient,,,11,8.25,,10.12,92,,,percent of total billed charges,92% of total billed charges,0.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,10.23,93,,,percent of total billed charges,93% of total billed charges,9.9,90,,,percent of total billed charges,90% of total billed charges,9.9,90,,,percent of total billed charges,90% of total billed charges,10.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,10.67,97,,,percent of total billed charges,97% of total billed charges,8.25,75,,,percent of total billed charges,75% of total billed charges,10.56,96,,,percent of total billed charges,96% of total billed charges,0.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,8.25,75,,,percent of total billed charges,75% of total billed charges,8.25,75,,,percent of total billed charges,75% of total billed charges,0.4,10.67,
ALLERGY TEST WITH DRUG/BIOLOGICALS W/INTERP  and  REPORT,78001850G,CDM,983,RC,95018,HCPCS,Outpatient,,,31,23.25,,28.52,92,,,percent of total billed charges,92% of total billed charges,0.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,28.83,93,,,percent of total billed charges,93% of total billed charges,27.9,90,,,percent of total billed charges,90% of total billed charges,27.9,90,,,percent of total billed charges,90% of total billed charges,30.07,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,30.07,97,,,percent of total billed charges,97% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges,29.76,96,,,percent of total billed charges,96% of total billed charges,0.51,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,23.25,75,,,percent of total billed charges,75% of total billed charges,23.25,75,,,percent of total billed charges,75% of total billed charges,0.51,30.07,
INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS,78001852G,CDM,983,RC,95024,HCPCS,Outpatient,,,13,9.75,,11.96,92,,,percent of total billed charges,92% of total billed charges,0.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,12.09,93,,,percent of total billed charges,93% of total billed charges,11.7,90,,,percent of total billed charges,90% of total billed charges,11.7,90,,,percent of total billed charges,90% of total billed charges,12.61,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,12.61,97,,,percent of total billed charges,97% of total billed charges,9.75,75,,,percent of total billed charges,75% of total billed charges,12.48,96,,,percent of total billed charges,96% of total billed charges,0.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,9.75,75,,,percent of total billed charges,75% of total billed charges,9.75,75,,,percent of total billed charges,75% of total billed charges,0.31,12.61,
PREPARATION  and  ALLERGEN IMMUNOTHERAPY,78001856G,CDM,983,RC,95165,HCPCS,Outpatient,,,23,17.25,,21.16,92,,,percent of total billed charges,92% of total billed charges,0.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,21.39,93,,,percent of total billed charges,93% of total billed charges,20.7,90,,,percent of total billed charges,90% of total billed charges,20.7,90,,,percent of total billed charges,90% of total billed charges,22.31,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,22.31,97,,,percent of total billed charges,97% of total billed charges,17.25,75,,,percent of total billed charges,75% of total billed charges,22.08,96,,,percent of total billed charges,96% of total billed charges,0.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,17.25,75,,,percent of total billed charges,75% of total billed charges,17.25,75,,,percent of total billed charges,75% of total billed charges,0.39,22.31,
SLEEP STUDY AIRFLOW HRT RATE and O2 SAT EFFORT UNATT,74100002G,CDM,986,RC,95806,HCPCS,Outpatient,,,234,175.5,,215.28,92,,,percent of total billed charges,92% of total billed charges,2.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,217.62,93,,,percent of total billed charges,93% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,226.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,226.98,97,,,percent of total billed charges,97% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges,224.64,96,,,percent of total billed charges,96% of total billed charges,2.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.5,75,,,percent of total billed charges,75% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges,2.31,226.98,
CANALITH REPOSITIONING PROCEDURE,78001859G,CDM,983,RC,95992,HCPCS,Outpatient,,,148,111,,136.16,92,,,percent of total billed charges,92% of total billed charges,2.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,137.64,93,,,percent of total billed charges,93% of total billed charges,133.2,90,,,percent of total billed charges,90% of total billed charges,133.2,90,,,percent of total billed charges,90% of total billed charges,143.56,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,143.56,97,,,percent of total billed charges,97% of total billed charges,111,75,,,percent of total billed charges,75% of total billed charges,142.08,96,,,percent of total billed charges,96% of total billed charges,2.03,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111,75,,,percent of total billed charges,75% of total billed charges,111,75,,,percent of total billed charges,75% of total billed charges,2.03,143.56,
PF BRIEF EMOTIONAL BEHAVIORAL ASSESSMENT,78001861P,CDM,983,RC,96127,HCPCS,Outpatient,,,73,54.75,,67.16,92,,,percent of total billed charges,92% of total billed charges,0.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,67.89,93,,,percent of total billed charges,93% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,65.7,90,,,percent of total billed charges,90% of total billed charges,70.81,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.81,97,,,percent of total billed charges,97% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges,70.08,96,,,percent of total billed charges,96% of total billed charges,0.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54.75,75,,,percent of total billed charges,75% of total billed charges,54.75,75,,,percent of total billed charges,75% of total billed charges,0.43,70.81,
DEBRIDEMENT OPEN WOUND 20 SQ CM/<,78001862G,CDM,983,RC,97597,HCPCS,Outpatient,,,198,148.5,,182.16,92,,,percent of total billed charges,92% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,184.14,93,,,percent of total billed charges,93% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,178.2,90,,,percent of total billed charges,90% of total billed charges,192.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,192.06,97,,,percent of total billed charges,97% of total billed charges,148.5,75,,,percent of total billed charges,75% of total billed charges,190.08,96,,,percent of total billed charges,96% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,148.5,75,,,percent of total billed charges,75% of total billed charges,148.5,75,,,percent of total billed charges,75% of total billed charges,2.84,192.06,
DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM,78001864G,CDM,983,RC,97598,HCPCS,Outpatient,,,316,237,,290.72,92,,,percent of total billed charges,92% of total billed charges,2.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,293.88,93,,,percent of total billed charges,93% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,284.4,90,,,percent of total billed charges,90% of total billed charges,306.52,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,306.52,97,,,percent of total billed charges,97% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,303.36,96,,,percent of total billed charges,96% of total billed charges,2.47,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,237,75,,,percent of total billed charges,75% of total billed charges,237,75,,,percent of total billed charges,75% of total billed charges,2.47,306.52,
REMOVAL DEVITALIZD TISS N-SLCTV DBRDMT W/O ANES,78001866G,CDM,983,RC,97602,HCPCS,Outpatient,,,185,138.75,,170.2,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,172.05,93,,,percent of total billed charges,93% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,166.5,90,,,percent of total billed charges,90% of total billed charges,179.45,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,179.45,97,,,percent of total billed charges,97% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,177.6,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,75,,,percent of total billed charges,75% of total billed charges,138.75,179.45,
NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQCM,78001867G,CDM,983,RC,97605,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.38,93,,,percent of total billed charges,93% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,64.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.02,97,,,percent of total billed charges,97% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,63.36,96,,,percent of total billed charges,96% of total billed charges,1.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.5,75,,,percent of total billed charges,75% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,1.1,64.02,
NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM,78001869G,CDM,983,RC,97606,HCPCS,Outpatient,,,72,54,,66.24,92,,,percent of total billed charges,92% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,66.96,93,,,percent of total billed charges,93% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,64.8,90,,,percent of total billed charges,90% of total billed charges,69.84,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,69.84,97,,,percent of total billed charges,97% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,69.12,96,,,percent of total billed charges,96% of total billed charges,1.18,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,54,75,,,percent of total billed charges,75% of total billed charges,54,75,,,percent of total billed charges,75% of total billed charges,1.18,69.84,
NEGATIVE PRESSURE WOUND THERAPY NON DME </= 50 SQ CM,78001871G,CDM,983,RC,97607,HCPCS,Outpatient,,,583,437.25,,536.36,92,,,percent of total billed charges,92% of total billed charges,2.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,542.19,93,,,percent of total billed charges,93% of total billed charges,524.7,90,,,percent of total billed charges,90% of total billed charges,524.7,90,,,percent of total billed charges,90% of total billed charges,565.51,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,565.51,97,,,percent of total billed charges,97% of total billed charges,437.25,75,,,percent of total billed charges,75% of total billed charges,559.68,96,,,percent of total billed charges,96% of total billed charges,2.35,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,437.25,75,,,percent of total billed charges,75% of total billed charges,437.25,75,,,percent of total billed charges,75% of total billed charges,2.35,565.51,
NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM,78001873G,CDM,983,RC,97608,HCPCS,Outpatient,,,296,222,,272.32,92,,,percent of total billed charges,92% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,275.28,93,,,percent of total billed charges,93% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,266.4,90,,,percent of total billed charges,90% of total billed charges,287.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,287.12,97,,,percent of total billed charges,97% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,284.16,96,,,percent of total billed charges,96% of total billed charges,3.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222,75,,,percent of total billed charges,75% of total billed charges,222,75,,,percent of total billed charges,75% of total billed charges,3.29,287.12,
OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS,78001875G,CDM,983,RC,98925,HCPCS,Outpatient,,,47,35.25,,43.24,92,,,percent of total billed charges,92% of total billed charges,1.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.71,93,,,percent of total billed charges,93% of total billed charges,42.3,90,,,percent of total billed charges,90% of total billed charges,42.3,90,,,percent of total billed charges,90% of total billed charges,45.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,45.59,97,,,percent of total billed charges,97% of total billed charges,35.25,75,,,percent of total billed charges,75% of total billed charges,45.12,96,,,percent of total billed charges,96% of total billed charges,1.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,35.25,75,,,percent of total billed charges,75% of total billed charges,35.25,75,,,percent of total billed charges,75% of total billed charges,1.6,45.59,
OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS,78001877G,CDM,983,RC,98926,HCPCS,Outpatient,,,66,49.5,,60.72,92,,,percent of total billed charges,92% of total billed charges,2.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.38,93,,,percent of total billed charges,93% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,59.4,90,,,percent of total billed charges,90% of total billed charges,64.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.02,97,,,percent of total billed charges,97% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,63.36,96,,,percent of total billed charges,96% of total billed charges,2.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.5,75,,,percent of total billed charges,75% of total billed charges,49.5,75,,,percent of total billed charges,75% of total billed charges,2.27,64.02,
OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS,78001879G,CDM,983,RC,98927,HCPCS,Outpatient,,,87,65.25,,80.04,92,,,percent of total billed charges,92% of total billed charges,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,80.91,93,,,percent of total billed charges,93% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,78.3,90,,,percent of total billed charges,90% of total billed charges,84.39,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,84.39,97,,,percent of total billed charges,97% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,83.52,96,,,percent of total billed charges,96% of total billed charges,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.25,75,,,percent of total billed charges,75% of total billed charges,65.25,75,,,percent of total billed charges,75% of total billed charges,2.93,84.39,
OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS,78001881G,CDM,983,RC,98928,HCPCS,Outpatient,,,106,79.5,,97.52,92,,,percent of total billed charges,92% of total billed charges,3.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,98.58,93,,,percent of total billed charges,93% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,95.4,90,,,percent of total billed charges,90% of total billed charges,102.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,102.82,97,,,percent of total billed charges,97% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges,101.76,96,,,percent of total billed charges,96% of total billed charges,3.89,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,79.5,75,,,percent of total billed charges,75% of total billed charges,79.5,75,,,percent of total billed charges,75% of total billed charges,3.89,102.82,
OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS,78001883G,CDM,983,RC,98929,HCPCS,Outpatient,,,126,94.5,,115.92,92,,,percent of total billed charges,92% of total billed charges,4.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117.18,93,,,percent of total billed charges,93% of total billed charges,113.4,90,,,percent of total billed charges,90% of total billed charges,113.4,90,,,percent of total billed charges,90% of total billed charges,122.22,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,122.22,97,,,percent of total billed charges,97% of total billed charges,94.5,75,,,percent of total billed charges,75% of total billed charges,120.96,96,,,percent of total billed charges,96% of total billed charges,4.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,94.5,75,,,percent of total billed charges,75% of total billed charges,94.5,75,,,percent of total billed charges,75% of total billed charges,4.55,122.22,
PF SERVICES PROVIDED IN OFFICE AFTER HOURS,78002864P,CDM,983,RC,99050,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,32.55,93,,,percent of total billed charges,93% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,33.95,97,,,percent of total billed charges,97% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,33.6,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,33.95,
PF ATTEND  and  SUPERVISE HYPERBARIC OXYGEN THERAPY,78001890P,CDM,983,RC,99183,HCPCS,Outpatient,,,282,211.5,,259.44,92,,,percent of total billed charges,92% of total billed charges,10.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,262.26,93,,,percent of total billed charges,93% of total billed charges,253.8,90,,,percent of total billed charges,90% of total billed charges,253.8,90,,,percent of total billed charges,90% of total billed charges,273.54,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,273.54,97,,,percent of total billed charges,97% of total billed charges,211.5,75,,,percent of total billed charges,75% of total billed charges,270.72,96,,,percent of total billed charges,96% of total billed charges,10.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,211.5,75,,,percent of total billed charges,75% of total billed charges,211.5,75,,,percent of total billed charges,75% of total billed charges,10.67,273.54,
COMPLEX CHRONIC CARE MANAGEMENT SVC 1ST 60 MIN,78002016G,CDM,983,RC,99487,HCPCS,Outpatient,,,196,147,,180.32,92,,,percent of total billed charges,92% of total billed charges,6.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,182.28,93,,,percent of total billed charges,93% of total billed charges,176.4,90,,,percent of total billed charges,90% of total billed charges,176.4,90,,,percent of total billed charges,90% of total billed charges,190.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,190.12,97,,,percent of total billed charges,97% of total billed charges,147,75,,,percent of total billed charges,75% of total billed charges,188.16,96,,,percent of total billed charges,96% of total billed charges,6.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147,75,,,percent of total billed charges,75% of total billed charges,147,75,,,percent of total billed charges,75% of total billed charges,6.34,190.12,
PF CHRONIC CARE MANAGEMENT SERVICES 1ST 20 MIN,78002423P,CDM,983,RC,99490,HCPCS,Outpatient,,,234,175.5,,215.28,92,,,percent of total billed charges,92% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,217.62,93,,,percent of total billed charges,93% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,226.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,226.98,97,,,percent of total billed charges,97% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges,224.64,96,,,percent of total billed charges,96% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.5,75,,,percent of total billed charges,75% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges,3.61,226.98,
PF SPORTS PHYSICAL,78002033P,CDM,983,RC,99997,HCPCS,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,18.6,93,,,percent of total billed charges,93% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,19.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.4,97,,,percent of total billed charges,97% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,19.2,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,15,75,,,percent of total billed charges,75% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,15,19.4,
DESTRUCTION BENIGN LESIONS UP TO 14,78000316G,CDM,983,RC,17110,HCPCS,Outpatient,,,206,154.5,,189.52,92,,,percent of total billed charges,92% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.58,93,,,percent of total billed charges,93% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,185.4,90,,,percent of total billed charges,90% of total billed charges,199.82,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,199.82,97,,,percent of total billed charges,97% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,197.76,96,,,percent of total billed charges,96% of total billed charges,4.28,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.5,75,,,percent of total billed charges,75% of total billed charges,154.5,75,,,percent of total billed charges,75% of total billed charges,4.28,199.82,
ASPIRATION INJECTION OF MEDIUM JOINT OR JOINT CAPSULE W/O US,78000362G,CDM,983,RC,20605,HCPCS,Outpatient,,,147,110.25,,135.24,92,,,percent of total billed charges,92% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,136.71,93,,,percent of total billed charges,93% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,142.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.59,97,,,percent of total billed charges,97% of total billed charges,110.25,75,,,percent of total billed charges,75% of total billed charges,141.12,96,,,percent of total billed charges,96% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.25,75,,,percent of total billed charges,75% of total billed charges,110.25,75,,,percent of total billed charges,75% of total billed charges,3.71,142.59,
ASPIRATION INJECTION OF SMALL JOINT OR JOINT CAPSULE W/O US,78000356G,CDM,983,RC,20600,HCPCS,Outpatient,,,142,106.5,,130.64,92,,,percent of total billed charges,92% of total billed charges,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.06,93,,,percent of total billed charges,93% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,127.8,90,,,percent of total billed charges,90% of total billed charges,137.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,137.74,97,,,percent of total billed charges,97% of total billed charges,106.5,75,,,percent of total billed charges,75% of total billed charges,136.32,96,,,percent of total billed charges,96% of total billed charges,3.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.5,75,,,percent of total billed charges,75% of total billed charges,106.5,75,,,percent of total billed charges,75% of total billed charges,3.67,137.74,
ECG ROUTINE ECG W/LEAST 12 LDS W/I and R,78001838G,CDM,985,RC,93000,HCPCS,Outpatient,,,118,88.5,,108.56,92,,,percent of total billed charges,92% of total billed charges,1.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,109.74,93,,,percent of total billed charges,93% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,106.2,90,,,percent of total billed charges,90% of total billed charges,114.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,114.46,97,,,percent of total billed charges,97% of total billed charges,88.5,75,,,percent of total billed charges,75% of total billed charges,113.28,96,,,percent of total billed charges,96% of total billed charges,1.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,88.5,75,,,percent of total billed charges,75% of total billed charges,88.5,75,,,percent of total billed charges,75% of total billed charges,1.04,114.46,
REMOVAL OF GROWTH (0.5 CENTIMETERS OR LESS) OF THE SCALP NEC,78000088G,CDM,983,RC,11420,HCPCS,Outpatient,,,193,144.75,,177.56,92,,,percent of total billed charges,92% of total billed charges,5.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.49,93,,,percent of total billed charges,93% of total billed charges,173.7,90,,,percent of total billed charges,90% of total billed charges,173.7,90,,,percent of total billed charges,90% of total billed charges,187.21,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,187.21,97,,,percent of total billed charges,97% of total billed charges,144.75,75,,,percent of total billed charges,75% of total billed charges,185.28,96,,,percent of total billed charges,96% of total billed charges,5.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.75,75,,,percent of total billed charges,75% of total billed charges,144.75,75,,,percent of total billed charges,75% of total billed charges,5.57,187.21,
EXCISE BENIGN LESN MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM,78000090G,CDM,983,RC,11421,HCPCS,Outpatient,,,241,180.75,,221.72,92,,,percent of total billed charges,92% of total billed charges,8.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,224.13,93,,,percent of total billed charges,93% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,233.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.77,97,,,percent of total billed charges,97% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,231.36,96,,,percent of total billed charges,96% of total billed charges,8.4,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.75,75,,,percent of total billed charges,75% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,8.4,233.77,
EXCISE BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM,78000104G,CDM,983,RC,11442,HCPCS,Outpatient,,,291,218.25,,267.72,92,,,percent of total billed charges,92% of total billed charges,11.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,270.63,93,,,percent of total billed charges,93% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,261.9,90,,,percent of total billed charges,90% of total billed charges,282.27,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,282.27,97,,,percent of total billed charges,97% of total billed charges,218.25,75,,,percent of total billed charges,75% of total billed charges,279.36,96,,,percent of total billed charges,96% of total billed charges,11.62,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,218.25,75,,,percent of total billed charges,75% of total billed charges,218.25,75,,,percent of total billed charges,75% of total billed charges,11.62,282.27,
EXCISION NAIL MATRIX PERMANENT REMOVAL,78000148G,CDM,983,RC,11750,HCPCS,Outpatient,,,241,180.75,,221.72,92,,,percent of total billed charges,92% of total billed charges,7.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,224.13,93,,,percent of total billed charges,93% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,216.9,90,,,percent of total billed charges,90% of total billed charges,233.77,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,233.77,97,,,percent of total billed charges,97% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,231.36,96,,,percent of total billed charges,96% of total billed charges,7.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.75,75,,,percent of total billed charges,75% of total billed charges,180.75,75,,,percent of total billed charges,75% of total billed charges,7.05,233.77,
PROSTATE CANCER SCREENING RECTAL EXAM,78002060G,CDM,983,RC,G0102,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,32.55,93,,,percent of total billed charges,93% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,33.95,97,,,percent of total billed charges,97% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,33.6,96,,,percent of total billed charges,96% of total billed charges,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,0.57,33.95,
GLAUCOMA SCREENING HIGH RISK,78002062G,CDM,983,RC,G0117,HCPCS,Outpatient,,,94,70.5,,86.48,92,,,percent of total billed charges,92% of total billed charges,2.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,87.42,93,,,percent of total billed charges,93% of total billed charges,84.6,90,,,percent of total billed charges,90% of total billed charges,84.6,90,,,percent of total billed charges,90% of total billed charges,91.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,91.18,97,,,percent of total billed charges,97% of total billed charges,70.5,75,,,percent of total billed charges,75% of total billed charges,90.24,96,,,percent of total billed charges,96% of total billed charges,2.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,70.5,75,,,percent of total billed charges,75% of total billed charges,70.5,75,,,percent of total billed charges,75% of total billed charges,2.74,91.18,
GLAUCOMA SCREEN HIGH RISK PATIENT DIRECT SUPERVISION,78002064G,CDM,983,RC,G0118,HCPCS,Outpatient,,,63,47.25,,57.96,92,,,percent of total billed charges,92% of total billed charges,1.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,58.59,93,,,percent of total billed charges,93% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,56.7,90,,,percent of total billed charges,90% of total billed charges,61.11,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,61.11,97,,,percent of total billed charges,97% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,60.48,96,,,percent of total billed charges,96% of total billed charges,1.72,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,47.25,75,,,percent of total billed charges,75% of total billed charges,47.25,75,,,percent of total billed charges,75% of total billed charges,1.72,61.11,
TRIMMING OF DYSTROPHIC NAILS ANY NUMBER,78002066G,CDM,983,RC,G0127,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,32.55,93,,,percent of total billed charges,93% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,33.95,97,,,percent of total billed charges,97% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,33.6,96,,,percent of total billed charges,96% of total billed charges,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,0.52,33.95,
HOME SLEEP TEST TYPE 3 PORT MONITOR UNATTENDED,78002074G,CDM,983,RC,G0399,HCPCS,Outpatient,,,212,159,,195.04,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,197.16,93,,,percent of total billed charges,93% of total billed charges,190.8,90,,,percent of total billed charges,90% of total billed charges,190.8,90,,,percent of total billed charges,90% of total billed charges,205.64,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,205.64,97,,,percent of total billed charges,97% of total billed charges,159,75,,,percent of total billed charges,75% of total billed charges,203.52,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,159,75,,,percent of total billed charges,75% of total billed charges,159,75,,,percent of total billed charges,75% of total billed charges,159,205.64,
INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,78000348G,CDM,983,RC,20550,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,95.79,93,,,percent of total billed charges,93% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,99.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,99.91,97,,,percent of total billed charges,97% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges,98.88,96,,,percent of total billed charges,96% of total billed charges,4.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,77.25,75,,,percent of total billed charges,75% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges,4.05,99.91,
REMOVAL OF SUTURES,78002103G,CDM,983,RC,S0630,HCPCS,Outpatient,,,24,18,,22.08,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,22.32,93,,,percent of total billed charges,93% of total billed charges,21.6,90,,,percent of total billed charges,90% of total billed charges,21.6,90,,,percent of total billed charges,90% of total billed charges,23.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,23.28,97,,,percent of total billed charges,97% of total billed charges,18,75,,,percent of total billed charges,75% of total billed charges,23.04,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,18,75,,,percent of total billed charges,75% of total billed charges,18,75,,,percent of total billed charges,75% of total billed charges,18,23.28,
SLEEP STD AIRFLOW HRT RATE and O2 SAT EFFORT UNATT,74100002G,CDM,986,RC,95806,HCPCS,Outpatient,,,234,175.5,,215.28,92,,,percent of total billed charges,92% of total billed charges,2.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,217.62,93,,,percent of total billed charges,93% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,226.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,226.98,97,,,percent of total billed charges,97% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges,224.64,96,,,percent of total billed charges,96% of total billed charges,2.31,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.5,75,,,percent of total billed charges,75% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges,2.31,226.98,
SPIROMETRY PRE & POST MEDICATION ADMIN,78001846G,CDM,976,RC,94060,HCPCS,Outpatient,,,102,76.5,,93.84,92,,,percent of total billed charges,92% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,94.86,93,,,percent of total billed charges,93% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,91.8,90,,,percent of total billed charges,90% of total billed charges,98.94,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,98.94,97,,,percent of total billed charges,97% of total billed charges,76.5,75,,,percent of total billed charges,75% of total billed charges,97.92,96,,,percent of total billed charges,96% of total billed charges,1.27,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,76.5,75,,,percent of total billed charges,75% of total billed charges,76.5,75,,,percent of total billed charges,75% of total billed charges,1.27,98.94,
TRIMMING OF FINGERNAILS OR TOENAILS,78000136G,CDM,983,RC,11719,HCPCS,Outpatient,,,21,15.75,,19.32,92,,,percent of total billed charges,92% of total billed charges,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,19.53,93,,,percent of total billed charges,93% of total billed charges,18.9,90,,,percent of total billed charges,90% of total billed charges,18.9,90,,,percent of total billed charges,90% of total billed charges,20.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,20.37,97,,,percent of total billed charges,97% of total billed charges,15.75,75,,,percent of total billed charges,75% of total billed charges,20.16,96,,,percent of total billed charges,96% of total billed charges,0.52,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,15.75,75,,,percent of total billed charges,75% of total billed charges,15.75,75,,,percent of total billed charges,75% of total billed charges,0.52,20.37,
INSERT NON-INDWELLING BLADDER CATHETER,78001532G,CDM,983,RC,51701,HCPCS,Outpatient,,,68,51,,62.56,92,,,percent of total billed charges,92% of total billed charges,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63.24,93,,,percent of total billed charges,93% of total billed charges,61.2,90,,,percent of total billed charges,90% of total billed charges,61.2,90,,,percent of total billed charges,90% of total billed charges,65.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,65.96,97,,,percent of total billed charges,97% of total billed charges,51,75,,,percent of total billed charges,75% of total billed charges,65.28,96,,,percent of total billed charges,96% of total billed charges,2.77,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,51,75,,,percent of total billed charges,75% of total billed charges,51,75,,,percent of total billed charges,75% of total billed charges,2.77,65.96,
PF INITIAL PRENATAL CARE VISIT,78002105P,CDM,960,RC,0500F,HCPCS,Outpatient,,,210,157.5,,193.2,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,195.3,93,,,percent of total billed charges,93% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,189,90,,,percent of total billed charges,90% of total billed charges,203.7,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,203.7,97,,,percent of total billed charges,97% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,201.6,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,157.5,75,,,percent of total billed charges,75% of total billed charges,157.5,75,,,percent of total billed charges,75% of total billed charges,157.5,203.7,
PSYCHOTHERAPY PATIENT / FAMILY 30 MINUTES,78001829G,CDM,983,RC,90832,HCPCS,Outpatient,,,114,85.5,,104.88,92,,,percent of total billed charges,92% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,106.02,93,,,percent of total billed charges,93% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,102.6,90,,,percent of total billed charges,90% of total billed charges,110.58,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.58,97,,,percent of total billed charges,97% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,109.44,96,,,percent of total billed charges,96% of total billed charges,3.71,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,85.5,75,,,percent of total billed charges,75% of total billed charges,85.5,75,,,percent of total billed charges,75% of total billed charges,3.71,110.58,
PSYCHOTHERAPY PATIENT / FAMILY 45 MINUTES,78001832G,CDM,983,RC,90834,HCPCS,Outpatient,,,150,112.5,,138,92,,,percent of total billed charges,92% of total billed charges,4.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,139.5,93,,,percent of total billed charges,93% of total billed charges,135,90,,,percent of total billed charges,90% of total billed charges,135,90,,,percent of total billed charges,90% of total billed charges,145.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,145.5,97,,,percent of total billed charges,97% of total billed charges,112.5,75,,,percent of total billed charges,75% of total billed charges,144,96,,,percent of total billed charges,96% of total billed charges,4.74,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,112.5,75,,,percent of total billed charges,75% of total billed charges,112.5,75,,,percent of total billed charges,75% of total billed charges,4.74,145.5,
PSYCHOTHERAPY PATIENT / FAMILY 60 MINUTES,78001835G,CDM,983,RC,90837,HCPCS,Outpatient,,,221,165.75,,203.32,92,,,percent of total billed charges,92% of total billed charges,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,205.53,93,,,percent of total billed charges,93% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,198.9,90,,,percent of total billed charges,90% of total billed charges,214.37,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,214.37,97,,,percent of total billed charges,97% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,212.16,96,,,percent of total billed charges,96% of total billed charges,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165.75,75,,,percent of total billed charges,75% of total billed charges,165.75,75,,,percent of total billed charges,75% of total billed charges,7.04,214.37,
SPEC NEW PATIENT VISIT LEVEL 2,78001893,CDM,983,RC,G0463,HCPCS,Outpatient,,,119,89.25,,109.48,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,110.67,93,,,percent of total billed charges,93% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,107.1,90,,,percent of total billed charges,90% of total billed charges,115.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,115.43,97,,,percent of total billed charges,97% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,114.24,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,89.25,75,,,percent of total billed charges,75% of total billed charges,89.25,75,,,percent of total billed charges,75% of total billed charges,89.25,115.43,
NEW PATIENT VISIT LEVEL 2,78001891,CDM,983,RC,99202,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,3.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,3.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,3.79,104.76,
NEW PATIENT VISIT LEVEL 3,78001895,CDM,983,RC,99203,HCPCS,Outpatient,,,146,109.5,,134.32,92,,,percent of total billed charges,92% of total billed charges,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.78,93,,,percent of total billed charges,93% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,141.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.62,97,,,percent of total billed charges,97% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,140.16,96,,,percent of total billed charges,96% of total billed charges,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,109.5,75,,,percent of total billed charges,75% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,7.15,141.62,
NEW PATIENT VISIT LEVEL 4,78001899,CDM,983,RC,99204,HCPCS,Outpatient,,,218,163.5,,200.56,92,,,percent of total billed charges,92% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,202.74,93,,,percent of total billed charges,93% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,211.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,211.46,97,,,percent of total billed charges,97% of total billed charges,163.5,75,,,percent of total billed charges,75% of total billed charges,209.28,96,,,percent of total billed charges,96% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.5,75,,,percent of total billed charges,75% of total billed charges,163.5,75,,,percent of total billed charges,75% of total billed charges,11.08,211.46,
NEW PATIENT VISIT LEVEL 4,78001899,CDM,983,RC,99204,HCPCS,Outpatient,,,218,163.5,,200.56,92,,,percent of total billed charges,92% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,202.74,93,,,percent of total billed charges,93% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,196.2,90,,,percent of total billed charges,90% of total billed charges,211.46,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,211.46,97,,,percent of total billed charges,97% of total billed charges,163.5,75,,,percent of total billed charges,75% of total billed charges,209.28,96,,,percent of total billed charges,96% of total billed charges,11.08,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.5,75,,,percent of total billed charges,75% of total billed charges,163.5,75,,,percent of total billed charges,75% of total billed charges,11.08,211.46,
NEW PATIENT VISIT LEVEL 5,78001903,CDM,983,RC,99205,HCPCS,Outpatient,,,288,216,,264.96,92,,,percent of total billed charges,92% of total billed charges,15.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,267.84,93,,,percent of total billed charges,93% of total billed charges,259.2,90,,,percent of total billed charges,90% of total billed charges,259.2,90,,,percent of total billed charges,90% of total billed charges,279.36,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,15.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,279.36,97,,,percent of total billed charges,97% of total billed charges,216,75,,,percent of total billed charges,75% of total billed charges,276.48,96,,,percent of total billed charges,96% of total billed charges,15.17,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,216,75,,,percent of total billed charges,75% of total billed charges,216,75,,,percent of total billed charges,75% of total billed charges,15.17,279.36,
ESTABLISHED PATIENT VISIT LEVEL 1,78001907,CDM,983,RC,99211,HCPCS,Outpatient,,,35,26.25,,32.2,92,,,percent of total billed charges,92% of total billed charges,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,32.55,93,,,percent of total billed charges,93% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,31.5,90,,,percent of total billed charges,90% of total billed charges,33.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,33.95,97,,,percent of total billed charges,97% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,33.6,96,,,percent of total billed charges,96% of total billed charges,0.57,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,26.25,75,,,percent of total billed charges,75% of total billed charges,26.25,75,,,percent of total billed charges,75% of total billed charges,0.57,33.95,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,983,RC,99212,HCPCS,Outpatient,,,84,63,,77.28,92,,,percent of total billed charges,92% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.12,93,,,percent of total billed charges,93% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,81.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.48,97,,,percent of total billed charges,97% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,80.64,96,,,percent of total billed charges,96% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63,75,,,percent of total billed charges,75% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,2.84,81.48,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,983,RC,99212,HCPCS,Outpatient,,,84,63,,77.28,92,,,percent of total billed charges,92% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.12,93,,,percent of total billed charges,93% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,81.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.48,97,,,percent of total billed charges,97% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,80.64,96,,,percent of total billed charges,96% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63,75,,,percent of total billed charges,75% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,2.84,81.48,
ESTABLISHED PATIENT VISIT LEVEL 2,78001911,CDM,983,RC,99212,HCPCS,Outpatient,,,84,63,,77.28,92,,,percent of total billed charges,92% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,78.12,93,,,percent of total billed charges,93% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,75.6,90,,,percent of total billed charges,90% of total billed charges,81.48,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81.48,97,,,percent of total billed charges,97% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,80.64,96,,,percent of total billed charges,96% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,63,75,,,percent of total billed charges,75% of total billed charges,63,75,,,percent of total billed charges,75% of total billed charges,2.84,81.48,
ESTABLISHED PATIENT VISIT LEVEL 3,78001915,CDM,983,RC,99213,HCPCS,Outpatient,,,120,90,,110.4,92,,,percent of total billed charges,92% of total billed charges,4.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,111.6,93,,,percent of total billed charges,93% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,108,90,,,percent of total billed charges,90% of total billed charges,116.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.4,97,,,percent of total billed charges,97% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,115.2,96,,,percent of total billed charges,96% of total billed charges,4.97,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,90,75,,,percent of total billed charges,75% of total billed charges,90,75,,,percent of total billed charges,75% of total billed charges,4.97,116.4,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,983,RC,99214,HCPCS,Outpatient,,,166,124.5,,152.72,92,,,percent of total billed charges,92% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.38,93,,,percent of total billed charges,93% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,161.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.02,97,,,percent of total billed charges,97% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,159.36,96,,,percent of total billed charges,96% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,124.5,75,,,percent of total billed charges,75% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,7.12,161.02,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,983,RC,99214,HCPCS,Outpatient,,,166,124.5,,152.72,92,,,percent of total billed charges,92% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.38,93,,,percent of total billed charges,93% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,161.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.02,97,,,percent of total billed charges,97% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,159.36,96,,,percent of total billed charges,96% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,124.5,75,,,percent of total billed charges,75% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,7.12,161.02,
ESTABLISHED PATIENT VISIT LEVEL 4,78001919,CDM,983,RC,99214,HCPCS,Outpatient,,,166,124.5,,152.72,92,,,percent of total billed charges,92% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,154.38,93,,,percent of total billed charges,93% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,149.4,90,,,percent of total billed charges,90% of total billed charges,161.02,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.02,97,,,percent of total billed charges,97% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,159.36,96,,,percent of total billed charges,96% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,124.5,75,,,percent of total billed charges,75% of total billed charges,124.5,75,,,percent of total billed charges,75% of total billed charges,7.12,161.02,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,983,RC,99215,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.6,93,,,percent of total billed charges,93% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,213.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.4,97,,,percent of total billed charges,97% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,211.2,96,,,percent of total billed charges,96% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165,75,,,percent of total billed charges,75% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,10.9,213.4,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,983,RC,99215,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.6,93,,,percent of total billed charges,93% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,213.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.4,97,,,percent of total billed charges,97% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,211.2,96,,,percent of total billed charges,96% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165,75,,,percent of total billed charges,75% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,10.9,213.4,
ESTABLISHED PATIENT VISIT LEVEL 5,78001923,CDM,983,RC,99215,HCPCS,Outpatient,,,220,165,,202.4,92,,,percent of total billed charges,92% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,204.6,93,,,percent of total billed charges,93% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,198,90,,,percent of total billed charges,90% of total billed charges,213.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,213.4,97,,,percent of total billed charges,97% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,211.2,96,,,percent of total billed charges,96% of total billed charges,10.9,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,165,75,,,percent of total billed charges,75% of total billed charges,165,75,,,percent of total billed charges,75% of total billed charges,10.9,213.4,
PF OBSERVATION OR IP CARE 40 MIN PER DAY,78001940P,CDM,983,RC,99234,HCPCS,Outpatient,,,475,356.25,,437,92,,,percent of total billed charges,92% of total billed charges,7.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,441.75,93,,,percent of total billed charges,93% of total billed charges,427.5,90,,,percent of total billed charges,90% of total billed charges,427.5,90,,,percent of total billed charges,90% of total billed charges,460.75,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,460.75,97,,,percent of total billed charges,97% of total billed charges,356.25,75,,,percent of total billed charges,75% of total billed charges,456,96,,,percent of total billed charges,96% of total billed charges,7.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,356.25,75,,,percent of total billed charges,75% of total billed charges,356.25,75,,,percent of total billed charges,75% of total billed charges,7.95,460.75,
OFFICE CONSULTATION NEW/EST PAT 30 MIN,78001947,CDM,983,RC,99242,HCPCS,Outpatient,,,176,132,,161.92,92,,,percent of total billed charges,92% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.68,93,,,percent of total billed charges,93% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,170.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,170.72,97,,,percent of total billed charges,97% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,168.96,96,,,percent of total billed charges,96% of total billed charges,3.81,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132,75,,,percent of total billed charges,75% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,3.81,170.72,
PATIENT OFFICE CONSULTATION  TYPICALLY 40 MINUTES,78001949,CDM,983,RC,99243,HCPCS,Outpatient,,,177,132.75,,162.84,92,,,percent of total billed charges,92% of total billed charges,6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.61,93,,,percent of total billed charges,93% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,159.3,90,,,percent of total billed charges,90% of total billed charges,171.69,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,171.69,97,,,percent of total billed charges,97% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,169.92,96,,,percent of total billed charges,96% of total billed charges,6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132.75,75,,,percent of total billed charges,75% of total billed charges,132.75,75,,,percent of total billed charges,75% of total billed charges,6,171.69,
OFFICE CONSULTATION NEW/EST PAT 60 MIN,78001951,CDM,983,RC,99244,HCPCS,Outpatient,,,264,198,,242.88,92,,,percent of total billed charges,92% of total billed charges,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.52,93,,,percent of total billed charges,93% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,256.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,256.08,97,,,percent of total billed charges,97% of total billed charges,198,75,,,percent of total billed charges,75% of total billed charges,253.44,96,,,percent of total billed charges,96% of total billed charges,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,198,75,,,percent of total billed charges,75% of total billed charges,198,75,,,percent of total billed charges,75% of total billed charges,8.93,256.08,
OFFICE CONSULTATION NEW/EST PAT 60 MIN,78001951G,CDM,983,RC,99244,HCPCS,Outpatient,,,264,198,,242.88,92,,,percent of total billed charges,92% of total billed charges,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,245.52,93,,,percent of total billed charges,93% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,237.6,90,,,percent of total billed charges,90% of total billed charges,256.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,256.08,97,,,percent of total billed charges,97% of total billed charges,198,75,,,percent of total billed charges,75% of total billed charges,253.44,96,,,percent of total billed charges,96% of total billed charges,8.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,198,75,,,percent of total billed charges,75% of total billed charges,198,75,,,percent of total billed charges,75% of total billed charges,8.93,256.08,
OFFICE CONSULTATION NEW/EST PAT 80 MIN,78001953,CDM,983,RC,99245,HCPCS,Outpatient,,,322,241.5,,296.24,92,,,percent of total billed charges,92% of total billed charges,12.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,299.46,93,,,percent of total billed charges,93% of total billed charges,289.8,90,,,percent of total billed charges,90% of total billed charges,289.8,90,,,percent of total billed charges,90% of total billed charges,312.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,312.34,97,,,percent of total billed charges,97% of total billed charges,241.5,75,,,percent of total billed charges,75% of total billed charges,309.12,96,,,percent of total billed charges,96% of total billed charges,12.41,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,241.5,75,,,percent of total billed charges,75% of total billed charges,241.5,75,,,percent of total billed charges,75% of total billed charges,12.41,312.34,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 40 MIN,78001956P,CDM,983,RC,99252,HCPCS,Outpatient,,,192,144,,176.64,92,,,percent of total billed charges,92% of total billed charges,4.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,178.56,93,,,percent of total billed charges,93% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,172.8,90,,,percent of total billed charges,90% of total billed charges,186.24,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186.24,97,,,percent of total billed charges,97% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,184.32,96,,,percent of total billed charges,96% of total billed charges,4.87,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144,75,,,percent of total billed charges,75% of total billed charges,144,75,,,percent of total billed charges,75% of total billed charges,4.87,186.24,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 55 MIN,78001957P,CDM,983,RC,99253,HCPCS,Outpatient,,,298,223.5,,274.16,92,,,percent of total billed charges,92% of total billed charges,6.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,277.14,93,,,percent of total billed charges,93% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,268.2,90,,,percent of total billed charges,90% of total billed charges,289.06,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,289.06,97,,,percent of total billed charges,97% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,286.08,96,,,percent of total billed charges,96% of total billed charges,6.66,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,223.5,75,,,percent of total billed charges,75% of total billed charges,223.5,75,,,percent of total billed charges,75% of total billed charges,6.66,289.06,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 80 MIN,78001958P,CDM,983,RC,99254,HCPCS,Outpatient,,,430,322.5,,395.6,92,,,percent of total billed charges,92% of total billed charges,9.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,399.9,93,,,percent of total billed charges,93% of total billed charges,387,90,,,percent of total billed charges,90% of total billed charges,387,90,,,percent of total billed charges,90% of total billed charges,417.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,417.1,97,,,percent of total billed charges,97% of total billed charges,322.5,75,,,percent of total billed charges,75% of total billed charges,412.8,96,,,percent of total billed charges,96% of total billed charges,9.07,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,322.5,75,,,percent of total billed charges,75% of total billed charges,322.5,75,,,percent of total billed charges,75% of total billed charges,9.07,417.1,
PF INITIAL IP CONSULT NEW/ESTABLISHED PT 110 MIN,78001959P,CDM,983,RC,99255,HCPCS,Outpatient,,,519,389.25,,477.48,92,,,percent of total billed charges,92% of total billed charges,12.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,482.67,93,,,percent of total billed charges,93% of total billed charges,467.1,90,,,percent of total billed charges,90% of total billed charges,467.1,90,,,percent of total billed charges,90% of total billed charges,503.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,503.43,97,,,percent of total billed charges,97% of total billed charges,389.25,75,,,percent of total billed charges,75% of total billed charges,498.24,96,,,percent of total billed charges,96% of total billed charges,12.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,389.25,75,,,percent of total billed charges,75% of total billed charges,389.25,75,,,percent of total billed charges,75% of total billed charges,12.6,503.43,
ER VISIT LEVEL 1 PROBLEM FOCUSED,68500030,CDM,983,RC,99281,HCPCS,Outpatient,,,57,42.75,,52.44,92,,,percent of total billed charges,92% of total billed charges,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.01,93,,,percent of total billed charges,93% of total billed charges,51.3,90,,,percent of total billed charges,90% of total billed charges,51.3,90,,,percent of total billed charges,90% of total billed charges,55.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,55.29,97,,,percent of total billed charges,97% of total billed charges,42.75,75,,,percent of total billed charges,75% of total billed charges,54.72,96,,,percent of total billed charges,96% of total billed charges,1.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,42.75,75,,,percent of total billed charges,75% of total billed charges,42.75,75,,,percent of total billed charges,75% of total billed charges,1.21,55.29,
ER VISIT LEVEL 2 EXPANDED PROBLEM FOCUSED,68500033,CDM,983,RC,99282,HCPCS,Outpatient,,,111,83.25,,102.12,92,,,percent of total billed charges,92% of total billed charges,4.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,103.23,93,,,percent of total billed charges,93% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,99.9,90,,,percent of total billed charges,90% of total billed charges,107.67,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,107.67,97,,,percent of total billed charges,97% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,106.56,96,,,percent of total billed charges,96% of total billed charges,4.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,83.25,75,,,percent of total billed charges,75% of total billed charges,83.25,75,,,percent of total billed charges,75% of total billed charges,4.14,107.67,
ER VISIT LEVEL 3 MOD SEVERITY,68500036,CDM,983,RC,99283,HCPCS,Outpatient,,,189,141.75,,173.88,92,,,percent of total billed charges,92% of total billed charges,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.77,93,,,percent of total billed charges,93% of total billed charges,170.1,90,,,percent of total billed charges,90% of total billed charges,170.1,90,,,percent of total billed charges,90% of total billed charges,183.33,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,183.33,97,,,percent of total billed charges,97% of total billed charges,141.75,75,,,percent of total billed charges,75% of total billed charges,181.44,96,,,percent of total billed charges,96% of total billed charges,7.04,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.75,75,,,percent of total billed charges,75% of total billed charges,141.75,75,,,percent of total billed charges,75% of total billed charges,7.04,183.33,
ER VISIT LEVEL 4 HIGH SEVERITY,68500039,CDM,983,RC,99284,HCPCS,Outpatient,,,319,239.25,,293.48,92,,,percent of total billed charges,92% of total billed charges,12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,296.67,93,,,percent of total billed charges,93% of total billed charges,287.1,90,,,percent of total billed charges,90% of total billed charges,287.1,90,,,percent of total billed charges,90% of total billed charges,309.43,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,309.43,97,,,percent of total billed charges,97% of total billed charges,239.25,75,,,percent of total billed charges,75% of total billed charges,306.24,96,,,percent of total billed charges,96% of total billed charges,12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,239.25,75,,,percent of total billed charges,75% of total billed charges,239.25,75,,,percent of total billed charges,75% of total billed charges,12,309.43,
ER VISIT LEVEL 5 HIGH SEVERITY,68500042,CDM,983,RC,99285,HCPCS,Outpatient,,,464,348,,426.88,92,,,percent of total billed charges,92% of total billed charges,17.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,431.52,93,,,percent of total billed charges,93% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,417.6,90,,,percent of total billed charges,90% of total billed charges,450.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,17.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,450.08,97,,,percent of total billed charges,97% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,445.44,96,,,percent of total billed charges,96% of total billed charges,17.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,348,75,,,percent of total billed charges,75% of total billed charges,348,75,,,percent of total billed charges,75% of total billed charges,17.38,450.08,
PF HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES,78001963P,CDM,983,RC,99341,HCPCS,Outpatient,,,197,147.75,,181.24,92,,,percent of total billed charges,92% of total billed charges,3.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,183.21,93,,,percent of total billed charges,93% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,191.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.09,97,,,percent of total billed charges,97% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,189.12,96,,,percent of total billed charges,96% of total billed charges,3.05,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.75,75,,,percent of total billed charges,75% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,3.05,191.09,
PF HOME VISIT EST PT SELF LTD/MINOR 15 MIN,78001964P,CDM,983,RC,99347,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges,2.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186,93,,,percent of total billed charges,93% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,194,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194,97,,,percent of total billed charges,97% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,192,96,,,percent of total billed charges,96% of total billed charges,2.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150,75,,,percent of total billed charges,75% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,2.91,194,
PF HOME VISIT EST PT LOW-MOD SEVERITY 25 MIN,78001965P,CDM,983,RC,99348,HCPCS,Outpatient,,,303,227.25,,278.76,92,,,percent of total billed charges,92% of total billed charges,4.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,281.79,93,,,percent of total billed charges,93% of total billed charges,272.7,90,,,percent of total billed charges,90% of total billed charges,272.7,90,,,percent of total billed charges,90% of total billed charges,293.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,293.91,97,,,percent of total billed charges,97% of total billed charges,227.25,75,,,percent of total billed charges,75% of total billed charges,290.88,96,,,percent of total billed charges,96% of total billed charges,4.79,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,227.25,75,,,percent of total billed charges,75% of total billed charges,227.25,75,,,percent of total billed charges,75% of total billed charges,4.79,293.91,
PF HOME VISIT EST PT MOD-HI SEVERITY 40 MIN,78001966P,CDM,983,RC,99349,HCPCS,Outpatient,,,468,351,,430.56,92,,,percent of total billed charges,92% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,435.24,93,,,percent of total billed charges,93% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,421.2,90,,,percent of total billed charges,90% of total billed charges,453.96,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,453.96,97,,,percent of total billed charges,97% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,449.28,96,,,percent of total billed charges,96% of total billed charges,8.7,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,351,75,,,percent of total billed charges,75% of total billed charges,351,75,,,percent of total billed charges,75% of total billed charges,8.7,453.96,
PF PROLNG E/M SVC BEFORE and /AFTER DIR PT CARE 1ST HR,78001970P,CDM,983,RC,99358,HCPCS,Outpatient,,,404,303,,371.68,92,,,percent of total billed charges,92% of total billed charges,5.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,375.72,93,,,percent of total billed charges,93% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,363.6,90,,,percent of total billed charges,90% of total billed charges,391.88,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,391.88,97,,,percent of total billed charges,97% of total billed charges,303,75,,,percent of total billed charges,75% of total billed charges,387.84,96,,,percent of total billed charges,96% of total billed charges,5.99,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,303,75,,,percent of total billed charges,75% of total billed charges,303,75,,,percent of total billed charges,75% of total billed charges,5.99,391.88,
PF PROLNG E/M BEFORE and /AFTER DIR CARE EA 30 MINUTES,78001971P,CDM,983,RC,99359,HCPCS,Outpatient,,,197,147.75,,181.24,92,,,percent of total billed charges,92% of total billed charges,2.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,183.21,93,,,percent of total billed charges,93% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,177.3,90,,,percent of total billed charges,90% of total billed charges,191.09,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,191.09,97,,,percent of total billed charges,97% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,189.12,96,,,percent of total billed charges,96% of total billed charges,2.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147.75,75,,,percent of total billed charges,75% of total billed charges,147.75,75,,,percent of total billed charges,75% of total billed charges,2.61,191.09,
INITIAL PREVENTIVE MEDICINE NEW PAT <1 YR,78001972,CDM,983,RC,99381,HCPCS,Outpatient,,,162,121.5,,149.04,92,,,percent of total billed charges,92% of total billed charges,4.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.66,93,,,percent of total billed charges,93% of total billed charges,145.8,90,,,percent of total billed charges,90% of total billed charges,145.8,90,,,percent of total billed charges,90% of total billed charges,157.14,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,157.14,97,,,percent of total billed charges,97% of total billed charges,121.5,75,,,percent of total billed charges,75% of total billed charges,155.52,96,,,percent of total billed charges,96% of total billed charges,4.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,121.5,75,,,percent of total billed charges,75% of total billed charges,121.5,75,,,percent of total billed charges,75% of total billed charges,4.94,157.14,
INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS,78001974,CDM,983,RC,99382,HCPCS,Outpatient,,,169,126.75,,155.48,92,,,percent of total billed charges,92% of total billed charges,5.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,157.17,93,,,percent of total billed charges,93% of total billed charges,152.1,90,,,percent of total billed charges,90% of total billed charges,152.1,90,,,percent of total billed charges,90% of total billed charges,163.93,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.93,97,,,percent of total billed charges,97% of total billed charges,126.75,75,,,percent of total billed charges,75% of total billed charges,162.24,96,,,percent of total billed charges,96% of total billed charges,5.38,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,126.75,75,,,percent of total billed charges,75% of total billed charges,126.75,75,,,percent of total billed charges,75% of total billed charges,5.38,163.93,
INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS,78001976,CDM,983,RC,99383,HCPCS,Outpatient,,,176,132,,161.92,92,,,percent of total billed charges,92% of total billed charges,5.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,163.68,93,,,percent of total billed charges,93% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,158.4,90,,,percent of total billed charges,90% of total billed charges,170.72,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,170.72,97,,,percent of total billed charges,97% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,168.96,96,,,percent of total billed charges,96% of total billed charges,5.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,132,75,,,percent of total billed charges,75% of total billed charges,132,75,,,percent of total billed charges,75% of total billed charges,5.54,170.72,
INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR,78001978,CDM,983,RC,99384,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186,93,,,percent of total billed charges,93% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,194,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194,97,,,percent of total billed charges,97% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,192,96,,,percent of total billed charges,96% of total billed charges,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150,75,,,percent of total billed charges,75% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,6.59,194,
INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS,78001980,CDM,983,RC,99385,HCPCS,Outpatient,,,194,145.5,,178.48,92,,,percent of total billed charges,92% of total billed charges,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.42,93,,,percent of total billed charges,93% of total billed charges,174.6,90,,,percent of total billed charges,90% of total billed charges,174.6,90,,,percent of total billed charges,90% of total billed charges,188.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,188.18,97,,,percent of total billed charges,97% of total billed charges,145.5,75,,,percent of total billed charges,75% of total billed charges,186.24,96,,,percent of total billed charges,96% of total billed charges,6.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,145.5,75,,,percent of total billed charges,75% of total billed charges,145.5,75,,,percent of total billed charges,75% of total billed charges,6.45,188.18,
INITIAL PREVENTIVE MEDICINE NEW PAT 40-64YRS,78001982,CDM,983,RC,99386,HCPCS,Outpatient,,,224,168,,206.08,92,,,percent of total billed charges,92% of total billed charges,7.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,208.32,93,,,percent of total billed charges,93% of total billed charges,201.6,90,,,percent of total billed charges,90% of total billed charges,201.6,90,,,percent of total billed charges,90% of total billed charges,217.28,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,217.28,97,,,percent of total billed charges,97% of total billed charges,168,75,,,percent of total billed charges,75% of total billed charges,215.04,96,,,percent of total billed charges,96% of total billed charges,7.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168,75,,,percent of total billed charges,75% of total billed charges,168,75,,,percent of total billed charges,75% of total billed charges,7.68,217.28,
INITIAL PREVENTIVE MEDICINE NEW PAT 65YRS and >,78001984,CDM,983,RC,99387,HCPCS,Outpatient,,,242,181.5,,222.64,92,,,percent of total billed charges,92% of total billed charges,8.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,225.06,93,,,percent of total billed charges,93% of total billed charges,217.8,90,,,percent of total billed charges,90% of total billed charges,217.8,90,,,percent of total billed charges,90% of total billed charges,234.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,234.74,97,,,percent of total billed charges,97% of total billed charges,181.5,75,,,percent of total billed charges,75% of total billed charges,232.32,96,,,percent of total billed charges,96% of total billed charges,8.23,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,181.5,75,,,percent of total billed charges,75% of total billed charges,181.5,75,,,percent of total billed charges,75% of total billed charges,8.23,234.74,
PERIODIC PREVENTIVE MED EST PAT <1Y,78001986,CDM,983,RC,99391,HCPCS,Outpatient,,,147,110.25,,135.24,92,,,percent of total billed charges,92% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,136.71,93,,,percent of total billed charges,93% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,132.3,90,,,percent of total billed charges,90% of total billed charges,142.59,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,142.59,97,,,percent of total billed charges,97% of total billed charges,110.25,75,,,percent of total billed charges,75% of total billed charges,141.12,96,,,percent of total billed charges,96% of total billed charges,4.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,110.25,75,,,percent of total billed charges,75% of total billed charges,110.25,75,,,percent of total billed charges,75% of total billed charges,4.45,142.59,
PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS,78001988,CDM,983,RC,99392,HCPCS,Outpatient,,,156,117,,143.52,92,,,percent of total billed charges,92% of total billed charges,4.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,145.08,93,,,percent of total billed charges,93% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,140.4,90,,,percent of total billed charges,90% of total billed charges,151.32,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,151.32,97,,,percent of total billed charges,97% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,149.76,96,,,percent of total billed charges,96% of total billed charges,4.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,117,75,,,percent of total billed charges,75% of total billed charges,117,75,,,percent of total billed charges,75% of total billed charges,4.94,151.32,
PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS,78001990,CDM,983,RC,99393,HCPCS,Outpatient,,,155,116.25,,142.6,92,,,percent of total billed charges,92% of total billed charges,4.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,144.15,93,,,percent of total billed charges,93% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,139.5,90,,,percent of total billed charges,90% of total billed charges,150.35,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150.35,97,,,percent of total billed charges,97% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,148.8,96,,,percent of total billed charges,96% of total billed charges,4.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,75,,,percent of total billed charges,75% of total billed charges,116.25,75,,,percent of total billed charges,75% of total billed charges,4.94,150.35,
PERIODIC PREVENTIVE MED EST PAT 12-17YRS,78001992,CDM,983,RC,99394,HCPCS,Outpatient,,,170,127.5,,156.4,92,,,percent of total billed charges,92% of total billed charges,5.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,158.1,93,,,percent of total billed charges,93% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,153,90,,,percent of total billed charges,90% of total billed charges,164.9,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,164.9,97,,,percent of total billed charges,97% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,163.2,96,,,percent of total billed charges,96% of total billed charges,5.54,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,127.5,75,,,percent of total billed charges,75% of total billed charges,127.5,75,,,percent of total billed charges,75% of total billed charges,5.54,164.9,
PERIODIC PREVENTIVE MED EST PAT 18-39 YRS,78001994,CDM,983,RC,99395,HCPCS,Outpatient,,,174,130.5,,160.08,92,,,percent of total billed charges,92% of total billed charges,5.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,161.82,93,,,percent of total billed charges,93% of total billed charges,156.6,90,,,percent of total billed charges,90% of total billed charges,156.6,90,,,percent of total billed charges,90% of total billed charges,168.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,168.78,97,,,percent of total billed charges,97% of total billed charges,130.5,75,,,percent of total billed charges,75% of total billed charges,167.04,96,,,percent of total billed charges,96% of total billed charges,5.91,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,130.5,75,,,percent of total billed charges,75% of total billed charges,130.5,75,,,percent of total billed charges,75% of total billed charges,5.91,168.78,
PERIODIC PREVENTIVE MED EST PAT 40-64YRS,78001996,CDM,983,RC,99396,HCPCS,Outpatient,,,186,139.5,,171.12,92,,,percent of total billed charges,92% of total billed charges,6.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,172.98,93,,,percent of total billed charges,93% of total billed charges,167.4,90,,,percent of total billed charges,90% of total billed charges,167.4,90,,,percent of total billed charges,90% of total billed charges,180.42,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,180.42,97,,,percent of total billed charges,97% of total billed charges,139.5,75,,,percent of total billed charges,75% of total billed charges,178.56,96,,,percent of total billed charges,96% of total billed charges,6.43,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,139.5,75,,,percent of total billed charges,75% of total billed charges,139.5,75,,,percent of total billed charges,75% of total billed charges,6.43,180.42,
PERIODIC PREVENTATIVE MED EST PAT 65 YRS and  OLDER,78001998,CDM,983,RC,99397,HCPCS,Outpatient,,,200,150,,184,92,,,percent of total billed charges,92% of total billed charges,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,186,93,,,percent of total billed charges,93% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,180,90,,,percent of total billed charges,90% of total billed charges,194,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,194,97,,,percent of total billed charges,97% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,192,96,,,percent of total billed charges,96% of total billed charges,6.59,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,150,75,,,percent of total billed charges,75% of total billed charges,150,75,,,percent of total billed charges,75% of total billed charges,6.59,194,
PF PREVENT MED COUNSEL/RISK FACTOR REDJ SPX 30 MIN,78002000P,CDM,983,RC,99402,HCPCS,Outpatient,,,239,179.25,,219.88,92,,,percent of total billed charges,92% of total billed charges,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,222.27,93,,,percent of total billed charges,93% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,215.1,90,,,percent of total billed charges,90% of total billed charges,231.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,231.83,97,,,percent of total billed charges,97% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,229.44,96,,,percent of total billed charges,96% of total billed charges,3.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,179.25,75,,,percent of total billed charges,75% of total billed charges,179.25,75,,,percent of total billed charges,75% of total billed charges,3.26,231.83,
SMOKING/TOBACCO CESSATION INTENSIVE >3/<10 MIN,78002001,CDM,983,RC,99406,HCPCS,Outpatient,,,57,42.75,,52.44,92,,,percent of total billed charges,92% of total billed charges,0.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.01,93,,,percent of total billed charges,93% of total billed charges,51.3,90,,,percent of total billed charges,90% of total billed charges,51.3,90,,,percent of total billed charges,90% of total billed charges,55.29,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,55.29,97,,,percent of total billed charges,97% of total billed charges,42.75,75,,,percent of total billed charges,75% of total billed charges,54.72,96,,,percent of total billed charges,96% of total billed charges,0.95,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,42.75,75,,,percent of total billed charges,75% of total billed charges,42.75,75,,,percent of total billed charges,75% of total billed charges,0.95,55.29,
SMOKING/TOBACCO CESSATION INTENSIVE >10 MIN,78002003,CDM,983,RC,99407,HCPCS,Outpatient,,,67,50.25,,61.64,92,,,percent of total billed charges,92% of total billed charges,1.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,62.31,93,,,percent of total billed charges,93% of total billed charges,60.3,90,,,percent of total billed charges,90% of total billed charges,60.3,90,,,percent of total billed charges,90% of total billed charges,64.99,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,64.99,97,,,percent of total billed charges,97% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges,64.32,96,,,percent of total billed charges,96% of total billed charges,1.94,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,50.25,75,,,percent of total billed charges,75% of total billed charges,50.25,75,,,percent of total billed charges,75% of total billed charges,1.94,64.99,
PF PROLONGED CLINICAL STAFF SVC OFFICE/O/P 1ST HR,78002005P,CDM,983,RC,99415,HCPCS,Outpatient,,,38,28.5,,34.96,92,,,percent of total billed charges,92% of total billed charges,1.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,35.34,93,,,percent of total billed charges,93% of total billed charges,34.2,90,,,percent of total billed charges,90% of total billed charges,34.2,90,,,percent of total billed charges,90% of total billed charges,36.86,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,36.86,97,,,percent of total billed charges,97% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges,36.48,96,,,percent of total billed charges,96% of total billed charges,1.26,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,28.5,75,,,percent of total billed charges,75% of total billed charges,28.5,75,,,percent of total billed charges,75% of total billed charges,1.26,36.86,
PF PROLONGED CLINICAL STAFF SVC OFFICE/O/P EA ADDL,78002006P,CDM,983,RC,99416,HCPCS,Outpatient,,,22,16.5,,20.24,92,,,percent of total billed charges,92% of total billed charges,0.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,20.46,93,,,percent of total billed charges,93% of total billed charges,19.8,90,,,percent of total billed charges,90% of total billed charges,19.8,90,,,percent of total billed charges,90% of total billed charges,21.34,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,21.34,97,,,percent of total billed charges,97% of total billed charges,16.5,75,,,percent of total billed charges,75% of total billed charges,21.12,96,,,percent of total billed charges,96% of total billed charges,0.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,16.5,75,,,percent of total billed charges,75% of total billed charges,16.5,75,,,percent of total billed charges,75% of total billed charges,0.6,21.34,
PF PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN,78002007P,CDM,983,RC,99417,HCPCS,Outpatient,,,117,87.75,,107.64,92,,,percent of total billed charges,92% of total billed charges,2.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,108.81,93,,,percent of total billed charges,93% of total billed charges,105.3,90,,,percent of total billed charges,90% of total billed charges,105.3,90,,,percent of total billed charges,90% of total billed charges,113.49,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,113.49,97,,,percent of total billed charges,97% of total billed charges,87.75,75,,,percent of total billed charges,75% of total billed charges,112.32,96,,,percent of total billed charges,96% of total billed charges,2.11,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,87.75,75,,,percent of total billed charges,75% of total billed charges,87.75,75,,,percent of total billed charges,75% of total billed charges,2.11,113.49,
PF TELEPHONE E/M BY PHYSICIAN 5-10 MIN,78002008P,CDM,983,RC,99441,HCPCS,Outpatient,,,208,156,,191.36,92,,,percent of total billed charges,92% of total billed charges,2.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,193.44,93,,,percent of total billed charges,93% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,187.2,90,,,percent of total billed charges,90% of total billed charges,201.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,201.76,97,,,percent of total billed charges,97% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,199.68,96,,,percent of total billed charges,96% of total billed charges,2.55,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,156,75,,,percent of total billed charges,75% of total billed charges,156,75,,,percent of total billed charges,75% of total billed charges,2.55,201.76,
PF TELEPHONE E/M BY PHYSICIAN 11-20 MIN,78002009P,CDM,983,RC,99442,HCPCS,Outpatient,,,335,251.25,,308.2,92,,,percent of total billed charges,92% of total billed charges,4.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,311.55,93,,,percent of total billed charges,93% of total billed charges,301.5,90,,,percent of total billed charges,90% of total billed charges,301.5,90,,,percent of total billed charges,90% of total billed charges,324.95,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,324.95,97,,,percent of total billed charges,97% of total billed charges,251.25,75,,,percent of total billed charges,75% of total billed charges,321.6,96,,,percent of total billed charges,96% of total billed charges,4.69,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,251.25,75,,,percent of total billed charges,75% of total billed charges,251.25,75,,,percent of total billed charges,75% of total billed charges,4.69,324.95,
PF TELEPHONE E/M BY PHYSICIAN 21-30 MIN,78002010P,CDM,983,RC,99443,HCPCS,Outpatient,,,474,355.5,,436.08,92,,,percent of total billed charges,92% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,440.82,93,,,percent of total billed charges,93% of total billed charges,426.6,90,,,percent of total billed charges,90% of total billed charges,426.6,90,,,percent of total billed charges,90% of total billed charges,459.78,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,459.78,97,,,percent of total billed charges,97% of total billed charges,355.5,75,,,percent of total billed charges,75% of total billed charges,455.04,96,,,percent of total billed charges,96% of total billed charges,7.12,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,355.5,75,,,percent of total billed charges,75% of total billed charges,355.5,75,,,percent of total billed charges,75% of total billed charges,7.12,459.78,
COMPLEX CHRONIC CARE MANAGEMENT SVC 1ST 60 MIN,78002016,CDM,983,RC,99487,HCPCS,Outpatient,,,196,147,,180.32,92,,,percent of total billed charges,92% of total billed charges,6.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,182.28,93,,,percent of total billed charges,93% of total billed charges,176.4,90,,,percent of total billed charges,90% of total billed charges,176.4,90,,,percent of total billed charges,90% of total billed charges,190.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,6.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,190.12,97,,,percent of total billed charges,97% of total billed charges,147,75,,,percent of total billed charges,75% of total billed charges,188.16,96,,,percent of total billed charges,96% of total billed charges,6.34,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,147,75,,,percent of total billed charges,75% of total billed charges,147,75,,,percent of total billed charges,75% of total billed charges,6.34,190.12,
COMPLEX CHRONIC CARE MGMT SERVICE EA ADDL 30MIN,78002018,CDM,983,RC,99489,HCPCS,Outpatient,,,103,77.25,,94.76,92,,,percent of total billed charges,92% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,95.79,93,,,percent of total billed charges,93% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,92.7,90,,,percent of total billed charges,90% of total billed charges,99.91,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,99.91,97,,,percent of total billed charges,97% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges,98.88,96,,,percent of total billed charges,96% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,77.25,75,,,percent of total billed charges,75% of total billed charges,77.25,75,,,percent of total billed charges,75% of total billed charges,3.61,99.91,
CHRONIC CARE MANAGEMENT SERVICES 1ST 20 MIN,78002423,CDM,983,RC,99490,HCPCS,Outpatient,,,234,175.5,,215.28,92,,,percent of total billed charges,92% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,217.62,93,,,percent of total billed charges,93% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,210.6,90,,,percent of total billed charges,90% of total billed charges,226.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,226.98,97,,,percent of total billed charges,97% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges,224.64,96,,,percent of total billed charges,96% of total billed charges,3.61,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,175.5,75,,,percent of total billed charges,75% of total billed charges,175.5,75,,,percent of total billed charges,75% of total billed charges,3.61,226.98,
PF CHRONIC CARE MGMT SVC AT LEAST 30 MIN PER MONTH,78002021P,CDM,983,RC,99491,HCPCS,Outpatient,,,315,236.25,,289.8,92,,,percent of total billed charges,92% of total billed charges,5.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,292.95,93,,,percent of total billed charges,93% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,283.5,90,,,percent of total billed charges,90% of total billed charges,305.55,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,305.55,97,,,percent of total billed charges,97% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,302.4,96,,,percent of total billed charges,96% of total billed charges,5.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,236.25,75,,,percent of total billed charges,75% of total billed charges,236.25,75,,,percent of total billed charges,75% of total billed charges,5.29,305.55,
PF TRANSITIONAL CARE MANAGE SRVC 14 DAY DISCHARGE,78002022P,CDM,983,RC,99495,HCPCS,Outpatient,,,764,573,,702.88,92,,,percent of total billed charges,92% of total billed charges,9.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,710.52,93,,,percent of total billed charges,93% of total billed charges,687.6,90,,,percent of total billed charges,90% of total billed charges,687.6,90,,,percent of total billed charges,90% of total billed charges,741.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,741.08,97,,,percent of total billed charges,97% of total billed charges,573,75,,,percent of total billed charges,75% of total billed charges,733.44,96,,,percent of total billed charges,96% of total billed charges,9.67,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,573,75,,,percent of total billed charges,75% of total billed charges,573,75,,,percent of total billed charges,75% of total billed charges,9.67,741.08,
PF TRANSITIONAL CARE MANAGE SRVC 7 DAY DISCHARGE,78002023P,CDM,983,RC,99496,HCPCS,Outpatient,,,1030,772.5,,947.6,92,,,percent of total billed charges,92% of total billed charges,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,957.9,93,,,percent of total billed charges,93% of total billed charges,927,90,,,percent of total billed charges,90% of total billed charges,927,90,,,percent of total billed charges,90% of total billed charges,999.1,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,999.1,97,,,percent of total billed charges,97% of total billed charges,772.5,75,,,percent of total billed charges,75% of total billed charges,988.8,96,,,percent of total billed charges,96% of total billed charges,13.01,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,772.5,75,,,percent of total billed charges,75% of total billed charges,772.5,75,,,percent of total billed charges,75% of total billed charges,13.01,999.1,
ADVANCE CARE PLANNING FIRST 30 MINS,78002024,CDM,983,RC,99497,HCPCS,Outpatient,,,125,93.75,,115,92,,,percent of total billed charges,92% of total billed charges,5.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,116.25,93,,,percent of total billed charges,93% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,112.5,90,,,percent of total billed charges,90% of total billed charges,121.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,121.25,97,,,percent of total billed charges,97% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,120,96,,,percent of total billed charges,96% of total billed charges,5.29,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.75,75,,,percent of total billed charges,75% of total billed charges,93.75,75,,,percent of total billed charges,75% of total billed charges,5.29,121.25,
ADVANCE CARE PLANNING ADDITIONAL 30 MINS,78002026,CDM,983,RC,99498,HCPCS,Outpatient,,,108,81,,99.36,92,,,percent of total billed charges,92% of total billed charges,5.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,100.44,93,,,percent of total billed charges,93% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,97.2,90,,,percent of total billed charges,90% of total billed charges,104.76,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,104.76,97,,,percent of total billed charges,97% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,103.68,96,,,percent of total billed charges,96% of total billed charges,5.14,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,81,75,,,percent of total billed charges,75% of total billed charges,81,75,,,percent of total billed charges,75% of total billed charges,5.14,104.76,
DOT OR PRE-EMPLOYMENT PHYSICAL,78002028,CDM,983,RC,99499,HCPCS,Outpatient,,,150,112.5,,138,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,139.5,93,,,percent of total billed charges,93% of total billed charges,135,90,,,percent of total billed charges,90% of total billed charges,135,90,,,percent of total billed charges,90% of total billed charges,145.5,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,145.5,97,,,percent of total billed charges,97% of total billed charges,112.5,75,,,percent of total billed charges,75% of total billed charges,144,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,112.5,75,,,percent of total billed charges,75% of total billed charges,112.5,75,,,percent of total billed charges,75% of total billed charges,112.5,145.5,
CERVICAL OR VAGINAL CANCER SCREEN W/BREAST EXAM,78002058,CDM,983,RC,G0101,HCPCS,Outpatient,,,58,43.5,,53.36,92,,,percent of total billed charges,92% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,53.94,93,,,percent of total billed charges,93% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,52.2,90,,,percent of total billed charges,90% of total billed charges,56.26,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,56.26,97,,,percent of total billed charges,97% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,55.68,96,,,percent of total billed charges,96% of total billed charges,2.84,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,43.5,75,,,percent of total billed charges,75% of total billed charges,43.5,75,,,percent of total billed charges,75% of total billed charges,2.84,56.26,
COUNSELING VISIT TO DISCUSS LDCT ELIGIBIITY,78002068,CDM,983,RC,G0296,HCPCS,Outpatient,,,42,31.5,,38.64,92,,,percent of total billed charges,92% of total billed charges,1.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,39.06,93,,,percent of total billed charges,93% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,37.8,90,,,percent of total billed charges,90% of total billed charges,40.74,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,40.74,97,,,percent of total billed charges,97% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,40.32,96,,,percent of total billed charges,96% of total billed charges,1.68,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,31.5,75,,,percent of total billed charges,75% of total billed charges,31.5,75,,,percent of total billed charges,75% of total billed charges,1.68,40.74,
ALCOHOL OR SUBSTANCE MISUSE ASSESSMENT 15-30MIN,78002070,CDM,983,RC,G0396,HCPCS,Outpatient,,,53,39.75,,48.76,92,,,percent of total billed charges,92% of total billed charges,2.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.29,93,,,percent of total billed charges,93% of total billed charges,47.7,90,,,percent of total billed charges,90% of total billed charges,47.7,90,,,percent of total billed charges,90% of total billed charges,51.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,51.41,97,,,percent of total billed charges,97% of total billed charges,39.75,75,,,percent of total billed charges,75% of total billed charges,50.88,96,,,percent of total billed charges,96% of total billed charges,2.44,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,39.75,75,,,percent of total billed charges,75% of total billed charges,39.75,75,,,percent of total billed charges,75% of total billed charges,2.44,51.41,
ALCOHOL OR SUBSTANCE MISUSE ASSESSMENT 30+ MIN,78002072,CDM,983,RC,G0397,HCPCS,Outpatient,,,101,75.75,,92.92,92,,,percent of total billed charges,92% of total billed charges,5.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.93,93,,,percent of total billed charges,93% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,90.9,90,,,percent of total billed charges,90% of total billed charges,97.97,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,5.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,97.97,97,,,percent of total billed charges,97% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,96.96,96,,,percent of total billed charges,96% of total billed charges,5.45,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,75.75,75,,,percent of total billed charges,75% of total billed charges,75.75,75,,,percent of total billed charges,75% of total billed charges,5.45,97.97,
INITIAL PRVNT EXAM NEW BENEFICIARY 1ST 12 MONTH,78002076,CDM,983,RC,G0402,HCPCS,Outpatient,,,620,465,,570.4,92,,,percent of total billed charges,92% of total billed charges,9.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,576.6,93,,,percent of total billed charges,93% of total billed charges,558,90,,,percent of total billed charges,90% of total billed charges,558,90,,,percent of total billed charges,90% of total billed charges,601.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,9.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,601.4,97,,,percent of total billed charges,97% of total billed charges,465,75,,,percent of total billed charges,75% of total billed charges,595.2,96,,,percent of total billed charges,96% of total billed charges,9.1,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,465,75,,,percent of total billed charges,75% of total billed charges,465,75,,,percent of total billed charges,75% of total billed charges,9.1,601.4,
ANNUAL WELLNESS VISIT INITIAL,78002079,CDM,983,RC,G0438,HCPCS,Outpatient,,,694,520.5,,638.48,92,,,percent of total billed charges,92% of total billed charges,10.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,645.42,93,,,percent of total billed charges,93% of total billed charges,624.6,90,,,percent of total billed charges,90% of total billed charges,624.6,90,,,percent of total billed charges,90% of total billed charges,673.18,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,10.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,673.18,97,,,percent of total billed charges,97% of total billed charges,520.5,75,,,percent of total billed charges,75% of total billed charges,666.24,96,,,percent of total billed charges,96% of total billed charges,10.33,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,520.5,75,,,percent of total billed charges,75% of total billed charges,520.5,75,,,percent of total billed charges,75% of total billed charges,10.33,673.18,
ANNUAL WELLNESS VISIT SUBSEQUENT,78002081P,CDM,983,RC,G0439,HCPCS,Outpatient,,,534,400.5,,491.28,92,,,percent of total billed charges,92% of total billed charges,8.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,496.62,93,,,percent of total billed charges,93% of total billed charges,480.6,90,,,percent of total billed charges,90% of total billed charges,480.6,90,,,percent of total billed charges,90% of total billed charges,517.98,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,8.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,517.98,97,,,percent of total billed charges,97% of total billed charges,400.5,75,,,percent of total billed charges,75% of total billed charges,512.64,96,,,percent of total billed charges,96% of total billed charges,8.02,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,400.5,75,,,percent of total billed charges,75% of total billed charges,400.5,75,,,percent of total billed charges,75% of total billed charges,8.02,517.98,
ANNUAL ALCOHOL MISUSE SCREENING 15 MINUTES,78002083,CDM,983,RC,G0442,HCPCS,Outpatient,,,28,21,,25.76,92,,,percent of total billed charges,92% of total billed charges,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,26.04,93,,,percent of total billed charges,93% of total billed charges,25.2,90,,,percent of total billed charges,90% of total billed charges,25.2,90,,,percent of total billed charges,90% of total billed charges,27.16,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,27.16,97,,,percent of total billed charges,97% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges,26.88,96,,,percent of total billed charges,96% of total billed charges,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,21,75,,,percent of total billed charges,75% of total billed charges,21,75,,,percent of total billed charges,75% of total billed charges,0.58,27.16,
BRIEF ALCOHOL COUNSELING EACH 15 MINUTES,78002085,CDM,983,RC,G0443,HCPCS,Outpatient,,,39,29.25,,35.88,92,,,percent of total billed charges,92% of total billed charges,1.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,36.27,93,,,percent of total billed charges,93% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,37.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,37.83,97,,,percent of total billed charges,97% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges,37.44,96,,,percent of total billed charges,96% of total billed charges,1.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,29.25,75,,,percent of total billed charges,75% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges,1.58,37.83,
DEPRESSION SCREENING EACH 15 MINUTES,78002087,CDM,983,RC,G0444,HCPCS,Outpatient,,,27,20.25,,24.84,92,,,percent of total billed charges,92% of total billed charges,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,25.11,93,,,percent of total billed charges,93% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,24.3,90,,,percent of total billed charges,90% of total billed charges,26.19,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,26.19,97,,,percent of total billed charges,97% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,25.92,96,,,percent of total billed charges,96% of total billed charges,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,20.25,75,,,percent of total billed charges,75% of total billed charges,20.25,75,,,percent of total billed charges,75% of total billed charges,0.58,26.19,
HIGH INTENS BEHAVIORAL COUNSEL FOR STD'S 30 MIN,78002089,CDM,983,RC,G0445,HCPCS,Outpatient,,,40,30,,36.8,92,,,percent of total billed charges,92% of total billed charges,1.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,37.2,93,,,percent of total billed charges,93% of total billed charges,36,90,,,percent of total billed charges,90% of total billed charges,36,90,,,percent of total billed charges,90% of total billed charges,38.8,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,38.8,97,,,percent of total billed charges,97% of total billed charges,30,75,,,percent of total billed charges,75% of total billed charges,38.4,96,,,percent of total billed charges,96% of total billed charges,1.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,30,75,,,percent of total billed charges,75% of total billed charges,30,75,,,percent of total billed charges,75% of total billed charges,1.58,38.8,
BEHAVIORAL THERAPY CARDIOVASCULAR DISEASE 15MIN,78002091,CDM,983,RC,G0446,HCPCS,Outpatient,,,39,29.25,,35.88,92,,,percent of total billed charges,92% of total billed charges,1.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,36.27,93,,,percent of total billed charges,93% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,37.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,37.83,97,,,percent of total billed charges,97% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges,37.44,96,,,percent of total billed charges,96% of total billed charges,1.6,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,29.25,75,,,percent of total billed charges,75% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges,1.6,37.83,
BEHAVIOR COUNSELING FOR OBESITY 15 MINUTES,78002093,CDM,983,RC,G0447,HCPCS,Outpatient,,,39,29.25,,35.88,92,,,percent of total billed charges,92% of total billed charges,1.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,36.27,93,,,percent of total billed charges,93% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,35.1,90,,,percent of total billed charges,90% of total billed charges,37.83,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,37.83,97,,,percent of total billed charges,97% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges,37.44,96,,,percent of total billed charges,96% of total billed charges,1.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,29.25,75,,,percent of total billed charges,75% of total billed charges,29.25,75,,,percent of total billed charges,75% of total billed charges,1.58,37.83,
PROLONGED PREVENTATIVE SERVICE EA ADDL 30 MIN,78002095,CDM,983,RC,G0514,HCPCS,Outpatient,,,96,72,,88.32,92,,,percent of total billed charges,92% of total billed charges,4.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,89.28,93,,,percent of total billed charges,93% of total billed charges,86.4,90,,,percent of total billed charges,90% of total billed charges,86.4,90,,,percent of total billed charges,90% of total billed charges,93.12,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,4.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,93.12,97,,,percent of total billed charges,97% of total billed charges,72,75,,,percent of total billed charges,75% of total billed charges,92.16,96,,,percent of total billed charges,96% of total billed charges,4.21,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,72,75,,,percent of total billed charges,75% of total billed charges,72,75,,,percent of total billed charges,75% of total billed charges,4.21,93.12,
PF REMOTE EVALUATION RECORDED VIDEO/IMAGE EST PAT,78002097P,CDM,983,RC,G2010,HCPCS,Outpatient,,,44,33,,40.48,92,,,percent of total billed charges,92% of total billed charges,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,40.92,93,,,percent of total billed charges,93% of total billed charges,39.6,90,,,percent of total billed charges,90% of total billed charges,39.6,90,,,percent of total billed charges,90% of total billed charges,42.68,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,42.68,97,,,percent of total billed charges,97% of total billed charges,33,75,,,percent of total billed charges,75% of total billed charges,42.24,96,,,percent of total billed charges,96% of total billed charges,0.58,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,33,75,,,percent of total billed charges,75% of total billed charges,33,75,,,percent of total billed charges,75% of total billed charges,0.58,42.68,
ALCOHOL AND/OR SUBSTANCE MISUSE ASSESS 5-14 MIN,78002098,CDM,983,RC,G2011,HCPCS,Outpatient,,,25,18.75,,23,92,,,percent of total billed charges,92% of total billed charges,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,23.25,93,,,percent of total billed charges,93% of total billed charges,22.5,90,,,percent of total billed charges,90% of total billed charges,22.5,90,,,percent of total billed charges,90% of total billed charges,24.25,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,24.25,97,,,percent of total billed charges,97% of total billed charges,18.75,75,,,percent of total billed charges,75% of total billed charges,24,96,,,percent of total billed charges,96% of total billed charges,1.39,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,18.75,75,,,percent of total billed charges,75% of total billed charges,18.75,75,,,percent of total billed charges,75% of total billed charges,1.39,24.25,
PF BRIEF VIRTUAL CHECK-IN BY PHYSICN OR OTHER QHP,78002100P,CDM,983,RC,G2012,HCPCS,Outpatient,,,53,39.75,,48.76,92,,,percent of total billed charges,92% of total billed charges,0.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,49.29,93,,,percent of total billed charges,93% of total billed charges,47.7,90,,,percent of total billed charges,90% of total billed charges,47.7,90,,,percent of total billed charges,90% of total billed charges,51.41,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,0.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,51.41,97,,,percent of total billed charges,97% of total billed charges,39.75,75,,,percent of total billed charges,75% of total billed charges,50.88,96,,,percent of total billed charges,96% of total billed charges,0.98,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,39.75,75,,,percent of total billed charges,75% of total billed charges,39.75,75,,,percent of total billed charges,75% of total billed charges,0.98,51.41,
OBTAINING SCREEN PAP SMEAR,78002101,CDM,983,RC,Q0091,HCPCS,Outpatient,,,64,48,,58.88,92,,,percent of total billed charges,92% of total billed charges,1.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,59.52,93,,,percent of total billed charges,93% of total billed charges,57.6,90,,,percent of total billed charges,90% of total billed charges,57.6,90,,,percent of total billed charges,90% of total billed charges,62.08,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,62.08,97,,,percent of total billed charges,97% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges,61.44,96,,,percent of total billed charges,96% of total billed charges,1.16,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,48,75,,,percent of total billed charges,75% of total billed charges,48,75,,,percent of total billed charges,75% of total billed charges,1.16,62.08,
PF SPORTS PHYSICAL,78002033P,CDM,983,RC,99997,HCPCS,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,18.6,93,,,percent of total billed charges,93% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,19.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.4,97,,,percent of total billed charges,97% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,19.2,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,15,75,,,percent of total billed charges,75% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,15,19.4,
PF SPORTS PHYSICAL,78002033P,CDM,983,RC,99997,HCPCS,Outpatient,,,20,15,,18.4,92,,,percent of total billed charges,92% of total billed charges,,,,,Other,Not Separately reimbursable ,18.6,93,,,percent of total billed charges,93% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,18,90,,,percent of total billed charges,90% of total billed charges,19.4,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,19.4,97,,,percent of total billed charges,97% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,19.2,96,,,percent of total billed charges,96% of total billed charges,,,,,Other,Not Separately reimbursable ,15,75,,,percent of total billed charges,75% of total billed charges,15,75,,,percent of total billed charges,75% of total billed charges,15,19.4,
PF US GUIDANCE NEEDLE PLACEMENT IMG SI,72600031P,CDM,983,RC,76942,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,1.25,1.25,
PF XR FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,71800468P,CDM,983,RC,77003,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable ,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.93,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,2.93,2.93,
NEW PATIENT VISIT LEVEL 3,78001895G,CDM,983,RC,99203,HCPCS,Outpatient,,,146,109.5,,134.32,92,,,percent of total billed charges,92% of total billed charges,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,135.78,93,,,percent of total billed charges,93% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,131.4,90,,,percent of total billed charges,90% of total billed charges,141.62,97,,,percent of total billed charges,97% of total billed charges,,,,,Other,Not Separately reimbursable ,,,,,Other,Not Separately reimbursable ,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,141.62,97,,,percent of total billed charges,97% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,140.16,96,,,percent of total billed charges,96% of total billed charges,7.15,115,,,fee schedule,115% CMS CAH physician fee schedule which is 100% of the CMS rate,109.5,75,,,percent of total billed charges,75% of total billed charges,109.5,75,,,percent of total billed charges,75% of total billed charges,7.15,141.62,