hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|WY,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Memorial Hospital of Carbon County,2024-06-10,2.0.0,Memorial Hospital of Carbon County,"2221 W Elm St, Rawlins, WY 82301",Wyoming 15399,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,BCBS PLAN,BCBS REIMBURSEMENT METHOD,BCBS MEDICARE PLAN,BCBS MEDICARE REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,CORECHOICE PLAN,CORECHOICE REIMBURSEMENT METHOD,FIRST CHOICE HEALTH PLAN,FIRST CHOICE HEALTH REIMBURSEMENT METHOD,INTERWESTS PPO NETWORK PLAN,INTERWESTS PPO NETWORK REIMBURSEMENT METHOD,LHI PLAN,LHI REIMBURSEMENT METHOD,MEDICAID PLAN,MEDICAID REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,MULTIPLAN PLAN,MULTIPLAN REIMBURSEMENT METHOD,THREE RIVER PROVIDERS NETWORK PLAN,THREE RIVER PROVIDERS NETWORK REIMBURSEMENT METHOD,UHC PLAN,UHC REIMBURSEMENT METHOD,VACCN PLAN,VACCN REIMBURSEMENT METHOD,WISE PROVIDER NETWORKS PLAN,WISE PROVIDER NETWORKS REIMBURSEMENT METHOD,ZELIS PLAN,ZELIS REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,EVALUATION & MANAGEMENT SERVICES,99203,"New patient office or other outpatient visit, typically 30 min",761,219,201.48,92% of total billed charges for outpatient setting,113.88,52% of total billed charges for outpatient setting,203.67,93% of total billed charges for outpatient setting,197.1,90% of total billed charges for outpatient setting,197.1,90% of total billed charges for outpatient setting,212.43,97% of total billed charges for outpatient setting,N/A,Not Applicable,219,100% of Medicaid WY Fee Schedule for Outpatient setting,113.88,52% of total billed charges for outpatient setting,212.43,97% of total billed charges for outpatient setting,164.25,75% of total billed charges for outpatient setting,210.24,96% of total billed charges for outpatient setting,113.88,52% of total billed charges for outpatient setting,164.25,75% of total billed charges for outpatient setting,164.25,75% of total billed charges for outpatient setting,113.88,219,164.25
Outpatient Medical Services,EVALUATION & MANAGEMENT SERVICES,99204,"New patient office of other outpatient visit, typically 45 min",761,327,300.84,92% of total billed charges for outpatient setting,170.04,52% of total billed charges for outpatient setting,304.11,93% of total billed charges for outpatient setting,294.3,90% of total billed charges for outpatient setting,294.3,90% of total billed charges for outpatient setting,317.19,97% of total billed charges for outpatient setting,N/A,Not Applicable,327,100% of Medicaid WY Fee Schedule for Outpatient setting,170.04,52% of total billed charges for outpatient setting,317.19,97% of total billed charges for outpatient setting,245.25,75% of total billed charges for outpatient setting,313.92,96% of total billed charges for outpatient setting,170.04,52% of total billed charges for outpatient setting,245.25,75% of total billed charges for outpatient setting,245.25,75% of total billed charges for outpatient setting,170.04,327,245.25
Outpatient Medical Services,EVALUATION & MANAGEMENT SERVICES,99205,"New patient office of other outpatient visit, typically 60 min",761,432,397.44,92% of total billed charges for outpatient setting,224.64,52% of total billed charges for outpatient setting,401.76,93% of total billed charges for outpatient setting,388.8,90% of total billed charges for outpatient setting,388.8,90% of total billed charges for outpatient setting,419.04,97% of total billed charges for outpatient setting,N/A,Not Applicable,432,100% of Medicaid WY Fee Schedule for Outpatient setting,224.64,52% of total billed charges for outpatient setting,419.04,97% of total billed charges for outpatient setting,324,75% of total billed charges for outpatient setting,414.72,96% of total billed charges for outpatient setting,224.64,52% of total billed charges for outpatient setting,324,75% of total billed charges for outpatient setting,324,75% of total billed charges for outpatient setting,224.64,432,324
Outpatient Medical Services,EVALUATION & MANAGEMENT SERVICES,99243,"Patient office consultation, typically 40 min",988,177,162.84,92% of total billed charges for outpatient setting,5.22,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,164.61,93% of total billed charges for outpatient setting,159.3,90% of total billed charges for outpatient setting,159.3,90% of total billed charges for outpatient setting,171.69,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,5.22,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,171.69,97% of total billed charges for outpatient setting,132.75,75% of total billed charges for outpatient setting,169.92,96% of total billed charges for outpatient setting,5.22,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,132.75,75% of total billed charges for outpatient setting,132.75,75% of total billed charges for outpatient setting,5.22,171.69,132.75
Outpatient Medical Services,EVALUATION & MANAGEMENT SERVICES,99244,"Patient office consultation, typically 60 min",988,264,242.88,92% of total billed charges for outpatient setting,7.77,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,245.52,93% of total billed charges for outpatient setting,237.6,90% of total billed charges for outpatient setting,237.6,90% of total billed charges for outpatient setting,256.08,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,7.77,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,256.08,97% of total billed charges for outpatient setting,198,75% of total billed charges for outpatient setting,253.44,96% of total billed charges for outpatient setting,7.77,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,198,75% of total billed charges for outpatient setting,198,75% of total billed charges for outpatient setting,7.77,256.08,198
Outpatient Medical Services,EVALUATION & MANAGEMENT SERVICES,99385,Initial new patient preventive medicine evaluation (18-39 years),510,291,267.72,92% of total billed charges for outpatient setting,151.32,52% of total billed charges for outpatient setting,270.63,93% of total billed charges for outpatient setting,261.9,90% of total billed charges for outpatient setting,261.9,90% of total billed charges for outpatient setting,282.27,97% of total billed charges for outpatient setting,N/A,Not Applicable,291,100% of Medicaid WY Fee Schedule for Outpatient setting,151.32,52% of total billed charges for outpatient setting,282.27,97% of total billed charges for outpatient setting,218.25,75% of total billed charges for outpatient setting,279.36,96% of total billed charges for outpatient setting,151.32,52% of total billed charges for outpatient setting,218.25,75% of total billed charges for outpatient setting,218.25,75% of total billed charges for outpatient setting,151.32,291,218.25
Outpatient Medical Services,EVALUATION & MANAGEMENT SERVICES,99386,Initial new patient preventive medicine evaluation (40-64 years),510,336,309.12,92% of total billed charges for outpatient setting,174.72,52% of total billed charges for outpatient setting,312.48,93% of total billed charges for outpatient setting,302.4,90% of total billed charges for outpatient setting,302.4,90% of total billed charges for outpatient setting,325.92,97% of total billed charges for outpatient setting,N/A,Not Applicable,336,100% of Medicaid WY Fee Schedule for Outpatient setting,174.72,52% of total billed charges for outpatient setting,325.92,97% of total billed charges for outpatient setting,252,75% of total billed charges for outpatient setting,322.56,96% of total billed charges for outpatient setting,174.72,52% of total billed charges for outpatient setting,252,75% of total billed charges for outpatient setting,252,75% of total billed charges for outpatient setting,174.72,336,252
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,80048,Basic metabolic panel,300,89,81.88,92% of total billed charges for outpatient setting,46.28,52% of total billed charges for outpatient setting,82.77,93% of total billed charges for outpatient setting,80.1,90% of total billed charges for outpatient setting,80.1,90% of total billed charges for outpatient setting,86.33,97% of total billed charges for outpatient setting,N/A,Not Applicable,89,100% of Medicaid WY Fee Schedule for Outpatient setting,46.28,52% of total billed charges for outpatient setting,86.33,97% of total billed charges for outpatient setting,66.75,75% of total billed charges for outpatient setting,85.44,96% of total billed charges for outpatient setting,46.28,52% of total billed charges for outpatient setting,66.75,75% of total billed charges for outpatient setting,66.75,75% of total billed charges for outpatient setting,46.28,89,66.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,80053,"Blood test, comprehensive group of blood chemicals",300,210,193.2,92% of total billed charges for outpatient setting,109.20,52% of total billed charges for outpatient setting,195.3,93% of total billed charges for outpatient setting,189,90% of total billed charges for outpatient setting,189,90% of total billed charges for outpatient setting,203.7,97% of total billed charges for outpatient setting,N/A,Not Applicable,210,100% of Medicaid WY Fee Schedule for Outpatient setting,109.20,52% of total billed charges for outpatient setting,203.7,97% of total billed charges for outpatient setting,157.5,75% of total billed charges for outpatient setting,201.6,96% of total billed charges for outpatient setting,109.20,52% of total billed charges for outpatient setting,157.5,75% of total billed charges for outpatient setting,157.5,75% of total billed charges for outpatient setting,109.2,210,157.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,80061,"Blood test, lipids (cholesterol and triglycerides)",300,10.83,9.96,92% of total billed charges for outpatient setting,5.63,52% of total billed charges for outpatient setting,10.07,93% of total billed charges for outpatient setting,9.75,90% of total billed charges for outpatient setting,9.75,90% of total billed charges for outpatient setting,10.51,97% of total billed charges for outpatient setting,N/A,Not Applicable,10.83,100% of Medicaid WY Fee Schedule for Outpatient setting,5.63,52% of total billed charges for outpatient setting,10.51,97% of total billed charges for outpatient setting,8.12,75% of total billed charges for outpatient setting,10.4,96% of total billed charges for outpatient setting,5.63,52% of total billed charges for outpatient setting,8.12,75% of total billed charges for outpatient setting,8.12,75% of total billed charges for outpatient setting,5.63,10.83,8.1225
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,80069,Kidney function panel test,300,160,147.2,92% of total billed charges for outpatient setting,83.20,52% of total billed charges for outpatient setting,148.8,93% of total billed charges for outpatient setting,144,90% of total billed charges for outpatient setting,144,90% of total billed charges for outpatient setting,155.2,97% of total billed charges for outpatient setting,N/A,Not Applicable,160,100% of Medicaid WY Fee Schedule for Outpatient setting,83.20,52% of total billed charges for outpatient setting,155.2,97% of total billed charges for outpatient setting,120,75% of total billed charges for outpatient setting,153.6,96% of total billed charges for outpatient setting,83.20,52% of total billed charges for outpatient setting,120,75% of total billed charges for outpatient setting,120,75% of total billed charges for outpatient setting,83.2,160,120
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,80076,Liver function blood test panel,300,92,84.64,92% of total billed charges for outpatient setting,47.84,52% of total billed charges for outpatient setting,85.56,93% of total billed charges for outpatient setting,82.8,90% of total billed charges for outpatient setting,82.8,90% of total billed charges for outpatient setting,89.24,97% of total billed charges for outpatient setting,N/A,Not Applicable,92,100% of Medicaid WY Fee Schedule for Outpatient setting,47.84,52% of total billed charges for outpatient setting,89.24,97% of total billed charges for outpatient setting,69,75% of total billed charges for outpatient setting,88.32,96% of total billed charges for outpatient setting,47.84,52% of total billed charges for outpatient setting,69,75% of total billed charges for outpatient setting,69,75% of total billed charges for outpatient setting,47.84,92,69
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,81001,Manual urinalysis test with examination using microscope,300,74,68.08,92% of total billed charges for outpatient setting,38.48,52% of total billed charges for outpatient setting,68.82,93% of total billed charges for outpatient setting,66.6,90% of total billed charges for outpatient setting,66.6,90% of total billed charges for outpatient setting,71.78,97% of total billed charges for outpatient setting,N/A,Not Applicable,74,100% of Medicaid WY Fee Schedule for Outpatient setting,38.48,52% of total billed charges for outpatient setting,71.78,97% of total billed charges for outpatient setting,55.5,75% of total billed charges for outpatient setting,71.04,96% of total billed charges for outpatient setting,38.48,52% of total billed charges for outpatient setting,55.5,75% of total billed charges for outpatient setting,55.5,75% of total billed charges for outpatient setting,38.48,74,55.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,81003,Automated urinalysis test,300,43,39.56,92% of total billed charges for outpatient setting,22.36,52% of total billed charges for outpatient setting,39.99,93% of total billed charges for outpatient setting,38.7,90% of total billed charges for outpatient setting,38.7,90% of total billed charges for outpatient setting,41.71,97% of total billed charges for outpatient setting,N/A,Not Applicable,43,100% of Medicaid WY Fee Schedule for Outpatient setting,22.36,52% of total billed charges for outpatient setting,41.71,97% of total billed charges for outpatient setting,32.25,75% of total billed charges for outpatient setting,41.28,96% of total billed charges for outpatient setting,22.36,52% of total billed charges for outpatient setting,32.25,75% of total billed charges for outpatient setting,32.25,75% of total billed charges for outpatient setting,22.36,43,32.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84153,PSA (prostate specific antigen),300,56,51.52,92% of total billed charges for outpatient setting,29.12,52% of total billed charges for outpatient setting,52.08,93% of total billed charges for outpatient setting,50.4,90% of total billed charges for outpatient setting,50.4,90% of total billed charges for outpatient setting,54.32,97% of total billed charges for outpatient setting,34.16,100% of LHI Fee Schedule for Outpatient setting,56,100% of Medicaid WY Fee Schedule for Outpatient setting,29.12,52% of total billed charges for outpatient setting,54.32,97% of total billed charges for outpatient setting,42,75% of total billed charges for outpatient setting,53.76,96% of total billed charges for outpatient setting,29.12,52% of total billed charges for outpatient setting,42,75% of total billed charges for outpatient setting,42,75% of total billed charges for outpatient setting,29.12,56,42
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84443,"Blood test, thyroid stimulating hormone (TSH)",300,90,82.8,92% of total billed charges for outpatient setting,46.80,52% of total billed charges for outpatient setting,83.7,93% of total billed charges for outpatient setting,81,90% of total billed charges for outpatient setting,81,90% of total billed charges for outpatient setting,87.3,97% of total billed charges for outpatient setting,N/A,Not Applicable,90,100% of Medicaid WY Fee Schedule for Outpatient setting,46.80,52% of total billed charges for outpatient setting,87.3,97% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,86.4,96% of total billed charges for outpatient setting,46.80,52% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,46.8,90,67.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,85025,"Complete blood cell count, with differential white blood cells, automated",300,61,56.12,92% of total billed charges for outpatient setting,31.72,52% of total billed charges for outpatient setting,56.73,93% of total billed charges for outpatient setting,54.9,90% of total billed charges for outpatient setting,54.9,90% of total billed charges for outpatient setting,59.17,97% of total billed charges for outpatient setting,N/A,Not Applicable,61,100% of Medicaid WY Fee Schedule for Outpatient setting,31.72,52% of total billed charges for outpatient setting,59.17,97% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,58.56,96% of total billed charges for outpatient setting,31.72,52% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,31.72,61,45.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,85027,"Complete blood count, automated",300,65,59.8,92% of total billed charges for outpatient setting,33.80,52% of total billed charges for outpatient setting,60.45,93% of total billed charges for outpatient setting,58.5,90% of total billed charges for outpatient setting,58.5,90% of total billed charges for outpatient setting,63.05,97% of total billed charges for outpatient setting,N/A,Not Applicable,65,100% of Medicaid WY Fee Schedule for Outpatient setting,33.80,52% of total billed charges for outpatient setting,63.05,97% of total billed charges for outpatient setting,48.75,75% of total billed charges for outpatient setting,62.4,96% of total billed charges for outpatient setting,33.80,52% of total billed charges for outpatient setting,48.75,75% of total billed charges for outpatient setting,48.75,75% of total billed charges for outpatient setting,33.8,65,48.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,85610,"Blood test, clotting time",300,65,59.8,92% of total billed charges for outpatient setting,33.80,52% of total billed charges for outpatient setting,60.45,93% of total billed charges for outpatient setting,58.5,90% of total billed charges for outpatient setting,58.5,90% of total billed charges for outpatient setting,63.05,97% of total billed charges for outpatient setting,N/A,Not Applicable,65,100% of Medicaid WY Fee Schedule for Outpatient setting,33.80,52% of total billed charges for outpatient setting,63.05,97% of total billed charges for outpatient setting,48.75,75% of total billed charges for outpatient setting,62.4,96% of total billed charges for outpatient setting,33.80,52% of total billed charges for outpatient setting,48.75,75% of total billed charges for outpatient setting,48.75,75% of total billed charges for outpatient setting,33.8,65,48.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,85730,Coagulation assessment blood test,300,114,104.88,92% of total billed charges for outpatient setting,59.28,52% of total billed charges for outpatient setting,106.02,93% of total billed charges for outpatient setting,102.6,90% of total billed charges for outpatient setting,102.6,90% of total billed charges for outpatient setting,110.58,97% of total billed charges for outpatient setting,N/A,Not Applicable,114,100% of Medicaid WY Fee Schedule for Outpatient setting,59.28,52% of total billed charges for outpatient setting,110.58,97% of total billed charges for outpatient setting,85.5,75% of total billed charges for outpatient setting,109.44,96% of total billed charges for outpatient setting,59.28,52% of total billed charges for outpatient setting,85.5,75% of total billed charges for outpatient setting,85.5,75% of total billed charges for outpatient setting,59.28,114,85.5
Outpatient Medical Services,RADIOLOGY SERVICES,70450,"CT scan, head or brain, without contrast",350,1752,1611.84,92% of total billed charges for outpatient setting,911.04,52% of total billed charges for outpatient setting,1629.36,93% of total billed charges for outpatient setting,1576.8,90% of total billed charges for outpatient setting,1576.8,90% of total billed charges for outpatient setting,1699.44,97% of total billed charges for outpatient setting,293.44,100% of LHI Fee Schedule for Outpatient setting,1752,100% of Medicaid WY Fee Schedule for Outpatient setting,911.04,52% of total billed charges for outpatient setting,1699.44,97% of total billed charges for outpatient setting,1314,75% of total billed charges for outpatient setting,1681.92,96% of total billed charges for outpatient setting,911.04,52% of total billed charges for outpatient setting,1314,75% of total billed charges for outpatient setting,1314,75% of total billed charges for outpatient setting,293.44,1752,1314
Outpatient Medical Services,RADIOLOGY SERVICES,70553,MRI scan of brain before and after contrast,611,3833,3526.36,92% of total billed charges for outpatient setting,1993.16,52% of total billed charges for outpatient setting,3564.69,93% of total billed charges for outpatient setting,3449.7,90% of total billed charges for outpatient setting,3449.7,90% of total billed charges for outpatient setting,3718.01,97% of total billed charges for outpatient setting,N/A,Not Applicable,3833,100% of Medicaid WY Fee Schedule for Outpatient setting,1993.16,52% of total billed charges for outpatient setting,3718.01,97% of total billed charges for outpatient setting,2874.75,75% of total billed charges for outpatient setting,3679.68,96% of total billed charges for outpatient setting,1993.16,52% of total billed charges for outpatient setting,2874.75,75% of total billed charges for outpatient setting,2874.75,75% of total billed charges for outpatient setting,1993.16,3833,2874.75
Outpatient Medical Services,RADIOLOGY SERVICES,72110,"X-Ray, lower back, minimum four views",320,526,483.92,92% of total billed charges for outpatient setting,273.52,52% of total billed charges for outpatient setting,489.18,93% of total billed charges for outpatient setting,473.4,90% of total billed charges for outpatient setting,473.4,90% of total billed charges for outpatient setting,510.22,97% of total billed charges for outpatient setting,102.99,100% of LHI Fee Schedule for Outpatient setting,526,100% of Medicaid WY Fee Schedule for Outpatient setting,273.52,52% of total billed charges for outpatient setting,510.22,97% of total billed charges for outpatient setting,394.5,75% of total billed charges for outpatient setting,504.96,96% of total billed charges for outpatient setting,273.52,52% of total billed charges for outpatient setting,394.5,75% of total billed charges for outpatient setting,394.5,75% of total billed charges for outpatient setting,102.99,526,394.5
Outpatient Medical Services,RADIOLOGY SERVICES,72148,MRI scan of lower spinal canal,612,3033,2790.36,92% of total billed charges for outpatient setting,1577.16,52% of total billed charges for outpatient setting,2820.69,93% of total billed charges for outpatient setting,2729.7,90% of total billed charges for outpatient setting,2729.7,90% of total billed charges for outpatient setting,2942.01,97% of total billed charges for outpatient setting,614.16,100% of LHI Fee Schedule for Outpatient setting,3033,100% of Medicaid WY Fee Schedule for Outpatient setting,1577.16,52% of total billed charges for outpatient setting,2942.01,97% of total billed charges for outpatient setting,2274.75,75% of total billed charges for outpatient setting,2911.68,96% of total billed charges for outpatient setting,1577.16,52% of total billed charges for outpatient setting,2274.75,75% of total billed charges for outpatient setting,2274.75,75% of total billed charges for outpatient setting,614.16,3033,2274.75
Outpatient Medical Services,RADIOLOGY SERVICES,72193,"CT scan, pelvis, with contrast",352,1983,1824.36,92% of total billed charges for outpatient setting,1031.16,52% of total billed charges for outpatient setting,1844.19,93% of total billed charges for outpatient setting,1784.7,90% of total billed charges for outpatient setting,1784.7,90% of total billed charges for outpatient setting,1923.51,97% of total billed charges for outpatient setting,N/A,Not Applicable,1983,100% of Medicaid WY Fee Schedule for Outpatient setting,1031.16,52% of total billed charges for outpatient setting,1923.51,97% of total billed charges for outpatient setting,1487.25,75% of total billed charges for outpatient setting,1903.68,96% of total billed charges for outpatient setting,1031.16,52% of total billed charges for outpatient setting,1487.25,75% of total billed charges for outpatient setting,1487.25,75% of total billed charges for outpatient setting,1031.16,1983,1487.25
Outpatient Medical Services,RADIOLOGY SERVICES,73721,MRI scan of leg joint,614,3218.4,2960.93,92% of total billed charges for outpatient setting,1673.57,52% of total billed charges for outpatient setting,2993.11,93% of total billed charges for outpatient setting,2896.56,90% of total billed charges for outpatient setting,2896.56,90% of total billed charges for outpatient setting,3121.85,97% of total billed charges for outpatient setting,603.94,100% of LHI Fee Schedule for Outpatient setting,3218.4,100% of Medicaid WY Fee Schedule for Outpatient setting,1673.57,52% of total billed charges for outpatient setting,3121.85,97% of total billed charges for outpatient setting,2413.8,75% of total billed charges for outpatient setting,3089.66,96% of total billed charges for outpatient setting,1673.57,52% of total billed charges for outpatient setting,2413.8,75% of total billed charges for outpatient setting,2413.8,75% of total billed charges for outpatient setting,603.94,3218.4,2413.8
Outpatient Medical Services,RADIOLOGY SERVICES,74177,CT scan of abdomen and pelvis with contrast,352,4525,4163,92% of total billed charges for outpatient setting,2353.00,52% of total billed charges for outpatient setting,4208.25,93% of total billed charges for outpatient setting,4072.5,90% of total billed charges for outpatient setting,4072.5,90% of total billed charges for outpatient setting,4389.25,97% of total billed charges for outpatient setting,N/A,Not Applicable,4525,100% of Medicaid WY Fee Schedule for Outpatient setting,2353.00,52% of total billed charges for outpatient setting,4389.25,97% of total billed charges for outpatient setting,3393.75,75% of total billed charges for outpatient setting,4344,96% of total billed charges for outpatient setting,2353.00,52% of total billed charges for outpatient setting,3393.75,75% of total billed charges for outpatient setting,3393.75,75% of total billed charges for outpatient setting,2353,4525,3393.75
Outpatient Medical Services,RADIOLOGY SERVICES,76700,Ultrasound of abdomen,402,1289,1185.88,92% of total billed charges for outpatient setting,670.28,52% of total billed charges for outpatient setting,1198.77,93% of total billed charges for outpatient setting,1160.1,90% of total billed charges for outpatient setting,1160.1,90% of total billed charges for outpatient setting,1250.33,97% of total billed charges for outpatient setting,188.62,100% of LHI Fee Schedule for Outpatient setting,1289,100% of Medicaid WY Fee Schedule for Outpatient setting,670.28,52% of total billed charges for outpatient setting,1250.33,97% of total billed charges for outpatient setting,966.75,75% of total billed charges for outpatient setting,1237.44,96% of total billed charges for outpatient setting,670.28,52% of total billed charges for outpatient setting,966.75,75% of total billed charges for outpatient setting,966.75,75% of total billed charges for outpatient setting,188.62,1289,966.75
Outpatient Medical Services,RADIOLOGY SERVICES,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,402,932,857.44,92% of total billed charges for outpatient setting,484.64,52% of total billed charges for outpatient setting,866.76,93% of total billed charges for outpatient setting,838.8,90% of total billed charges for outpatient setting,838.8,90% of total billed charges for outpatient setting,904.04,97% of total billed charges for outpatient setting,N/A,Not Applicable,932,100% of Medicaid WY Fee Schedule for Outpatient setting,484.64,52% of total billed charges for outpatient setting,904.04,97% of total billed charges for outpatient setting,699,75% of total billed charges for outpatient setting,894.72,96% of total billed charges for outpatient setting,484.64,52% of total billed charges for outpatient setting,699,75% of total billed charges for outpatient setting,699,75% of total billed charges for outpatient setting,484.64,932,699
Outpatient Medical Services,RADIOLOGY SERVICES,76830,Ultrasound pelvis through vagina,402,715,657.8,92% of total billed charges for outpatient setting,371.80,52% of total billed charges for outpatient setting,664.95,93% of total billed charges for outpatient setting,643.5,90% of total billed charges for outpatient setting,643.5,90% of total billed charges for outpatient setting,693.55,97% of total billed charges for outpatient setting,166.49,100% of LHI Fee Schedule for Outpatient setting,715,100% of Medicaid WY Fee Schedule for Outpatient setting,371.80,52% of total billed charges for outpatient setting,693.55,97% of total billed charges for outpatient setting,536.25,75% of total billed charges for outpatient setting,686.4,96% of total billed charges for outpatient setting,371.80,52% of total billed charges for outpatient setting,536.25,75% of total billed charges for outpatient setting,536.25,75% of total billed charges for outpatient setting,166.49,715,536.25
Outpatient Medical Services,RADIOLOGY SERVICES,77065,Mammography of one breast,401,338,310.96,92% of total billed charges for outpatient setting,175.76,52% of total billed charges for outpatient setting,314.34,93% of total billed charges for outpatient setting,304.2,90% of total billed charges for outpatient setting,304.2,90% of total billed charges for outpatient setting,327.86,97% of total billed charges for outpatient setting,N/A,Not Applicable,338,100% of Medicaid WY Fee Schedule for Outpatient setting,175.76,52% of total billed charges for outpatient setting,327.86,97% of total billed charges for outpatient setting,253.5,75% of total billed charges for outpatient setting,324.48,96% of total billed charges for outpatient setting,175.76,52% of total billed charges for outpatient setting,253.5,75% of total billed charges for outpatient setting,253.5,75% of total billed charges for outpatient setting,175.76,338,253.5
Outpatient Medical Services,RADIOLOGY SERVICES,77066,Mammography of both breasts,401,703,646.76,92% of total billed charges for outpatient setting,365.56,52% of total billed charges for outpatient setting,653.79,93% of total billed charges for outpatient setting,632.7,90% of total billed charges for outpatient setting,632.7,90% of total billed charges for outpatient setting,681.91,97% of total billed charges for outpatient setting,N/A,Not Applicable,703,100% of Medicaid WY Fee Schedule for Outpatient setting,365.56,52% of total billed charges for outpatient setting,681.91,97% of total billed charges for outpatient setting,527.25,75% of total billed charges for outpatient setting,674.88,96% of total billed charges for outpatient setting,365.56,52% of total billed charges for outpatient setting,527.25,75% of total billed charges for outpatient setting,527.25,75% of total billed charges for outpatient setting,365.56,703,527.25
Outpatient Medical Services,RADIOLOGY SERVICES,77067,"Mammography, screening, bilateral",403,272,250.24,92% of total billed charges for outpatient setting,141.44,52% of total billed charges for outpatient setting,252.96,93% of total billed charges for outpatient setting,244.8,90% of total billed charges for outpatient setting,244.8,90% of total billed charges for outpatient setting,263.84,97% of total billed charges for outpatient setting,N/A,Not Applicable,272,100% of Medicaid WY Fee Schedule for Outpatient setting,141.44,52% of total billed charges for outpatient setting,263.84,97% of total billed charges for outpatient setting,204,75% of total billed charges for outpatient setting,261.12,96% of total billed charges for outpatient setting,141.44,52% of total billed charges for outpatient setting,204,75% of total billed charges for outpatient setting,204,75% of total billed charges for outpatient setting,141.44,272,204
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,19120,"Removal of 1 or more breast growth, open procedure",975,1838,1690.96,92% of total billed charges for outpatient setting,47.35,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,1709.34,93% of total billed charges for outpatient setting,1654.2,90% of total billed charges for outpatient setting,1654.2,90% of total billed charges for outpatient setting,1782.86,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,47.35,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,1782.86,97% of total billed charges for outpatient setting,1378.5,75% of total billed charges for outpatient setting,1764.48,96% of total billed charges for outpatient setting,47.35,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,1378.5,75% of total billed charges for outpatient setting,1378.5,75% of total billed charges for outpatient setting,47.35,1782.86,1378.5
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,29826,Shaving of shoulder bone using an endoscope,975,675,621,92% of total billed charges for outpatient setting,18.79,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,627.75,93% of total billed charges for outpatient setting,607.5,90% of total billed charges for outpatient setting,607.5,90% of total billed charges for outpatient setting,654.75,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,18.79,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,654.75,97% of total billed charges for outpatient setting,506.25,75% of total billed charges for outpatient setting,648,96% of total billed charges for outpatient setting,18.79,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,506.25,75% of total billed charges for outpatient setting,506.25,75% of total billed charges for outpatient setting,18.79,654.75,506.25
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,29881,Removal of one knee cartilage using an endoscope,975,675,621,92% of total billed charges for outpatient setting,49.54,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,627.75,93% of total billed charges for outpatient setting,607.5,90% of total billed charges for outpatient setting,607.5,90% of total billed charges for outpatient setting,654.75,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,49.54,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,654.75,97% of total billed charges for outpatient setting,506.25,75% of total billed charges for outpatient setting,648,96% of total billed charges for outpatient setting,49.54,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,506.25,75% of total billed charges for outpatient setting,506.25,75% of total billed charges for outpatient setting,49.54,654.75,506.25
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,42820,Removal of tonsils and adenoid glands patient younger than age 12,975,773,711.16,92% of total billed charges for outpatient setting,23.25,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,718.89,93% of total billed charges for outpatient setting,695.7,90% of total billed charges for outpatient setting,695.7,90% of total billed charges for outpatient setting,749.81,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,23.25,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,749.81,97% of total billed charges for outpatient setting,579.75,75% of total billed charges for outpatient setting,742.08,96% of total billed charges for outpatient setting,23.25,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,579.75,75% of total billed charges for outpatient setting,579.75,75% of total billed charges for outpatient setting,23.25,749.81,579.75
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",975,1343,1235.56,92% of total billed charges for outpatient setting,9.77,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,1248.99,93% of total billed charges for outpatient setting,1208.7,90% of total billed charges for outpatient setting,1208.7,90% of total billed charges for outpatient setting,1302.71,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,9.77,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,1302.71,97% of total billed charges for outpatient setting,1007.25,75% of total billed charges for outpatient setting,1289.28,96% of total billed charges for outpatient setting,9.77,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,1007.25,75% of total billed charges for outpatient setting,1007.25,75% of total billed charges for outpatient setting,9.77,1302.71,1007.25
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",750,2789,2565.88,92% of total billed charges for outpatient setting,1450.28,52% of total billed charges for outpatient setting,2593.77,93% of total billed charges for outpatient setting,2510.1,90% of total billed charges for outpatient setting,2510.1,90% of total billed charges for outpatient setting,2705.33,97% of total billed charges for outpatient setting,N/A,Not Applicable,2789,100% of Medicaid WY Fee Schedule for Outpatient setting,1450.28,52% of total billed charges for outpatient setting,2705.33,97% of total billed charges for outpatient setting,2091.75,75% of total billed charges for outpatient setting,2677.44,96% of total billed charges for outpatient setting,1450.28,52% of total billed charges for outpatient setting,2091.75,75% of total billed charges for outpatient setting,2091.75,75% of total billed charges for outpatient setting,1450.28,2789,2091.75
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,45378,Diagnostic examination of large bowel using an endoscope,975,2188,2012.96,92% of total billed charges for outpatient setting,15.36,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,2034.84,93% of total billed charges for outpatient setting,1969.2,90% of total billed charges for outpatient setting,1969.2,90% of total billed charges for outpatient setting,2122.36,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,15.36,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,2122.36,97% of total billed charges for outpatient setting,1641,75% of total billed charges for outpatient setting,2100.48,96% of total billed charges for outpatient setting,15.36,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,1641,75% of total billed charges for outpatient setting,1641,75% of total billed charges for outpatient setting,15.36,2122.36,1641
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,45380,Biopsy of large bowel using an endoscope,975,2188,2012.96,92% of total billed charges for outpatient setting,16.30,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,2034.84,93% of total billed charges for outpatient setting,1969.2,90% of total billed charges for outpatient setting,1969.2,90% of total billed charges for outpatient setting,2122.36,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,16.30,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,2122.36,97% of total billed charges for outpatient setting,1641,75% of total billed charges for outpatient setting,2100.48,96% of total billed charges for outpatient setting,16.30,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,1641,75% of total billed charges for outpatient setting,1641,75% of total billed charges for outpatient setting,16.30,2122.36,1641
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,45385,Removal of polyps or growths of large bowel using an endoscope,975,2188,2012.96,92% of total billed charges for outpatient setting,20.71,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,2034.84,93% of total billed charges for outpatient setting,1969.2,90% of total billed charges for outpatient setting,1969.2,90% of total billed charges for outpatient setting,2122.36,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,20.71,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,2122.36,97% of total billed charges for outpatient setting,1641,75% of total billed charges for outpatient setting,2100.48,96% of total billed charges for outpatient setting,20.71,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,1641,75% of total billed charges for outpatient setting,1641,75% of total billed charges for outpatient setting,20.71,2122.36,1641
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,47562,Removal of gallbladder using an endoscope,975,11196,10300.32,92% of total billed charges for outpatient setting,82.22,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,10412.28,93% of total billed charges for outpatient setting,10076.4,90% of total billed charges for outpatient setting,10076.4,90% of total billed charges for outpatient setting,10860.12,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,82.22,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,10860.12,97% of total billed charges for outpatient setting,8397,75% of total billed charges for outpatient setting,10748.16,96% of total billed charges for outpatient setting,82.22,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,8397,75% of total billed charges for outpatient setting,8397,75% of total billed charges for outpatient setting,82.22,10860.12,8397
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,49505,Repair of groin hernia patient age 5 years or older,975,3703,3406.76,92% of total billed charges for outpatient setting,63.25,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,3443.79,93% of total billed charges for outpatient setting,3332.7,90% of total billed charges for outpatient setting,3332.7,90% of total billed charges for outpatient setting,3591.91,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,63.25,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,3591.91,97% of total billed charges for outpatient setting,2777.25,75% of total billed charges for outpatient setting,3554.88,96% of total billed charges for outpatient setting,63.25,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,2777.25,75% of total billed charges for outpatient setting,2777.25,75% of total billed charges for outpatient setting,63.25,3591.91,2777.25
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,62322,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,361,2066,1900.72,92% of total billed charges for outpatient setting,1074.32,52% of total billed charges for outpatient setting,1921.38,93% of total billed charges for outpatient setting,1859.4,90% of total billed charges for outpatient setting,1859.4,90% of total billed charges for outpatient setting,2004.02,97% of total billed charges for outpatient setting,N/A,Not Applicable,2066,100% of Medicaid WY Fee Schedule for Outpatient setting,1074.32,52% of total billed charges for outpatient setting,2004.02,97% of total billed charges for outpatient setting,1549.5,75% of total billed charges for outpatient setting,1983.36,96% of total billed charges for outpatient setting,1074.32,52% of total billed charges for outpatient setting,1549.5,75% of total billed charges for outpatient setting,1549.5,75% of total billed charges for outpatient setting,1074.32,2066,1549.5
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,450,2257,2076.44,92% of total billed charges for outpatient setting,1173.64,52% of total billed charges for outpatient setting,2099.01,93% of total billed charges for outpatient setting,2031.3,90% of total billed charges for outpatient setting,2031.3,90% of total billed charges for outpatient setting,2189.29,97% of total billed charges for outpatient setting,N/A,Not Applicable,2257,100% of Medicaid WY Fee Schedule for Outpatient setting,1173.64,52% of total billed charges for outpatient setting,2189.29,97% of total billed charges for outpatient setting,1692.75,75% of total billed charges for outpatient setting,2166.72,96% of total billed charges for outpatient setting,1173.64,52% of total billed charges for outpatient setting,1692.75,75% of total billed charges for outpatient setting,1692.75,75% of total billed charges for outpatient setting,1173.64,2257,1692.75
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,93000,"Electrocardiogram, routine, with interpretation and report",352,3341,3073.72,92% of total billed charges for outpatient setting,1737.32,52% of total billed charges for outpatient setting,3107.13,93% of total billed charges for outpatient setting,3006.9,90% of total billed charges for outpatient setting,3006.9,90% of total billed charges for outpatient setting,3240.77,97% of total billed charges for outpatient setting,N/A,Not Applicable,3341,100% of Medicaid WY Fee Schedule for Outpatient setting,1737.32,52% of total billed charges for outpatient setting,3240.77,97% of total billed charges for outpatient setting,2505.75,75% of total billed charges for outpatient setting,3207.36,96% of total billed charges for outpatient setting,1737.32,52% of total billed charges for outpatient setting,2505.75,75% of total billed charges for outpatient setting,2505.75,75% of total billed charges for outpatient setting,1737.32,3341,2505.75
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,95810,Sleep study,740,4184,3849.28,92% of total billed charges for outpatient setting,2175.68,52% of total billed charges for outpatient setting,3891.12,93% of total billed charges for outpatient setting,3765.6,90% of total billed charges for outpatient setting,3765.6,90% of total billed charges for outpatient setting,4058.48,97% of total billed charges for outpatient setting,N/A,Not Applicable,4184,100% of Medicaid WY Fee Schedule for Outpatient setting,2175.68,52% of total billed charges for outpatient setting,4058.48,97% of total billed charges for outpatient setting,3138,75% of total billed charges for outpatient setting,4016.64,96% of total billed charges for outpatient setting,2175.68,52% of total billed charges for outpatient setting,3138,75% of total billed charges for outpatient setting,3138,75% of total billed charges for outpatient setting,2175.68,4184,3138
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,97110,"Physical therapy, therapeutic exercise",420,124,114.08,92% of total billed charges for outpatient setting,64.48,52% of total billed charges for outpatient setting,115.32,93% of total billed charges for outpatient setting,111.6,90% of total billed charges for outpatient setting,111.6,90% of total billed charges for outpatient setting,120.28,97% of total billed charges for outpatient setting,N/A,Not Applicable,124,100% of Medicaid WY Fee Schedule for Outpatient setting,64.48,52% of total billed charges for outpatient setting,120.28,97% of total billed charges for outpatient setting,93,75% of total billed charges for outpatient setting,119.04,96% of total billed charges for outpatient setting,64.48,52% of total billed charges for outpatient setting,93,75% of total billed charges for outpatient setting,93,75% of total billed charges for outpatient setting,64.48,124,93
Outpatient Medical Services,RADIOLOGY SERVICES,74178,CT Abdomen and Pelvis w/+w/o Contrast,352,4790,4406.8,92% of total billed charges for outpatient setting,2490.80,52% of total billed charges for outpatient setting,4454.7,93% of total billed charges for outpatient setting,4311,90% of total billed charges for outpatient setting,4311,90% of total billed charges for outpatient setting,4646.3,97% of total billed charges for outpatient setting,488.88,100% of LHI Fee Schedule for Outpatient setting,4790,100% of Medicaid WY Fee Schedule for Outpatient setting,2490.80,52% of total billed charges for outpatient setting,4646.3,97% of total billed charges for outpatient setting,3592.5,75% of total billed charges for outpatient setting,4598.4,96% of total billed charges for outpatient setting,2490.80,52% of total billed charges for outpatient setting,3592.5,75% of total billed charges for outpatient setting,3592.5,75% of total billed charges for outpatient setting,488.88,4790,3592.5
Outpatient Medical Services,RADIOLOGY SERVICES,74176,CT Abdomen and Pelvis w/o Contrast,352,4259,3918.28,92% of total billed charges for outpatient setting,2214.68,52% of total billed charges for outpatient setting,3960.87,93% of total billed charges for outpatient setting,3833.1,90% of total billed charges for outpatient setting,3833.1,90% of total billed charges for outpatient setting,4131.23,97% of total billed charges for outpatient setting,243.33,100% of LHI Fee Schedule for Outpatient setting,4259,100% of Medicaid WY Fee Schedule for Outpatient setting,2214.68,52% of total billed charges for outpatient setting,4131.23,97% of total billed charges for outpatient setting,3194.25,75% of total billed charges for outpatient setting,4088.64,96% of total billed charges for outpatient setting,2214.68,52% of total billed charges for outpatient setting,3194.25,75% of total billed charges for outpatient setting,3194.25,75% of total billed charges for outpatient setting,243.33,4259,3194.25
Outpatient Medical Services,RADIOLOGY SERVICES,74170,CT Abdomen w/+ w/o Contrast,352,2840,2612.8,92% of total billed charges for outpatient setting,1476.80,52% of total billed charges for outpatient setting,2641.2,93% of total billed charges for outpatient setting,2556,90% of total billed charges for outpatient setting,2556,90% of total billed charges for outpatient setting,2754.8,97% of total billed charges for outpatient setting,5548.84,100% of LHI Fee Schedule for Outpatient setting,2840,100% of Medicaid WY Fee Schedule for Outpatient setting,1476.80,52% of total billed charges for outpatient setting,2754.8,97% of total billed charges for outpatient setting,2130,75% of total billed charges for outpatient setting,2726.4,96% of total billed charges for outpatient setting,1476.80,52% of total billed charges for outpatient setting,2130,75% of total billed charges for outpatient setting,2130,75% of total billed charges for outpatient setting,1476.8,5548.84,2130
Outpatient Medical Services,RADIOLOGY SERVICES,75635,CT Angio Abdomen/Pelvis w/Runoff,350,3614,3324.88,92% of total billed charges for outpatient setting,1879.28,52% of total billed charges for outpatient setting,3361.02,93% of total billed charges for outpatient setting,3252.6,90% of total billed charges for outpatient setting,3252.6,90% of total billed charges for outpatient setting,3505.58,97% of total billed charges for outpatient setting,N/A,Not Applicable,3614,100% of Medicaid WY Fee Schedule for Outpatient setting,1879.28,52% of total billed charges for outpatient setting,3505.58,97% of total billed charges for outpatient setting,2710.5,75% of total billed charges for outpatient setting,3469.44,96% of total billed charges for outpatient setting,1879.28,52% of total billed charges for outpatient setting,2710.5,75% of total billed charges for outpatient setting,2710.5,75% of total billed charges for outpatient setting,1879.28,3614,2710.5
Outpatient Medical Services,RADIOLOGY SERVICES,70496,CT Angio Brain/Head,351,1572,1446.24,92% of total billed charges for outpatient setting,817.44,52% of total billed charges for outpatient setting,1461.96,93% of total billed charges for outpatient setting,1414.8,90% of total billed charges for outpatient setting,1414.8,90% of total billed charges for outpatient setting,1524.84,97% of total billed charges for outpatient setting,N/A,Not Applicable,1572,100% of Medicaid WY Fee Schedule for Outpatient setting,817.44,52% of total billed charges for outpatient setting,1524.84,97% of total billed charges for outpatient setting,1179,75% of total billed charges for outpatient setting,1509.12,96% of total billed charges for outpatient setting,817.44,52% of total billed charges for outpatient setting,1179,75% of total billed charges for outpatient setting,1179,75% of total billed charges for outpatient setting,817.44,1572,1179
Outpatient Medical Services,RADIOLOGY SERVICES,71275,CT Angio Chest PE,352,2887,2656.04,92% of total billed charges for outpatient setting,1501.24,52% of total billed charges for outpatient setting,2684.91,93% of total billed charges for outpatient setting,2598.3,90% of total billed charges for outpatient setting,2598.3,90% of total billed charges for outpatient setting,2800.39,97% of total billed charges for outpatient setting,N/A,Not Applicable,2887,100% of Medicaid WY Fee Schedule for Outpatient setting,1501.24,52% of total billed charges for outpatient setting,2800.39,97% of total billed charges for outpatient setting,2165.25,75% of total billed charges for outpatient setting,2771.52,96% of total billed charges for outpatient setting,1501.24,52% of total billed charges for outpatient setting,2165.25,75% of total billed charges for outpatient setting,2165.25,75% of total billed charges for outpatient setting,1501.24,2887,2165.25
Outpatient Medical Services,RADIOLOGY SERVICES,70498,CT Angio Neck,351,2660,2447.2,92% of total billed charges for outpatient setting,1383.20,52% of total billed charges for outpatient setting,2473.8,93% of total billed charges for outpatient setting,2394,90% of total billed charges for outpatient setting,2394,90% of total billed charges for outpatient setting,2580.2,97% of total billed charges for outpatient setting,N/A,Not Applicable,2660,100% of Medicaid WY Fee Schedule for Outpatient setting,1383.20,52% of total billed charges for outpatient setting,2580.2,97% of total billed charges for outpatient setting,1995,75% of total billed charges for outpatient setting,2553.6,96% of total billed charges for outpatient setting,1383.20,52% of total billed charges for outpatient setting,1995,75% of total billed charges for outpatient setting,1995,75% of total billed charges for outpatient setting,1383.2,2660,1995
Outpatient Medical Services,RADIOLOGY SERVICES,73700,CT Ankle w/o Contrast,352,2963.25,2726.19,92% of total billed charges for outpatient setting,1540.89,52% of total billed charges for outpatient setting,2755.82,93% of total billed charges for outpatient setting,2666.93,90% of total billed charges for outpatient setting,2666.93,90% of total billed charges for outpatient setting,2874.35,97% of total billed charges for outpatient setting,326.58,100% of LHI Fee Schedule for Outpatient setting,2963.25,100% of Medicaid WY Fee Schedule for Outpatient setting,1540.89,52% of total billed charges for outpatient setting,2874.35,97% of total billed charges for outpatient setting,2222.44,75% of total billed charges for outpatient setting,2844.72,96% of total billed charges for outpatient setting,1540.89,52% of total billed charges for outpatient setting,2222.44,75% of total billed charges for outpatient setting,2222.44,75% of total billed charges for outpatient setting,326.58,2963.25,2222.4375
Outpatient Medical Services,RADIOLOGY SERVICES,71250,CT Chest w/o Contrast,352,1623,1493.16,92% of total billed charges for outpatient setting,843.96,52% of total billed charges for outpatient setting,1509.39,93% of total billed charges for outpatient setting,1460.7,90% of total billed charges for outpatient setting,1460.7,90% of total billed charges for outpatient setting,1574.31,97% of total billed charges for outpatient setting,357.77,100% of LHI Fee Schedule for Outpatient setting,1623,100% of Medicaid WY Fee Schedule for Outpatient setting,843.96,52% of total billed charges for outpatient setting,1574.31,97% of total billed charges for outpatient setting,1217.25,75% of total billed charges for outpatient setting,1558.08,96% of total billed charges for outpatient setting,843.96,52% of total billed charges for outpatient setting,1217.25,75% of total billed charges for outpatient setting,1217.25,75% of total billed charges for outpatient setting,357.77,1623,1217.25
Outpatient Medical Services,RADIOLOGY SERVICES,71260,CT Chest/Abd/Pelvis w Contrast,352,1968,1810.56,92% of total billed charges for outpatient setting,1023.36,52% of total billed charges for outpatient setting,1830.24,93% of total billed charges for outpatient setting,1771.2,90% of total billed charges for outpatient setting,1771.2,90% of total billed charges for outpatient setting,1908.96,97% of total billed charges for outpatient setting,N/A,Not Applicable,1968,100% of Medicaid WY Fee Schedule for Outpatient setting,1023.36,52% of total billed charges for outpatient setting,1908.96,97% of total billed charges for outpatient setting,1476,75% of total billed charges for outpatient setting,1889.28,96% of total billed charges for outpatient setting,1023.36,52% of total billed charges for outpatient setting,1476,75% of total billed charges for outpatient setting,1476,75% of total billed charges for outpatient setting,1023.36,1968,1476
Outpatient Medical Services,RADIOLOGY SERVICES,71271,CT Low Dose Lung Screening,352,500,460,92% of total billed charges for outpatient setting,260.00,52% of total billed charges for outpatient setting,465,93% of total billed charges for outpatient setting,450,90% of total billed charges for outpatient setting,450,90% of total billed charges for outpatient setting,485,97% of total billed charges for outpatient setting,N/A,Not Applicable,500,100% of Medicaid WY Fee Schedule for Outpatient setting,260.00,52% of total billed charges for outpatient setting,485,97% of total billed charges for outpatient setting,375,75% of total billed charges for outpatient setting,480,96% of total billed charges for outpatient setting,260.00,52% of total billed charges for outpatient setting,375,75% of total billed charges for outpatient setting,375,75% of total billed charges for outpatient setting,260,500,375
Outpatient Medical Services,RADIOLOGY SERVICES,70486,CT Maxillofacial w/o Contrast,350,2273,2091.16,92% of total billed charges for outpatient setting,1181.96,52% of total billed charges for outpatient setting,2113.89,93% of total billed charges for outpatient setting,2045.7,90% of total billed charges for outpatient setting,2045.7,90% of total billed charges for outpatient setting,2204.81,97% of total billed charges for outpatient setting,335.35,100% of LHI Fee Schedule for Outpatient setting,2273,100% of Medicaid WY Fee Schedule for Outpatient setting,1181.96,52% of total billed charges for outpatient setting,2204.81,97% of total billed charges for outpatient setting,1704.75,75% of total billed charges for outpatient setting,2182.08,96% of total billed charges for outpatient setting,1181.96,52% of total billed charges for outpatient setting,1704.75,75% of total billed charges for outpatient setting,1704.75,75% of total billed charges for outpatient setting,335.35,2273,1704.75
Outpatient Medical Services,RADIOLOGY SERVICES,70491,CT Neck Soft Tissue w/ Conrast,350,2886,2655.12,92% of total billed charges for outpatient setting,1500.72,52% of total billed charges for outpatient setting,2683.98,93% of total billed charges for outpatient setting,2597.4,90% of total billed charges for outpatient setting,2597.4,90% of total billed charges for outpatient setting,2799.42,97% of total billed charges for outpatient setting,N/A,Not Applicable,2886,100% of Medicaid WY Fee Schedule for Outpatient setting,1500.72,52% of total billed charges for outpatient setting,2799.42,97% of total billed charges for outpatient setting,2164.5,75% of total billed charges for outpatient setting,2770.56,96% of total billed charges for outpatient setting,1500.72,52% of total billed charges for outpatient setting,2164.5,75% of total billed charges for outpatient setting,2164.5,75% of total billed charges for outpatient setting,1500.72,2886,2164.5
Outpatient Medical Services,RADIOLOGY SERVICES,70480,"CT Orbit Sella etc, or IAC w/o Contrast",350,3647,3355.24,92% of total billed charges for outpatient setting,1896.44,52% of total billed charges for outpatient setting,3391.71,93% of total billed charges for outpatient setting,3282.3,90% of total billed charges for outpatient setting,3282.3,90% of total billed charges for outpatient setting,3537.59,97% of total billed charges for outpatient setting,384.1,100% of LHI Fee Schedule for Outpatient setting,3647,100% of Medicaid WY Fee Schedule for Outpatient setting,1896.44,52% of total billed charges for outpatient setting,3537.59,97% of total billed charges for outpatient setting,2735.25,75% of total billed charges for outpatient setting,3501.12,96% of total billed charges for outpatient setting,1896.44,52% of total billed charges for outpatient setting,2735.25,75% of total billed charges for outpatient setting,2735.25,75% of total billed charges for outpatient setting,384.1,3647,2735.25
Outpatient Medical Services,RADIOLOGY SERVICES,72125,CT Spine Cervical w/o Contrast,352,2705,2488.6,92% of total billed charges for outpatient setting,1406.60,52% of total billed charges for outpatient setting,2515.65,93% of total billed charges for outpatient setting,2434.5,90% of total billed charges for outpatient setting,2434.5,90% of total billed charges for outpatient setting,2623.85,97% of total billed charges for outpatient setting,N/A,Not Applicable,2705,100% of Medicaid WY Fee Schedule for Outpatient setting,1406.60,52% of total billed charges for outpatient setting,2623.85,97% of total billed charges for outpatient setting,2028.75,75% of total billed charges for outpatient setting,2596.8,96% of total billed charges for outpatient setting,1406.60,52% of total billed charges for outpatient setting,2028.75,75% of total billed charges for outpatient setting,2028.75,75% of total billed charges for outpatient setting,1406.6,2705,2028.75
Outpatient Medical Services,RADIOLOGY SERVICES,72131,CT Spine Lumbar w/o Contrast,352,2256,2075.52,92% of total billed charges for outpatient setting,1173.12,52% of total billed charges for outpatient setting,2098.08,93% of total billed charges for outpatient setting,2030.4,90% of total billed charges for outpatient setting,2030.4,90% of total billed charges for outpatient setting,2188.32,97% of total billed charges for outpatient setting,353.87,100% of LHI Fee Schedule for Outpatient setting,2256,100% of Medicaid WY Fee Schedule for Outpatient setting,1173.12,52% of total billed charges for outpatient setting,2188.32,97% of total billed charges for outpatient setting,1692,75% of total billed charges for outpatient setting,2165.76,96% of total billed charges for outpatient setting,1173.12,52% of total billed charges for outpatient setting,1692,75% of total billed charges for outpatient setting,1692,75% of total billed charges for outpatient setting,353.87,2256,1692
Outpatient Medical Services,RADIOLOGY SERVICES,72128,CT Spine Thoracic w/o Contrast,352,2618,2408.56,92% of total billed charges for outpatient setting,1361.36,52% of total billed charges for outpatient setting,2434.74,93% of total billed charges for outpatient setting,2356.2,90% of total billed charges for outpatient setting,2356.2,90% of total billed charges for outpatient setting,2539.46,97% of total billed charges for outpatient setting,N/A,Not Applicable,2618,100% of Medicaid WY Fee Schedule for Outpatient setting,1361.36,52% of total billed charges for outpatient setting,2539.46,97% of total billed charges for outpatient setting,1963.5,75% of total billed charges for outpatient setting,2513.28,96% of total billed charges for outpatient setting,1361.36,52% of total billed charges for outpatient setting,1963.5,75% of total billed charges for outpatient setting,1963.5,75% of total billed charges for outpatient setting,1361.36,2618,1963.5
Outpatient Medical Services,RADIOLOGY SERVICES,72128,CT Spine Thoracic/Lumbar w/o Contrast,352,2618,2408.56,92% of total billed charges for outpatient setting,1361.36,52% of total billed charges for outpatient setting,2434.74,93% of total billed charges for outpatient setting,2356.2,90% of total billed charges for outpatient setting,2356.2,90% of total billed charges for outpatient setting,2539.46,97% of total billed charges for outpatient setting,N/A,Not Applicable,2618,100% of Medicaid WY Fee Schedule for Outpatient setting,1361.36,52% of total billed charges for outpatient setting,2539.46,97% of total billed charges for outpatient setting,1963.5,75% of total billed charges for outpatient setting,2513.28,96% of total billed charges for outpatient setting,1361.36,52% of total billed charges for outpatient setting,1963.5,75% of total billed charges for outpatient setting,1963.5,75% of total billed charges for outpatient setting,1361.36,2618,1963.5
Outpatient Medical Services,RADIOLOGY SERVICES,70544,MRA Brain/Headw/o Contrast,615,3434,3159.28,92% of total billed charges for outpatient setting,1785.68,52% of total billed charges for outpatient setting,3193.62,93% of total billed charges for outpatient setting,3090.6,90% of total billed charges for outpatient setting,3090.6,90% of total billed charges for outpatient setting,3330.98,97% of total billed charges for outpatient setting,5683.38,100% of LHI Fee Schedule for Outpatient setting,3434,100% of Medicaid WY Fee Schedule for Outpatient setting,1785.68,52% of total billed charges for outpatient setting,3330.98,97% of total billed charges for outpatient setting,2575.5,75% of total billed charges for outpatient setting,3296.64,96% of total billed charges for outpatient setting,1785.68,52% of total billed charges for outpatient setting,2575.5,75% of total billed charges for outpatient setting,2575.5,75% of total billed charges for outpatient setting,1785.68,5683.38,2575.5
Outpatient Medical Services,RADIOLOGY SERVICES,74183,MRI Abdomenw/ + w/o Contrast,614,3266,3004.72,92% of total billed charges for outpatient setting,1698.32,52% of total billed charges for outpatient setting,3037.38,93% of total billed charges for outpatient setting,2939.4,90% of total billed charges for outpatient setting,2939.4,90% of total billed charges for outpatient setting,3168.02,97% of total billed charges for outpatient setting,N/A,Not Applicable,3266,100% of Medicaid WY Fee Schedule for Outpatient setting,1698.32,52% of total billed charges for outpatient setting,3168.02,97% of total billed charges for outpatient setting,2449.5,75% of total billed charges for outpatient setting,3135.36,96% of total billed charges for outpatient setting,1698.32,52% of total billed charges for outpatient setting,2449.5,75% of total billed charges for outpatient setting,2449.5,75% of total billed charges for outpatient setting,1698.32,3266,2449.5
Outpatient Medical Services,RADIOLOGY SERVICES,73723,MRI Ankle w/ + w/o Contrast,614,4233.6,3894.91,92% of total billed charges for outpatient setting,2201.47,52% of total billed charges for outpatient setting,3937.25,93% of total billed charges for outpatient setting,3810.24,90% of total billed charges for outpatient setting,3810.24,90% of total billed charges for outpatient setting,4106.59,97% of total billed charges for outpatient setting,912.47,100% of LHI Fee Schedule for Outpatient setting,4233.6,100% of Medicaid WY Fee Schedule for Outpatient setting,2201.47,52% of total billed charges for outpatient setting,4106.59,97% of total billed charges for outpatient setting,3175.2,75% of total billed charges for outpatient setting,4064.26,96% of total billed charges for outpatient setting,2201.47,52% of total billed charges for outpatient setting,3175.2,75% of total billed charges for outpatient setting,3175.2,75% of total billed charges for outpatient setting,912.47,4233.6,3175.2
Outpatient Medical Services,RADIOLOGY SERVICES,70552,MRI Brain w/ Contrast,611,4061,3736.12,92% of total billed charges for outpatient setting,2111.72,52% of total billed charges for outpatient setting,3776.73,93% of total billed charges for outpatient setting,3654.9,90% of total billed charges for outpatient setting,3654.9,90% of total billed charges for outpatient setting,3939.17,97% of total billed charges for outpatient setting,N/A,Not Applicable,4061,100% of Medicaid WY Fee Schedule for Outpatient setting,2111.72,52% of total billed charges for outpatient setting,3939.17,97% of total billed charges for outpatient setting,3045.75,75% of total billed charges for outpatient setting,3898.56,96% of total billed charges for outpatient setting,2111.72,52% of total billed charges for outpatient setting,3045.75,75% of total billed charges for outpatient setting,3045.75,75% of total billed charges for outpatient setting,2111.72,4061,3045.75
Outpatient Medical Services,RADIOLOGY SERVICES,70551,MRI Brain w/o Contrast,611,2636,2425.12,92% of total billed charges for outpatient setting,1370.72,52% of total billed charges for outpatient setting,2451.48,93% of total billed charges for outpatient setting,2372.4,90% of total billed charges for outpatient setting,2372.4,90% of total billed charges for outpatient setting,2556.92,97% of total billed charges for outpatient setting,N/A,Not Applicable,2636,100% of Medicaid WY Fee Schedule for Outpatient setting,1370.72,52% of total billed charges for outpatient setting,2556.92,97% of total billed charges for outpatient setting,1977,75% of total billed charges for outpatient setting,2530.56,96% of total billed charges for outpatient setting,1370.72,52% of total billed charges for outpatient setting,1977,75% of total billed charges for outpatient setting,1977,75% of total billed charges for outpatient setting,1370.72,2636,1977
Outpatient Medical Services,RADIOLOGY SERVICES,73221,MRI Elbow w/o,614,2435,2240.2,92% of total billed charges for outpatient setting,1266.20,52% of total billed charges for outpatient setting,2264.55,93% of total billed charges for outpatient setting,2191.5,90% of total billed charges for outpatient setting,2191.5,90% of total billed charges for outpatient setting,2361.95,97% of total billed charges for outpatient setting,581.02,100% of LHI Fee Schedule for Outpatient setting,2435,100% of Medicaid WY Fee Schedule for Outpatient setting,1266.20,52% of total billed charges for outpatient setting,2361.95,97% of total billed charges for outpatient setting,1826.25,75% of total billed charges for outpatient setting,2337.6,96% of total billed charges for outpatient setting,1266.20,52% of total billed charges for outpatient setting,1826.25,75% of total billed charges for outpatient setting,1826.25,75% of total billed charges for outpatient setting,581.02,2435,1826.25
Outpatient Medical Services,RADIOLOGY SERVICES,73718,MRI Femur w/o Contrast,614,2840.4,2613.17,92% of total billed charges for outpatient setting,1477.01,52% of total billed charges for outpatient setting,2641.57,93% of total billed charges for outpatient setting,2556.36,90% of total billed charges for outpatient setting,2556.36,90% of total billed charges for outpatient setting,2755.19,97% of total billed charges for outpatient setting,607.33,100% of LHI Fee Schedule for Outpatient setting,2840.4,100% of Medicaid WY Fee Schedule for Outpatient setting,1477.01,52% of total billed charges for outpatient setting,2755.19,97% of total billed charges for outpatient setting,2130.3,75% of total billed charges for outpatient setting,2726.78,96% of total billed charges for outpatient setting,1477.01,52% of total billed charges for outpatient setting,2130.3,75% of total billed charges for outpatient setting,2130.3,75% of total billed charges for outpatient setting,607.33,2840.4,2130.3
Outpatient Medical Services,RADIOLOGY SERVICES,73720,MRI Foot w/ + w/o Contrast,614,4008.15,3687.5,92% of total billed charges for outpatient setting,2084.24,52% of total billed charges for outpatient setting,3727.58,93% of total billed charges for outpatient setting,3607.34,90% of total billed charges for outpatient setting,3607.34,90% of total billed charges for outpatient setting,3887.91,97% of total billed charges for outpatient setting,694.92,100% of LHI Fee Schedule for Outpatient setting,4008.15,100% of Medicaid WY Fee Schedule for Outpatient setting,2084.24,52% of total billed charges for outpatient setting,3887.91,97% of total billed charges for outpatient setting,3006.11,75% of total billed charges for outpatient setting,3847.82,96% of total billed charges for outpatient setting,2084.24,52% of total billed charges for outpatient setting,3006.11,75% of total billed charges for outpatient setting,3006.11,75% of total billed charges for outpatient setting,694.92,4008.15,3006.1125
Outpatient Medical Services,RADIOLOGY SERVICES,73718,MRI Foot w/o Contrast,614,2840.4,2613.17,92% of total billed charges for outpatient setting,1477.01,52% of total billed charges for outpatient setting,2641.57,93% of total billed charges for outpatient setting,2556.36,90% of total billed charges for outpatient setting,2556.36,90% of total billed charges for outpatient setting,2755.19,97% of total billed charges for outpatient setting,607.33,100% of LHI Fee Schedule for Outpatient setting,2840.4,100% of Medicaid WY Fee Schedule for Outpatient setting,1477.01,52% of total billed charges for outpatient setting,2755.19,97% of total billed charges for outpatient setting,2130.3,75% of total billed charges for outpatient setting,2726.78,96% of total billed charges for outpatient setting,1477.01,52% of total billed charges for outpatient setting,2130.3,75% of total billed charges for outpatient setting,2130.3,75% of total billed charges for outpatient setting,607.33,2840.4,2130.3
Outpatient Medical Services,RADIOLOGY SERVICES,73218,MRI Hand w/o Contrast,614,3487.05,3208.09,92% of total billed charges for outpatient setting,1813.27,52% of total billed charges for outpatient setting,3242.96,93% of total billed charges for outpatient setting,3138.35,90% of total billed charges for outpatient setting,3138.35,90% of total billed charges for outpatient setting,3382.44,97% of total billed charges for outpatient setting,606.36,100% of LHI Fee Schedule for Outpatient setting,3487.05,100% of Medicaid WY Fee Schedule for Outpatient setting,1813.27,52% of total billed charges for outpatient setting,3382.44,97% of total billed charges for outpatient setting,2615.29,75% of total billed charges for outpatient setting,3347.57,96% of total billed charges for outpatient setting,1813.27,52% of total billed charges for outpatient setting,2615.29,75% of total billed charges for outpatient setting,2615.29,75% of total billed charges for outpatient setting,606.36,3487.05,2615.2875
Outpatient Medical Services,RADIOLOGY SERVICES,73721,MRI Hip w/o Contrast,614,3218.4,2960.93,92% of total billed charges for outpatient setting,1673.57,52% of total billed charges for outpatient setting,2993.11,93% of total billed charges for outpatient setting,2896.56,90% of total billed charges for outpatient setting,2896.56,90% of total billed charges for outpatient setting,3121.85,97% of total billed charges for outpatient setting,603.94,100% of LHI Fee Schedule for Outpatient setting,3218.4,100% of Medicaid WY Fee Schedule for Outpatient setting,1673.57,52% of total billed charges for outpatient setting,3121.85,97% of total billed charges for outpatient setting,2413.8,75% of total billed charges for outpatient setting,3089.66,96% of total billed charges for outpatient setting,1673.57,52% of total billed charges for outpatient setting,2413.8,75% of total billed charges for outpatient setting,2413.8,75% of total billed charges for outpatient setting,603.94,3218.4,2413.8
Outpatient Medical Services,RADIOLOGY SERVICES,73721,MRI Knee w/o Contrast,614,3218.4,2960.93,92% of total billed charges for outpatient setting,1673.57,52% of total billed charges for outpatient setting,2993.11,93% of total billed charges for outpatient setting,2896.56,90% of total billed charges for outpatient setting,2896.56,90% of total billed charges for outpatient setting,3121.85,97% of total billed charges for outpatient setting,603.94,100% of LHI Fee Schedule for Outpatient setting,3218.4,100% of Medicaid WY Fee Schedule for Outpatient setting,1673.57,52% of total billed charges for outpatient setting,3121.85,97% of total billed charges for outpatient setting,2413.8,75% of total billed charges for outpatient setting,3089.66,96% of total billed charges for outpatient setting,1673.57,52% of total billed charges for outpatient setting,2413.8,75% of total billed charges for outpatient setting,2413.8,75% of total billed charges for outpatient setting,603.94,3218.4,2413.8
Outpatient Medical Services,RADIOLOGY SERVICES,73221,MRI Shoulder w/o Contrast,614,2435,2240.2,92% of total billed charges for outpatient setting,1266.20,52% of total billed charges for outpatient setting,2264.55,93% of total billed charges for outpatient setting,2191.5,90% of total billed charges for outpatient setting,2191.5,90% of total billed charges for outpatient setting,2361.95,97% of total billed charges for outpatient setting,581.02,100% of LHI Fee Schedule for Outpatient setting,2435,100% of Medicaid WY Fee Schedule for Outpatient setting,1266.20,52% of total billed charges for outpatient setting,2361.95,97% of total billed charges for outpatient setting,1826.25,75% of total billed charges for outpatient setting,2337.6,96% of total billed charges for outpatient setting,1266.20,52% of total billed charges for outpatient setting,1826.25,75% of total billed charges for outpatient setting,1826.25,75% of total billed charges for outpatient setting,581.02,2435,1826.25
Outpatient Medical Services,RADIOLOGY SERVICES,72141,MRI Spine Cervial w/o Contrast,612,2987,2748.04,92% of total billed charges for outpatient setting,1553.24,52% of total billed charges for outpatient setting,2777.91,93% of total billed charges for outpatient setting,2688.3,90% of total billed charges for outpatient setting,2688.3,90% of total billed charges for outpatient setting,2897.39,97% of total billed charges for outpatient setting,5603.43,100% of LHI Fee Schedule for Outpatient setting,2987,100% of Medicaid WY Fee Schedule for Outpatient setting,1553.24,52% of total billed charges for outpatient setting,2897.39,97% of total billed charges for outpatient setting,2240.25,75% of total billed charges for outpatient setting,2867.52,96% of total billed charges for outpatient setting,1553.24,52% of total billed charges for outpatient setting,2240.25,75% of total billed charges for outpatient setting,2240.25,75% of total billed charges for outpatient setting,1553.24,5603.43,2240.25
Outpatient Medical Services,RADIOLOGY SERVICES,72146,MRI Spine thoracic w/o Contrast,612,2911,2678.12,92% of total billed charges for outpatient setting,1513.72,52% of total billed charges for outpatient setting,2707.23,93% of total billed charges for outpatient setting,2619.9,90% of total billed charges for outpatient setting,2619.9,90% of total billed charges for outpatient setting,2823.67,97% of total billed charges for outpatient setting,5631.71,100% of LHI Fee Schedule for Outpatient setting,2911,100% of Medicaid WY Fee Schedule for Outpatient setting,1513.72,52% of total billed charges for outpatient setting,2823.67,97% of total billed charges for outpatient setting,2183.25,75% of total billed charges for outpatient setting,2794.56,96% of total billed charges for outpatient setting,1513.72,52% of total billed charges for outpatient setting,2183.25,75% of total billed charges for outpatient setting,2183.25,75% of total billed charges for outpatient setting,1513.72,5631.71,2183.25
Outpatient Medical Services,RADIOLOGY SERVICES,73718,MRI Tibia/Fibula w/o Contrast,614,2840.4,2613.17,92% of total billed charges for outpatient setting,1477.01,52% of total billed charges for outpatient setting,2641.57,93% of total billed charges for outpatient setting,2556.36,90% of total billed charges for outpatient setting,2556.36,90% of total billed charges for outpatient setting,2755.19,97% of total billed charges for outpatient setting,607.33,100% of LHI Fee Schedule for Outpatient setting,2840.4,100% of Medicaid WY Fee Schedule for Outpatient setting,1477.01,52% of total billed charges for outpatient setting,2755.19,97% of total billed charges for outpatient setting,2130.3,75% of total billed charges for outpatient setting,2726.78,96% of total billed charges for outpatient setting,1477.01,52% of total billed charges for outpatient setting,2130.3,75% of total billed charges for outpatient setting,2130.3,75% of total billed charges for outpatient setting,607.33,2840.4,2130.3
Outpatient Medical Services,RADIOLOGY SERVICES,73221,MRI Wrist w/o Contrast,614,2435,2240.2,92% of total billed charges for outpatient setting,1266.20,52% of total billed charges for outpatient setting,2264.55,93% of total billed charges for outpatient setting,2191.5,90% of total billed charges for outpatient setting,2191.5,90% of total billed charges for outpatient setting,2361.95,97% of total billed charges for outpatient setting,581.02,100% of LHI Fee Schedule for Outpatient setting,2435,100% of Medicaid WY Fee Schedule for Outpatient setting,1266.20,52% of total billed charges for outpatient setting,2361.95,97% of total billed charges for outpatient setting,1826.25,75% of total billed charges for outpatient setting,2337.6,96% of total billed charges for outpatient setting,1266.20,52% of total billed charges for outpatient setting,1826.25,75% of total billed charges for outpatient setting,1826.25,75% of total billed charges for outpatient setting,581.02,2435,1826.25
Outpatient Medical Services,RADIOLOGY SERVICES,76706,US AAA Screening,402,840,772.8,92% of total billed charges for outpatient setting,436.80,52% of total billed charges for outpatient setting,781.2,93% of total billed charges for outpatient setting,756,90% of total billed charges for outpatient setting,756,90% of total billed charges for outpatient setting,814.8,97% of total billed charges for outpatient setting,N/A,Not Applicable,840,100% of Medicaid WY Fee Schedule for Outpatient setting,436.80,52% of total billed charges for outpatient setting,814.8,97% of total billed charges for outpatient setting,630,75% of total billed charges for outpatient setting,806.4,96% of total billed charges for outpatient setting,436.80,52% of total billed charges for outpatient setting,630,75% of total billed charges for outpatient setting,630,75% of total billed charges for outpatient setting,436.8,840,630
Outpatient Medical Services,RADIOLOGY SERVICES,76705,US Abdomen Limited,402,660,607.2,92% of total billed charges for outpatient setting,343.20,52% of total billed charges for outpatient setting,613.8,93% of total billed charges for outpatient setting,594,90% of total billed charges for outpatient setting,594,90% of total billed charges for outpatient setting,640.2,97% of total billed charges for outpatient setting,139.54,100% of LHI Fee Schedule for Outpatient setting,660,100% of Medicaid WY Fee Schedule for Outpatient setting,343.20,52% of total billed charges for outpatient setting,640.2,97% of total billed charges for outpatient setting,495,75% of total billed charges for outpatient setting,633.6,96% of total billed charges for outpatient setting,343.20,52% of total billed charges for outpatient setting,495,75% of total billed charges for outpatient setting,495,75% of total billed charges for outpatient setting,139.54,660,495
Outpatient Medical Services,RADIOLOGY SERVICES,76642,US Breast Litited,402,470,432.4,92% of total billed charges for outpatient setting,244.40,52% of total billed charges for outpatient setting,437.1,93% of total billed charges for outpatient setting,423,90% of total billed charges for outpatient setting,423,90% of total billed charges for outpatient setting,455.9,97% of total billed charges for outpatient setting,N/A,Not Applicable,470,100% of Medicaid WY Fee Schedule for Outpatient setting,244.40,52% of total billed charges for outpatient setting,455.9,97% of total billed charges for outpatient setting,352.5,75% of total billed charges for outpatient setting,451.2,96% of total billed charges for outpatient setting,244.40,52% of total billed charges for outpatient setting,352.5,75% of total billed charges for outpatient setting,352.5,75% of total billed charges for outpatient setting,244.4,470,352.5
Outpatient Medical Services,RADIOLOGY SERVICES,93880,US Carotid Duplex Bilateral,402,2567,2361.64,92% of total billed charges for outpatient setting,1334.84,52% of total billed charges for outpatient setting,2387.31,93% of total billed charges for outpatient setting,2310.3,90% of total billed charges for outpatient setting,2310.3,90% of total billed charges for outpatient setting,2489.99,97% of total billed charges for outpatient setting,N/A,Not Applicable,2567,100% of Medicaid WY Fee Schedule for Outpatient setting,1334.84,52% of total billed charges for outpatient setting,2489.99,97% of total billed charges for outpatient setting,1925.25,75% of total billed charges for outpatient setting,2464.32,96% of total billed charges for outpatient setting,1334.84,52% of total billed charges for outpatient setting,1925.25,75% of total billed charges for outpatient setting,1925.25,75% of total billed charges for outpatient setting,1334.84,2567,1925.25
Outpatient Medical Services,RADIOLOGY SERVICES,93306,US Echo 2D Comp 2/ Color Flow Doppler,483,2246,2066.32,92% of total billed charges for outpatient setting,1167.92,52% of total billed charges for outpatient setting,2088.78,93% of total billed charges for outpatient setting,2021.4,90% of total billed charges for outpatient setting,2021.4,90% of total billed charges for outpatient setting,2178.62,97% of total billed charges for outpatient setting,315.65,100% of LHI Fee Schedule for Outpatient setting,2246,100% of Medicaid WY Fee Schedule for Outpatient setting,1167.92,52% of total billed charges for outpatient setting,2178.62,97% of total billed charges for outpatient setting,1684.5,75% of total billed charges for outpatient setting,2156.16,96% of total billed charges for outpatient setting,1167.92,52% of total billed charges for outpatient setting,1684.5,75% of total billed charges for outpatient setting,1684.5,75% of total billed charges for outpatient setting,315.65,2246,1684.5
Outpatient Medical Services,RADIOLOGY SERVICES,10005,US Fine Needle Aspiration Thyroid Gland,402,1784,1641.28,92% of total billed charges for outpatient setting,927.68,52% of total billed charges for outpatient setting,1659.12,93% of total billed charges for outpatient setting,1605.6,90% of total billed charges for outpatient setting,1605.6,90% of total billed charges for outpatient setting,1730.48,97% of total billed charges for outpatient setting,N/A,Not Applicable,1784,100% of Medicaid WY Fee Schedule for Outpatient setting,927.68,52% of total billed charges for outpatient setting,1730.48,97% of total billed charges for outpatient setting,1338,75% of total billed charges for outpatient setting,1712.64,96% of total billed charges for outpatient setting,927.68,52% of total billed charges for outpatient setting,1338,75% of total billed charges for outpatient setting,1338,75% of total billed charges for outpatient setting,927.68,1784,1338
Outpatient Medical Services,RADIOLOGY SERVICES,93970,US Lower Ext Venous Duples,402,1973,1815.16,92% of total billed charges for outpatient setting,1025.96,52% of total billed charges for outpatient setting,1834.89,93% of total billed charges for outpatient setting,1775.7,90% of total billed charges for outpatient setting,1775.7,90% of total billed charges for outpatient setting,1913.81,97% of total billed charges for outpatient setting,N/A,Not Applicable,1973,100% of Medicaid WY Fee Schedule for Outpatient setting,1025.96,52% of total billed charges for outpatient setting,1913.81,97% of total billed charges for outpatient setting,1479.75,75% of total billed charges for outpatient setting,1894.08,96% of total billed charges for outpatient setting,1025.96,52% of total billed charges for outpatient setting,1479.75,75% of total billed charges for outpatient setting,1479.75,75% of total billed charges for outpatient setting,1025.96,1973,1479.75
Outpatient Medical Services,RADIOLOGY SERVICES,76811,US OB Detailed Complete First Gest,402,1078,991.76,92% of total billed charges for outpatient setting,560.56,52% of total billed charges for outpatient setting,1002.54,93% of total billed charges for outpatient setting,970.2,90% of total billed charges for outpatient setting,970.2,90% of total billed charges for outpatient setting,1045.66,97% of total billed charges for outpatient setting,N/A,Not Applicable,1078,100% of Medicaid WY Fee Schedule for Outpatient setting,560.56,52% of total billed charges for outpatient setting,1045.66,97% of total billed charges for outpatient setting,808.5,75% of total billed charges for outpatient setting,1034.88,96% of total billed charges for outpatient setting,560.56,52% of total billed charges for outpatient setting,808.5,75% of total billed charges for outpatient setting,808.5,75% of total billed charges for outpatient setting,560.56,1078,808.5
Outpatient Medical Services,RADIOLOGY SERVICES,76801,US OB Less Than 14 Weeks Single,402,819,753.48,92% of total billed charges for outpatient setting,425.88,52% of total billed charges for outpatient setting,761.67,93% of total billed charges for outpatient setting,737.1,90% of total billed charges for outpatient setting,737.1,90% of total billed charges for outpatient setting,794.43,97% of total billed charges for outpatient setting,N/A,Not Applicable,819,100% of Medicaid WY Fee Schedule for Outpatient setting,425.88,52% of total billed charges for outpatient setting,794.43,97% of total billed charges for outpatient setting,614.25,75% of total billed charges for outpatient setting,786.24,96% of total billed charges for outpatient setting,425.88,52% of total billed charges for outpatient setting,614.25,75% of total billed charges for outpatient setting,614.25,75% of total billed charges for outpatient setting,425.88,819,614.25
Outpatient Medical Services,RADIOLOGY SERVICES,76817,US OB Transvaginal,402,809,744.28,92% of total billed charges for outpatient setting,420.68,52% of total billed charges for outpatient setting,752.37,93% of total billed charges for outpatient setting,728.1,90% of total billed charges for outpatient setting,728.1,90% of total billed charges for outpatient setting,784.73,97% of total billed charges for outpatient setting,N/A,Not Applicable,809,100% of Medicaid WY Fee Schedule for Outpatient setting,420.68,52% of total billed charges for outpatient setting,784.73,97% of total billed charges for outpatient setting,606.75,75% of total billed charges for outpatient setting,776.64,96% of total billed charges for outpatient setting,420.68,52% of total billed charges for outpatient setting,606.75,75% of total billed charges for outpatient setting,606.75,75% of total billed charges for outpatient setting,420.68,809,606.75
Outpatient Medical Services,RADIOLOGY SERVICES,49083,US Paracentesis,450,1768,1626.56,92% of total billed charges for outpatient setting,919.36,52% of total billed charges for outpatient setting,1644.24,93% of total billed charges for outpatient setting,1591.2,90% of total billed charges for outpatient setting,1591.2,90% of total billed charges for outpatient setting,1714.96,97% of total billed charges for outpatient setting,N/A,Not Applicable,1768,100% of Medicaid WY Fee Schedule for Outpatient setting,919.36,52% of total billed charges for outpatient setting,1714.96,97% of total billed charges for outpatient setting,1326,75% of total billed charges for outpatient setting,1697.28,96% of total billed charges for outpatient setting,919.36,52% of total billed charges for outpatient setting,1326,75% of total billed charges for outpatient setting,1326,75% of total billed charges for outpatient setting,919.36,1768,1326
Outpatient Medical Services,RADIOLOGY SERVICES,76856,US Pelvic Complete,402,1010,929.2,92% of total billed charges for outpatient setting,525.20,52% of total billed charges for outpatient setting,939.3,93% of total billed charges for outpatient setting,909,90% of total billed charges for outpatient setting,909,90% of total billed charges for outpatient setting,979.7,97% of total billed charges for outpatient setting,166.49,100% of LHI Fee Schedule for Outpatient setting,1010,100% of Medicaid WY Fee Schedule for Outpatient setting,525.20,52% of total billed charges for outpatient setting,979.7,97% of total billed charges for outpatient setting,757.5,75% of total billed charges for outpatient setting,969.6,96% of total billed charges for outpatient setting,525.20,52% of total billed charges for outpatient setting,757.5,75% of total billed charges for outpatient setting,757.5,75% of total billed charges for outpatient setting,166.49,1010,757.5
Outpatient Medical Services,RADIOLOGY SERVICES,76770,US Retroperitoneal Complete,402,907,834.44,92% of total billed charges for outpatient setting,471.64,52% of total billed charges for outpatient setting,843.51,93% of total billed charges for outpatient setting,816.3,90% of total billed charges for outpatient setting,816.3,90% of total billed charges for outpatient setting,879.79,97% of total billed charges for outpatient setting,176.11,100% of LHI Fee Schedule for Outpatient setting,907,100% of Medicaid WY Fee Schedule for Outpatient setting,471.64,52% of total billed charges for outpatient setting,879.79,97% of total billed charges for outpatient setting,680.25,75% of total billed charges for outpatient setting,870.72,96% of total billed charges for outpatient setting,471.64,52% of total billed charges for outpatient setting,680.25,75% of total billed charges for outpatient setting,680.25,75% of total billed charges for outpatient setting,176.11,907,680.25
Outpatient Medical Services,RADIOLOGY SERVICES,76870,US Scrotum (Contents),402,711,654.12,92% of total billed charges for outpatient setting,369.72,52% of total billed charges for outpatient setting,661.23,93% of total billed charges for outpatient setting,639.9,90% of total billed charges for outpatient setting,639.9,90% of total billed charges for outpatient setting,689.67,97% of total billed charges for outpatient setting,159.75,100% of LHI Fee Schedule for Outpatient setting,711,100% of Medicaid WY Fee Schedule for Outpatient setting,369.72,52% of total billed charges for outpatient setting,689.67,97% of total billed charges for outpatient setting,533.25,75% of total billed charges for outpatient setting,682.56,96% of total billed charges for outpatient setting,369.72,52% of total billed charges for outpatient setting,533.25,75% of total billed charges for outpatient setting,533.25,75% of total billed charges for outpatient setting,159.75,711,533.25
Outpatient Medical Services,RADIOLOGY SERVICES,76536,US Thyroid,402,769,707.48,92% of total billed charges for outpatient setting,399.88,52% of total billed charges for outpatient setting,715.17,93% of total billed charges for outpatient setting,692.1,90% of total billed charges for outpatient setting,692.1,90% of total billed charges for outpatient setting,745.93,97% of total billed charges for outpatient setting,150.13,100% of LHI Fee Schedule for Outpatient setting,769,100% of Medicaid WY Fee Schedule for Outpatient setting,399.88,52% of total billed charges for outpatient setting,745.93,97% of total billed charges for outpatient setting,576.75,75% of total billed charges for outpatient setting,738.24,96% of total billed charges for outpatient setting,399.88,52% of total billed charges for outpatient setting,576.75,75% of total billed charges for outpatient setting,576.75,75% of total billed charges for outpatient setting,150.13,769,576.75
Outpatient Medical Services,RADIOLOGY SERVICES,93970,US Upper Ext Venous Duplex Bilateral,402,1973,1815.16,92% of total billed charges for outpatient setting,1025.96,52% of total billed charges for outpatient setting,1834.89,93% of total billed charges for outpatient setting,1775.7,90% of total billed charges for outpatient setting,1775.7,90% of total billed charges for outpatient setting,1913.81,97% of total billed charges for outpatient setting,N/A,Not Applicable,1973,100% of Medicaid WY Fee Schedule for Outpatient setting,1025.96,52% of total billed charges for outpatient setting,1913.81,97% of total billed charges for outpatient setting,1479.75,75% of total billed charges for outpatient setting,1894.08,96% of total billed charges for outpatient setting,1025.96,52% of total billed charges for outpatient setting,1479.75,75% of total billed charges for outpatient setting,1479.75,75% of total billed charges for outpatient setting,1025.96,1973,1479.75
Outpatient Medical Services,RADIOLOGY SERVICES,93971,US Upper Ext Venous Duplex,402,817,751.64,92% of total billed charges for outpatient setting,424.84,52% of total billed charges for outpatient setting,759.81,93% of total billed charges for outpatient setting,735.3,90% of total billed charges for outpatient setting,735.3,90% of total billed charges for outpatient setting,792.49,97% of total billed charges for outpatient setting,N/A,Not Applicable,817,100% of Medicaid WY Fee Schedule for Outpatient setting,424.84,52% of total billed charges for outpatient setting,792.49,97% of total billed charges for outpatient setting,612.75,75% of total billed charges for outpatient setting,784.32,96% of total billed charges for outpatient setting,424.84,52% of total billed charges for outpatient setting,612.75,75% of total billed charges for outpatient setting,612.75,75% of total billed charges for outpatient setting,424.84,817,612.75
Outpatient Medical Services,RADIOLOGY SERVICES,78315,NM Bone Three Phase Study,341,2312,2127.04,92% of total billed charges for outpatient setting,1202.24,52% of total billed charges for outpatient setting,2150.16,93% of total billed charges for outpatient setting,2080.8,90% of total billed charges for outpatient setting,2080.8,90% of total billed charges for outpatient setting,2242.64,97% of total billed charges for outpatient setting,N/A,Not Applicable,2312,100% of Medicaid WY Fee Schedule for Outpatient setting,1202.24,52% of total billed charges for outpatient setting,2242.64,97% of total billed charges for outpatient setting,1734,75% of total billed charges for outpatient setting,2219.52,96% of total billed charges for outpatient setting,1202.24,52% of total billed charges for outpatient setting,1734,75% of total billed charges for outpatient setting,1734,75% of total billed charges for outpatient setting,1202.24,2312,1734
Outpatient Medical Services,RADIOLOGY SERVICES,78284,NM Gastric Emptying Study,341,1623,1493.16,92% of total billed charges for outpatient setting,843.96,52% of total billed charges for outpatient setting,1509.39,93% of total billed charges for outpatient setting,1460.7,90% of total billed charges for outpatient setting,1460.7,90% of total billed charges for outpatient setting,1574.31,97% of total billed charges for outpatient setting,N/A,Not Applicable,1623,100% of Medicaid WY Fee Schedule for Outpatient setting,843.96,52% of total billed charges for outpatient setting,1574.31,97% of total billed charges for outpatient setting,1217.25,75% of total billed charges for outpatient setting,1558.08,96% of total billed charges for outpatient setting,843.96,52% of total billed charges for outpatient setting,1217.25,75% of total billed charges for outpatient setting,1217.25,75% of total billed charges for outpatient setting,843.96,1623,1217.25
Outpatient Medical Services,RADIOLOGY SERVICES,78227,NM Hepatobiliary Imaging w/Drug,341,2415,2221.8,92% of total billed charges for outpatient setting,1255.80,52% of total billed charges for outpatient setting,2245.95,93% of total billed charges for outpatient setting,2173.5,90% of total billed charges for outpatient setting,2173.5,90% of total billed charges for outpatient setting,2342.55,97% of total billed charges for outpatient setting,N/A,Not Applicable,2415,100% of Medicaid WY Fee Schedule for Outpatient setting,1255.80,52% of total billed charges for outpatient setting,2342.55,97% of total billed charges for outpatient setting,1811.25,75% of total billed charges for outpatient setting,2318.4,96% of total billed charges for outpatient setting,1255.80,52% of total billed charges for outpatient setting,1811.25,75% of total billed charges for outpatient setting,1811.25,75% of total billed charges for outpatient setting,1255.8,2415,1811.25
Outpatient Medical Services,RADIOLOGY SERVICES,78452,NM Myocardial SPECT Rest and Stress,341,3170,2916.4,92% of total billed charges for outpatient setting,1648.40,52% of total billed charges for outpatient setting,2948.1,93% of total billed charges for outpatient setting,2853,90% of total billed charges for outpatient setting,2853,90% of total billed charges for outpatient setting,3074.9,97% of total billed charges for outpatient setting,N/A,Not Applicable,3170,100% of Medicaid WY Fee Schedule for Outpatient setting,1648.40,52% of total billed charges for outpatient setting,3074.9,97% of total billed charges for outpatient setting,2377.5,75% of total billed charges for outpatient setting,3043.2,96% of total billed charges for outpatient setting,1648.40,52% of total billed charges for outpatient setting,2377.5,75% of total billed charges for outpatient setting,2377.5,75% of total billed charges for outpatient setting,1648.4,3170,2377.5
Outpatient Medical Services,RADIOLOGY SERVICES,78070,NM Parathyroid Imaging,341,1542,1418.64,92% of total billed charges for outpatient setting,801.84,52% of total billed charges for outpatient setting,1434.06,93% of total billed charges for outpatient setting,1387.8,90% of total billed charges for outpatient setting,1387.8,90% of total billed charges for outpatient setting,1495.74,97% of total billed charges for outpatient setting,N/A,Not Applicable,1542,100% of Medicaid WY Fee Schedule for Outpatient setting,801.84,52% of total billed charges for outpatient setting,1495.74,97% of total billed charges for outpatient setting,1156.5,75% of total billed charges for outpatient setting,1480.32,96% of total billed charges for outpatient setting,801.84,52% of total billed charges for outpatient setting,1156.5,75% of total billed charges for outpatient setting,1156.5,75% of total billed charges for outpatient setting,801.84,1542,1156.5
Outpatient Medical Services,RADIOLOGY SERVICES,77080,BD Bone Density DEXA APP Skeleton,320,517,475.64,92% of total billed charges for outpatient setting,268.84,52% of total billed charges for outpatient setting,480.81,93% of total billed charges for outpatient setting,465.3,90% of total billed charges for outpatient setting,465.3,90% of total billed charges for outpatient setting,501.49,97% of total billed charges for outpatient setting,N/A,Not Applicable,517,100% of Medicaid WY Fee Schedule for Outpatient setting,268.84,52% of total billed charges for outpatient setting,501.49,97% of total billed charges for outpatient setting,387.75,75% of total billed charges for outpatient setting,496.32,96% of total billed charges for outpatient setting,268.84,52% of total billed charges for outpatient setting,387.75,75% of total billed charges for outpatient setting,387.75,75% of total billed charges for outpatient setting,268.84,517,387.75
Outpatient Medical Services,RADIOLOGY SERVICES,74018,XR Abdomen 1 View,320,320,294.4,92% of total billed charges for outpatient setting,166.40,52% of total billed charges for outpatient setting,297.6,93% of total billed charges for outpatient setting,288,90% of total billed charges for outpatient setting,288,90% of total billed charges for outpatient setting,310.4,97% of total billed charges for outpatient setting,N/A,Not Applicable,320,100% of Medicaid WY Fee Schedule for Outpatient setting,166.40,52% of total billed charges for outpatient setting,310.4,97% of total billed charges for outpatient setting,240,75% of total billed charges for outpatient setting,307.2,96% of total billed charges for outpatient setting,166.40,52% of total billed charges for outpatient setting,240,75% of total billed charges for outpatient setting,240,75% of total billed charges for outpatient setting,166.4,320,240
Outpatient Medical Services,RADIOLOGY SERVICES,74022,XR Abdomen Series + Chest 1 View,320,499,459.08,92% of total billed charges for outpatient setting,259.48,52% of total billed charges for outpatient setting,464.07,93% of total billed charges for outpatient setting,449.1,90% of total billed charges for outpatient setting,449.1,90% of total billed charges for outpatient setting,484.03,97% of total billed charges for outpatient setting,N/A,Not Applicable,499,100% of Medicaid WY Fee Schedule for Outpatient setting,259.48,52% of total billed charges for outpatient setting,484.03,97% of total billed charges for outpatient setting,374.25,75% of total billed charges for outpatient setting,479.04,96% of total billed charges for outpatient setting,259.48,52% of total billed charges for outpatient setting,374.25,75% of total billed charges for outpatient setting,374.25,75% of total billed charges for outpatient setting,259.48,499,374.25
Outpatient Medical Services,RADIOLOGY SERVICES,73610,XR Ankle Complete 3+ Views,320,477.9,439.67,92% of total billed charges for outpatient setting,248.51,52% of total billed charges for outpatient setting,444.45,93% of total billed charges for outpatient setting,430.11,90% of total billed charges for outpatient setting,430.11,90% of total billed charges for outpatient setting,463.56,97% of total billed charges for outpatient setting,44.27,100% of LHI Fee Schedule for Outpatient setting,477.9,100% of Medicaid WY Fee Schedule for Outpatient setting,248.51,52% of total billed charges for outpatient setting,463.56,97% of total billed charges for outpatient setting,358.43,75% of total billed charges for outpatient setting,458.78,96% of total billed charges for outpatient setting,248.51,52% of total billed charges for outpatient setting,358.43,75% of total billed charges for outpatient setting,358.43,75% of total billed charges for outpatient setting,44.27,477.9,358.425
Outpatient Medical Services,RADIOLOGY SERVICES,23350,XR Arthrogram Injection Shoulder,320,464,426.88,92% of total billed charges for outpatient setting,241.28,52% of total billed charges for outpatient setting,431.52,93% of total billed charges for outpatient setting,417.6,90% of total billed charges for outpatient setting,417.6,90% of total billed charges for outpatient setting,450.08,97% of total billed charges for outpatient setting,N/A,Not Applicable,464,100% of Medicaid WY Fee Schedule for Outpatient setting,241.28,52% of total billed charges for outpatient setting,450.08,97% of total billed charges for outpatient setting,348,75% of total billed charges for outpatient setting,445.44,96% of total billed charges for outpatient setting,241.28,52% of total billed charges for outpatient setting,348,75% of total billed charges for outpatient setting,348,75% of total billed charges for outpatient setting,241.28,464,348
Outpatient Medical Services,RADIOLOGY SERVICES,27093,XR Arthrogram Injection Hip,450,758,697.36,92% of total billed charges for outpatient setting,394.16,52% of total billed charges for outpatient setting,704.94,93% of total billed charges for outpatient setting,682.2,90% of total billed charges for outpatient setting,682.2,90% of total billed charges for outpatient setting,735.26,97% of total billed charges for outpatient setting,N/A,Not Applicable,758,100% of Medicaid WY Fee Schedule for Outpatient setting,394.16,52% of total billed charges for outpatient setting,735.26,97% of total billed charges for outpatient setting,568.5,75% of total billed charges for outpatient setting,727.68,96% of total billed charges for outpatient setting,394.16,52% of total billed charges for outpatient setting,568.5,75% of total billed charges for outpatient setting,568.5,75% of total billed charges for outpatient setting,394.16,758,568.5
Outpatient Medical Services,RADIOLOGY SERVICES,73650,XR Calcaneus,320,361.8,332.86,92% of total billed charges for outpatient setting,188.14,52% of total billed charges for outpatient setting,336.47,93% of total billed charges for outpatient setting,325.62,90% of total billed charges for outpatient setting,325.62,90% of total billed charges for outpatient setting,350.95,97% of total billed charges for outpatient setting,37.53,100% of LHI Fee Schedule for Outpatient setting,361.8,100% of Medicaid WY Fee Schedule for Outpatient setting,188.14,52% of total billed charges for outpatient setting,350.95,97% of total billed charges for outpatient setting,271.35,75% of total billed charges for outpatient setting,347.33,96% of total billed charges for outpatient setting,188.14,52% of total billed charges for outpatient setting,271.35,75% of total billed charges for outpatient setting,271.35,75% of total billed charges for outpatient setting,37.53,361.8,271.35
Outpatient Medical Services,RADIOLOGY SERVICES,71045,XR Chest 1 View,324,270,248.4,92% of total billed charges for outpatient setting,140.40,52% of total billed charges for outpatient setting,251.1,93% of total billed charges for outpatient setting,243,90% of total billed charges for outpatient setting,243,90% of total billed charges for outpatient setting,261.9,97% of total billed charges for outpatient setting,N/A,Not Applicable,270,100% of Medicaid WY Fee Schedule for Outpatient setting,140.40,52% of total billed charges for outpatient setting,261.9,97% of total billed charges for outpatient setting,202.5,75% of total billed charges for outpatient setting,259.2,96% of total billed charges for outpatient setting,140.40,52% of total billed charges for outpatient setting,202.5,75% of total billed charges for outpatient setting,202.5,75% of total billed charges for outpatient setting,140.4,270,202.5
Outpatient Medical Services,RADIOLOGY SERVICES,71046,XR Chest 2 Views,324,332,305.44,92% of total billed charges for outpatient setting,172.64,52% of total billed charges for outpatient setting,308.76,93% of total billed charges for outpatient setting,298.8,90% of total billed charges for outpatient setting,298.8,90% of total billed charges for outpatient setting,322.04,97% of total billed charges for outpatient setting,N/A,Not Applicable,332,100% of Medicaid WY Fee Schedule for Outpatient setting,172.64,52% of total billed charges for outpatient setting,322.04,97% of total billed charges for outpatient setting,249,75% of total billed charges for outpatient setting,318.72,96% of total billed charges for outpatient setting,172.64,52% of total billed charges for outpatient setting,249,75% of total billed charges for outpatient setting,249,75% of total billed charges for outpatient setting,172.64,332,249
Outpatient Medical Services,RADIOLOGY SERVICES,73000,XR Clavical,320,441.45,406.13,92% of total billed charges for outpatient setting,229.55,52% of total billed charges for outpatient setting,410.55,93% of total billed charges for outpatient setting,397.31,90% of total billed charges for outpatient setting,397.31,90% of total billed charges for outpatient setting,428.21,97% of total billed charges for outpatient setting,40.42,100% of LHI Fee Schedule for Outpatient setting,441.45,100% of Medicaid WY Fee Schedule for Outpatient setting,229.55,52% of total billed charges for outpatient setting,428.21,97% of total billed charges for outpatient setting,331.09,75% of total billed charges for outpatient setting,423.79,96% of total billed charges for outpatient setting,229.55,52% of total billed charges for outpatient setting,331.09,75% of total billed charges for outpatient setting,331.09,75% of total billed charges for outpatient setting,40.42,441.45,331.0875
Outpatient Medical Services,RADIOLOGY SERVICES,73080,XR Elbow 3+ Views,320,523.8,481.9,92% of total billed charges for outpatient setting,272.38,52% of total billed charges for outpatient setting,487.13,93% of total billed charges for outpatient setting,471.42,90% of total billed charges for outpatient setting,471.42,90% of total billed charges for outpatient setting,508.09,97% of total billed charges for outpatient setting,48.12,100% of LHI Fee Schedule for Outpatient setting,523.8,100% of Medicaid WY Fee Schedule for Outpatient setting,272.38,52% of total billed charges for outpatient setting,508.09,97% of total billed charges for outpatient setting,392.85,75% of total billed charges for outpatient setting,502.85,96% of total billed charges for outpatient setting,272.38,52% of total billed charges for outpatient setting,392.85,75% of total billed charges for outpatient setting,392.85,75% of total billed charges for outpatient setting,48.12,523.8,392.85
Outpatient Medical Services,RADIOLOGY SERVICES,73552,XR Femur 2 Views,320,473.85,435.94,92% of total billed charges for outpatient setting,246.40,52% of total billed charges for outpatient setting,440.68,93% of total billed charges for outpatient setting,426.47,90% of total billed charges for outpatient setting,426.47,90% of total billed charges for outpatient setting,459.63,97% of total billed charges for outpatient setting,N/A,Not Applicable,473.85,100% of Medicaid WY Fee Schedule for Outpatient setting,246.40,52% of total billed charges for outpatient setting,459.63,97% of total billed charges for outpatient setting,355.39,75% of total billed charges for outpatient setting,454.9,96% of total billed charges for outpatient setting,246.40,52% of total billed charges for outpatient setting,355.39,75% of total billed charges for outpatient setting,355.39,75% of total billed charges for outpatient setting,246.4,473.85,355.3875
Outpatient Medical Services,RADIOLOGY SERVICES,73140,XR Finger(s) 2+ Views,320,246,226.32,92% of total billed charges for outpatient setting,127.92,52% of total billed charges for outpatient setting,228.78,93% of total billed charges for outpatient setting,221.4,90% of total billed charges for outpatient setting,221.4,90% of total billed charges for outpatient setting,238.62,97% of total billed charges for outpatient setting,39.46,100% of LHI Fee Schedule for Outpatient setting,246,100% of Medicaid WY Fee Schedule for Outpatient setting,127.92,52% of total billed charges for outpatient setting,238.62,97% of total billed charges for outpatient setting,184.5,75% of total billed charges for outpatient setting,236.16,96% of total billed charges for outpatient setting,127.92,52% of total billed charges for outpatient setting,184.5,75% of total billed charges for outpatient setting,184.5,75% of total billed charges for outpatient setting,39.46,246,184.5
Outpatient Medical Services,RADIOLOGY SERVICES,73620,XR Foot 2 View,320,504.9,464.51,92% of total billed charges for outpatient setting,262.55,52% of total billed charges for outpatient setting,469.56,93% of total billed charges for outpatient setting,454.41,90% of total billed charges for outpatient setting,454.41,90% of total billed charges for outpatient setting,489.75,97% of total billed charges for outpatient setting,36.57,100% of LHI Fee Schedule for Outpatient setting,504.9,100% of Medicaid WY Fee Schedule for Outpatient setting,262.55,52% of total billed charges for outpatient setting,489.75,97% of total billed charges for outpatient setting,378.68,75% of total billed charges for outpatient setting,484.7,96% of total billed charges for outpatient setting,262.55,52% of total billed charges for outpatient setting,378.68,75% of total billed charges for outpatient setting,378.68,75% of total billed charges for outpatient setting,36.57,504.9,378.675
Outpatient Medical Services,RADIOLOGY SERVICES,73630,XR Foot Complete 3+ Views,320,441.45,406.13,92% of total billed charges for outpatient setting,229.55,52% of total billed charges for outpatient setting,410.55,93% of total billed charges for outpatient setting,397.31,90% of total billed charges for outpatient setting,397.31,90% of total billed charges for outpatient setting,428.21,97% of total billed charges for outpatient setting,42.34,100% of LHI Fee Schedule for Outpatient setting,441.45,100% of Medicaid WY Fee Schedule for Outpatient setting,229.55,52% of total billed charges for outpatient setting,428.21,97% of total billed charges for outpatient setting,331.09,75% of total billed charges for outpatient setting,423.79,96% of total billed charges for outpatient setting,229.55,52% of total billed charges for outpatient setting,331.09,75% of total billed charges for outpatient setting,331.09,75% of total billed charges for outpatient setting,42.34,441.45,331.0875
Outpatient Medical Services,RADIOLOGY SERVICES,73090,XR Forearm 2 Views,320,441.45,406.13,92% of total billed charges for outpatient setting,229.55,52% of total billed charges for outpatient setting,410.55,93% of total billed charges for outpatient setting,397.31,90% of total billed charges for outpatient setting,397.31,90% of total billed charges for outpatient setting,428.21,97% of total billed charges for outpatient setting,40.42,100% of LHI Fee Schedule for Outpatient setting,441.45,100% of Medicaid WY Fee Schedule for Outpatient setting,229.55,52% of total billed charges for outpatient setting,428.21,97% of total billed charges for outpatient setting,331.09,75% of total billed charges for outpatient setting,423.79,96% of total billed charges for outpatient setting,229.55,52% of total billed charges for outpatient setting,331.09,75% of total billed charges for outpatient setting,331.09,75% of total billed charges for outpatient setting,40.42,441.45,331.0875
Outpatient Medical Services,RADIOLOGY SERVICES,73120,XR Hand 2 Views,320,425.25,391.23,92% of total billed charges for outpatient setting,221.13,52% of total billed charges for outpatient setting,395.48,93% of total billed charges for outpatient setting,382.73,90% of total billed charges for outpatient setting,382.73,90% of total billed charges for outpatient setting,412.49,97% of total billed charges for outpatient setting,37.53,100% of LHI Fee Schedule for Outpatient setting,425.25,100% of Medicaid WY Fee Schedule for Outpatient setting,221.13,52% of total billed charges for outpatient setting,412.49,97% of total billed charges for outpatient setting,318.94,75% of total billed charges for outpatient setting,408.24,96% of total billed charges for outpatient setting,221.13,52% of total billed charges for outpatient setting,318.94,75% of total billed charges for outpatient setting,318.94,75% of total billed charges for outpatient setting,37.53,425.25,318.9375
Outpatient Medical Services,RADIOLOGY SERVICES,73130,XR Hand 3+ Views,320,472.5,434.7,92% of total billed charges for outpatient setting,245.70,52% of total billed charges for outpatient setting,439.43,93% of total billed charges for outpatient setting,425.25,90% of total billed charges for outpatient setting,425.25,90% of total billed charges for outpatient setting,458.33,97% of total billed charges for outpatient setting,44.27,100% of LHI Fee Schedule for Outpatient setting,472.5,100% of Medicaid WY Fee Schedule for Outpatient setting,245.70,52% of total billed charges for outpatient setting,458.33,97% of total billed charges for outpatient setting,354.38,75% of total billed charges for outpatient setting,453.6,96% of total billed charges for outpatient setting,245.70,52% of total billed charges for outpatient setting,354.38,75% of total billed charges for outpatient setting,354.38,75% of total billed charges for outpatient setting,44.27,472.5,354.375
Outpatient Medical Services,RADIOLOGY SERVICES,73501,XR Hip 1 View w/AP Pelvis,320,290,266.8,92% of total billed charges for outpatient setting,150.80,52% of total billed charges for outpatient setting,269.7,93% of total billed charges for outpatient setting,261,90% of total billed charges for outpatient setting,261,90% of total billed charges for outpatient setting,281.3,97% of total billed charges for outpatient setting,N/A,Not Applicable,290,100% of Medicaid WY Fee Schedule for Outpatient setting,150.80,52% of total billed charges for outpatient setting,281.3,97% of total billed charges for outpatient setting,217.5,75% of total billed charges for outpatient setting,278.4,96% of total billed charges for outpatient setting,150.80,52% of total billed charges for outpatient setting,217.5,75% of total billed charges for outpatient setting,217.5,75% of total billed charges for outpatient setting,150.8,290,217.5
Outpatient Medical Services,RADIOLOGY SERVICES,73502,XR Hip 2-3 Views,320,277,254.84,92% of total billed charges for outpatient setting,144.04,52% of total billed charges for outpatient setting,257.61,93% of total billed charges for outpatient setting,249.3,90% of total billed charges for outpatient setting,249.3,90% of total billed charges for outpatient setting,268.69,97% of total billed charges for outpatient setting,N/A,Not Applicable,277,100% of Medicaid WY Fee Schedule for Outpatient setting,144.04,52% of total billed charges for outpatient setting,268.69,97% of total billed charges for outpatient setting,207.75,75% of total billed charges for outpatient setting,265.92,96% of total billed charges for outpatient setting,144.04,52% of total billed charges for outpatient setting,207.75,75% of total billed charges for outpatient setting,207.75,75% of total billed charges for outpatient setting,144.04,277,207.75
Outpatient Medical Services,RADIOLOGY SERVICES,73521,XR Hip 2-3 Views w/AP Pelvis,320,465,427.8,92% of total billed charges for outpatient setting,241.80,52% of total billed charges for outpatient setting,432.45,93% of total billed charges for outpatient setting,418.5,90% of total billed charges for outpatient setting,418.5,90% of total billed charges for outpatient setting,451.05,97% of total billed charges for outpatient setting,N/A,Not Applicable,465,100% of Medicaid WY Fee Schedule for Outpatient setting,241.80,52% of total billed charges for outpatient setting,451.05,97% of total billed charges for outpatient setting,348.75,75% of total billed charges for outpatient setting,446.4,96% of total billed charges for outpatient setting,241.80,52% of total billed charges for outpatient setting,348.75,75% of total billed charges for outpatient setting,348.75,75% of total billed charges for outpatient setting,241.8,465,348.75
Outpatient Medical Services,RADIOLOGY SERVICES,73060,XR Humerus,320,412.2,379.22,92% of total billed charges for outpatient setting,214.34,52% of total billed charges for outpatient setting,383.35,93% of total billed charges for outpatient setting,370.98,90% of total billed charges for outpatient setting,370.98,90% of total billed charges for outpatient setting,399.83,97% of total billed charges for outpatient setting,44.27,100% of LHI Fee Schedule for Outpatient setting,412.2,100% of Medicaid WY Fee Schedule for Outpatient setting,214.34,52% of total billed charges for outpatient setting,399.83,97% of total billed charges for outpatient setting,309.15,75% of total billed charges for outpatient setting,395.71,96% of total billed charges for outpatient setting,214.34,52% of total billed charges for outpatient setting,309.15,75% of total billed charges for outpatient setting,309.15,75% of total billed charges for outpatient setting,44.27,412.2,309.15
Outpatient Medical Services,RADIOLOGY SERVICES,73562,XR Knee 3 Views,320,476.55,438.43,92% of total billed charges for outpatient setting,247.81,52% of total billed charges for outpatient setting,443.19,93% of total billed charges for outpatient setting,428.9,90% of total billed charges for outpatient setting,428.9,90% of total billed charges for outpatient setting,462.25,97% of total billed charges for outpatient setting,47.16,100% of LHI Fee Schedule for Outpatient setting,476.55,100% of Medicaid WY Fee Schedule for Outpatient setting,247.81,52% of total billed charges for outpatient setting,462.25,97% of total billed charges for outpatient setting,357.41,75% of total billed charges for outpatient setting,457.49,96% of total billed charges for outpatient setting,247.81,52% of total billed charges for outpatient setting,357.41,75% of total billed charges for outpatient setting,357.41,75% of total billed charges for outpatient setting,47.16,476.55,357.4125
Outpatient Medical Services,RADIOLOGY SERVICES,73564,XR Knee Complete 4+ Views,320,409,376.28,92% of total billed charges for outpatient setting,212.68,52% of total billed charges for outpatient setting,380.37,93% of total billed charges for outpatient setting,368.1,90% of total billed charges for outpatient setting,368.1,90% of total billed charges for outpatient setting,396.73,97% of total billed charges for outpatient setting,55.82,100% of LHI Fee Schedule for Outpatient setting,409,100% of Medicaid WY Fee Schedule for Outpatient setting,212.68,52% of total billed charges for outpatient setting,396.73,97% of total billed charges for outpatient setting,306.75,75% of total billed charges for outpatient setting,392.64,96% of total billed charges for outpatient setting,212.68,52% of total billed charges for outpatient setting,306.75,75% of total billed charges for outpatient setting,306.75,75% of total billed charges for outpatient setting,55.82,409,306.75
Outpatient Medical Services,RADIOLOGY SERVICES,71101,XR Ribs w/PA Chest,324,424,390.08,92% of total billed charges for outpatient setting,220.48,52% of total billed charges for outpatient setting,394.32,93% of total billed charges for outpatient setting,381.6,90% of total billed charges for outpatient setting,381.6,90% of total billed charges for outpatient setting,411.28,97% of total billed charges for outpatient setting,60.45,100% of LHI Fee Schedule for Outpatient setting,424,100% of Medicaid WY Fee Schedule for Outpatient setting,220.48,52% of total billed charges for outpatient setting,411.28,97% of total billed charges for outpatient setting,318,75% of total billed charges for outpatient setting,407.04,96% of total billed charges for outpatient setting,220.48,52% of total billed charges for outpatient setting,318,75% of total billed charges for outpatient setting,318,75% of total billed charges for outpatient setting,60.45,424,318
Outpatient Medical Services,RADIOLOGY SERVICES,72220,XR Sacrum/Coccyx 2+ Views,320,337,310.04,92% of total billed charges for outpatient setting,175.24,52% of total billed charges for outpatient setting,313.41,93% of total billed charges for outpatient setting,303.3,90% of total billed charges for outpatient setting,303.3,90% of total billed charges for outpatient setting,326.89,97% of total billed charges for outpatient setting,47.16,100% of LHI Fee Schedule for Outpatient setting,337,100% of Medicaid WY Fee Schedule for Outpatient setting,175.24,52% of total billed charges for outpatient setting,326.89,97% of total billed charges for outpatient setting,252.75,75% of total billed charges for outpatient setting,323.52,96% of total billed charges for outpatient setting,175.24,52% of total billed charges for outpatient setting,252.75,75% of total billed charges for outpatient setting,252.75,75% of total billed charges for outpatient setting,47.16,337,252.75
Outpatient Medical Services,RADIOLOGY SERVICES,73030,XR Shoulder Complete 2+ Views,320,457.65,421.04,92% of total billed charges for outpatient setting,237.98,52% of total billed charges for outpatient setting,425.61,93% of total billed charges for outpatient setting,411.89,90% of total billed charges for outpatient setting,411.89,90% of total billed charges for outpatient setting,443.92,97% of total billed charges for outpatient setting,48.12,100% of LHI Fee Schedule for Outpatient setting,457.65,100% of Medicaid WY Fee Schedule for Outpatient setting,237.98,52% of total billed charges for outpatient setting,443.92,97% of total billed charges for outpatient setting,343.24,75% of total billed charges for outpatient setting,439.34,96% of total billed charges for outpatient setting,237.98,52% of total billed charges for outpatient setting,343.24,75% of total billed charges for outpatient setting,343.24,75% of total billed charges for outpatient setting,48.12,457.65,343.2375
Outpatient Medical Services,RADIOLOGY SERVICES,72040,XR Spine Cervical 2 or 3 Views,320,424,390.08,92% of total billed charges for outpatient setting,220.48,52% of total billed charges for outpatient setting,394.32,93% of total billed charges for outpatient setting,381.6,90% of total billed charges for outpatient setting,381.6,90% of total billed charges for outpatient setting,411.28,97% of total billed charges for outpatient setting,51.93,100% of LHI Fee Schedule for Outpatient setting,424,100% of Medicaid WY Fee Schedule for Outpatient setting,220.48,52% of total billed charges for outpatient setting,411.28,97% of total billed charges for outpatient setting,318,75% of total billed charges for outpatient setting,407.04,96% of total billed charges for outpatient setting,220.48,52% of total billed charges for outpatient setting,318,75% of total billed charges for outpatient setting,318,75% of total billed charges for outpatient setting,51.93,424,318
Outpatient Medical Services,RADIOLOGY SERVICES,72100,XR Spine Lumbosacral 2 or 3  Views,320,425,391,92% of total billed charges for outpatient setting,221.00,52% of total billed charges for outpatient setting,395.25,93% of total billed charges for outpatient setting,382.5,90% of total billed charges for outpatient setting,382.5,90% of total billed charges for outpatient setting,412.25,97% of total billed charges for outpatient setting,72.99,100% of LHI Fee Schedule for Outpatient setting,425,100% of Medicaid WY Fee Schedule for Outpatient setting,221.00,52% of total billed charges for outpatient setting,412.25,97% of total billed charges for outpatient setting,318.75,75% of total billed charges for outpatient setting,408,96% of total billed charges for outpatient setting,221.00,52% of total billed charges for outpatient setting,318.75,75% of total billed charges for outpatient setting,318.75,75% of total billed charges for outpatient setting,72.99,425,318.75
Outpatient Medical Services,RADIOLOGY SERVICES,72082,XR Spine Scoliosis 2-3 Views,320,536,493.12,92% of total billed charges for outpatient setting,278.72,52% of total billed charges for outpatient setting,498.48,93% of total billed charges for outpatient setting,482.4,90% of total billed charges for outpatient setting,482.4,90% of total billed charges for outpatient setting,519.92,97% of total billed charges for outpatient setting,N/A,Not Applicable,536,100% of Medicaid WY Fee Schedule for Outpatient setting,278.72,52% of total billed charges for outpatient setting,519.92,97% of total billed charges for outpatient setting,402,75% of total billed charges for outpatient setting,514.56,96% of total billed charges for outpatient setting,278.72,52% of total billed charges for outpatient setting,402,75% of total billed charges for outpatient setting,402,75% of total billed charges for outpatient setting,278.72,536,402
Outpatient Medical Services,RADIOLOGY SERVICES,72072,XR Spine Thoracic 3 Views,320,591,543.72,92% of total billed charges for outpatient setting,307.32,52% of total billed charges for outpatient setting,549.63,93% of total billed charges for outpatient setting,531.9,90% of total billed charges for outpatient setting,531.9,90% of total billed charges for outpatient setting,573.27,97% of total billed charges for outpatient setting,56.92,100% of LHI Fee Schedule for Outpatient setting,591,100% of Medicaid WY Fee Schedule for Outpatient setting,307.32,52% of total billed charges for outpatient setting,573.27,97% of total billed charges for outpatient setting,443.25,75% of total billed charges for outpatient setting,567.36,96% of total billed charges for outpatient setting,307.32,52% of total billed charges for outpatient setting,443.25,75% of total billed charges for outpatient setting,443.25,75% of total billed charges for outpatient setting,56.92,591,443.25
Outpatient Medical Services,RADIOLOGY SERVICES,71120,XR Sternum 2+ Views,324,591,543.72,92% of total billed charges for outpatient setting,307.32,52% of total billed charges for outpatient setting,549.63,93% of total billed charges for outpatient setting,531.9,90% of total billed charges for outpatient setting,531.9,90% of total billed charges for outpatient setting,573.27,97% of total billed charges for outpatient setting,51.66,100% of LHI Fee Schedule for Outpatient setting,591,100% of Medicaid WY Fee Schedule for Outpatient setting,307.32,52% of total billed charges for outpatient setting,573.27,97% of total billed charges for outpatient setting,443.25,75% of total billed charges for outpatient setting,567.36,96% of total billed charges for outpatient setting,307.32,52% of total billed charges for outpatient setting,443.25,75% of total billed charges for outpatient setting,443.25,75% of total billed charges for outpatient setting,51.66,591,443.25
Outpatient Medical Services,RADIOLOGY SERVICES,73590,XR Tibia/Fibula,320,440.1,404.89,92% of total billed charges for outpatient setting,228.85,52% of total billed charges for outpatient setting,409.29,93% of total billed charges for outpatient setting,396.09,90% of total billed charges for outpatient setting,396.09,90% of total billed charges for outpatient setting,426.9,97% of total billed charges for outpatient setting,40.42,100% of LHI Fee Schedule for Outpatient setting,440.1,100% of Medicaid WY Fee Schedule for Outpatient setting,228.85,52% of total billed charges for outpatient setting,426.9,97% of total billed charges for outpatient setting,330.08,75% of total billed charges for outpatient setting,422.5,96% of total billed charges for outpatient setting,228.85,52% of total billed charges for outpatient setting,330.08,75% of total billed charges for outpatient setting,330.08,75% of total billed charges for outpatient setting,40.42,440.1,330.075
Outpatient Medical Services,RADIOLOGY SERVICES,73660,XR Toe(s) 2+ Views,320,329.4,303.05,92% of total billed charges for outpatient setting,171.29,52% of total billed charges for outpatient setting,306.34,93% of total billed charges for outpatient setting,296.46,90% of total billed charges for outpatient setting,296.46,90% of total billed charges for outpatient setting,319.52,97% of total billed charges for outpatient setting,36.57,100% of LHI Fee Schedule for Outpatient setting,329.4,100% of Medicaid WY Fee Schedule for Outpatient setting,171.29,52% of total billed charges for outpatient setting,319.52,97% of total billed charges for outpatient setting,247.05,75% of total billed charges for outpatient setting,316.22,96% of total billed charges for outpatient setting,171.29,52% of total billed charges for outpatient setting,247.05,75% of total billed charges for outpatient setting,247.05,75% of total billed charges for outpatient setting,36.57,329.4,247.05
Outpatient Medical Services,RADIOLOGY SERVICES,74240,XR Upper GI,320,1088,1000.96,92% of total billed charges for outpatient setting,565.76,52% of total billed charges for outpatient setting,1011.84,93% of total billed charges for outpatient setting,979.2,90% of total billed charges for outpatient setting,979.2,90% of total billed charges for outpatient setting,1055.36,97% of total billed charges for outpatient setting,N/A,Not Applicable,1088,100% of Medicaid WY Fee Schedule for Outpatient setting,565.76,52% of total billed charges for outpatient setting,1055.36,97% of total billed charges for outpatient setting,816,75% of total billed charges for outpatient setting,1044.48,96% of total billed charges for outpatient setting,565.76,52% of total billed charges for outpatient setting,816,75% of total billed charges for outpatient setting,816,75% of total billed charges for outpatient setting,565.76,1088,816
Outpatient Medical Services,RADIOLOGY SERVICES,73100,XR Wrist 2 Views,320,272,250.24,92% of total billed charges for outpatient setting,141.44,52% of total billed charges for outpatient setting,252.96,93% of total billed charges for outpatient setting,244.8,90% of total billed charges for outpatient setting,244.8,90% of total billed charges for outpatient setting,263.84,97% of total billed charges for outpatient setting,41.38,100% of LHI Fee Schedule for Outpatient setting,272,100% of Medicaid WY Fee Schedule for Outpatient setting,141.44,52% of total billed charges for outpatient setting,263.84,97% of total billed charges for outpatient setting,204,75% of total billed charges for outpatient setting,261.12,96% of total billed charges for outpatient setting,141.44,52% of total billed charges for outpatient setting,204,75% of total billed charges for outpatient setting,204,75% of total billed charges for outpatient setting,41.38,272,204
Outpatient Medical Services,RADIOLOGY SERVICES,73110,XR Wrist Complete 3+ Views,320,425.25,391.23,92% of total billed charges for outpatient setting,221.13,52% of total billed charges for outpatient setting,395.48,93% of total billed charges for outpatient setting,382.73,90% of total billed charges for outpatient setting,382.73,90% of total billed charges for outpatient setting,412.49,97% of total billed charges for outpatient setting,47.16,100% of LHI Fee Schedule for Outpatient setting,425.25,100% of Medicaid WY Fee Schedule for Outpatient setting,221.13,52% of total billed charges for outpatient setting,412.49,97% of total billed charges for outpatient setting,318.94,75% of total billed charges for outpatient setting,408.24,96% of total billed charges for outpatient setting,221.13,52% of total billed charges for outpatient setting,318.94,75% of total billed charges for outpatient setting,318.94,75% of total billed charges for outpatient setting,47.16,425.25,318.9375
Outpatient Medical Services,RADIOLOGY SERVICES,19281,MG Device Plcmnt w/ Mammo Guide,450,1623,1493.16,92% of total billed charges for outpatient setting,843.96,52% of total billed charges for outpatient setting,1509.39,93% of total billed charges for outpatient setting,1460.7,90% of total billed charges for outpatient setting,1460.7,90% of total billed charges for outpatient setting,1574.31,97% of total billed charges for outpatient setting,N/A,Not Applicable,1623,100% of Medicaid WY Fee Schedule for Outpatient setting,843.96,52% of total billed charges for outpatient setting,1574.31,97% of total billed charges for outpatient setting,1217.25,75% of total billed charges for outpatient setting,1558.08,96% of total billed charges for outpatient setting,843.96,52% of total billed charges for outpatient setting,1217.25,75% of total billed charges for outpatient setting,1217.25,75% of total billed charges for outpatient setting,843.96,1623,1217.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86900,ABO/RH,300,349,321.08,92% of total billed charges for outpatient setting,181.48,52% of total billed charges for outpatient setting,324.57,93% of total billed charges for outpatient setting,314.1,90% of total billed charges for outpatient setting,314.1,90% of total billed charges for outpatient setting,338.53,97% of total billed charges for outpatient setting,N/A,Not Applicable,349,100% of Medicaid WY Fee Schedule for Outpatient setting,181.48,52% of total billed charges for outpatient setting,338.53,97% of total billed charges for outpatient setting,261.75,75% of total billed charges for outpatient setting,335.04,96% of total billed charges for outpatient setting,181.48,52% of total billed charges for outpatient setting,261.75,75% of total billed charges for outpatient setting,261.75,75% of total billed charges for outpatient setting,181.48,349,261.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86015,Actin (Smooth Muscle) Antibody LC,300,60,55.2,92% of total billed charges for outpatient setting,31.20,52% of total billed charges for outpatient setting,55.8,93% of total billed charges for outpatient setting,54,90% of total billed charges for outpatient setting,54,90% of total billed charges for outpatient setting,58.2,97% of total billed charges for outpatient setting,N/A,Not Applicable,60,100% of Medicaid WY Fee Schedule for Outpatient setting,31.20,52% of total billed charges for outpatient setting,58.2,97% of total billed charges for outpatient setting,45,75% of total billed charges for outpatient setting,57.6,96% of total billed charges for outpatient setting,31.20,52% of total billed charges for outpatient setting,45,75% of total billed charges for outpatient setting,45,75% of total billed charges for outpatient setting,31.2,60,45
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87077,Aerobe ID + Suscept LC,300,35,32.2,92% of total billed charges for outpatient setting,18.20,52% of total billed charges for outpatient setting,32.55,93% of total billed charges for outpatient setting,31.5,90% of total billed charges for outpatient setting,31.5,90% of total billed charges for outpatient setting,33.95,97% of total billed charges for outpatient setting,N/A,Not Applicable,35,100% of Medicaid WY Fee Schedule for Outpatient setting,18.20,52% of total billed charges for outpatient setting,33.95,97% of total billed charges for outpatient setting,26.25,75% of total billed charges for outpatient setting,33.6,96% of total billed charges for outpatient setting,18.20,52% of total billed charges for outpatient setting,26.25,75% of total billed charges for outpatient setting,26.25,75% of total billed charges for outpatient setting,18.2,35,26.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82105,"AFP, Serum, Tumor Marker LC",300,189,173.88,92% of total billed charges for outpatient setting,98.28,52% of total billed charges for outpatient setting,175.77,93% of total billed charges for outpatient setting,170.1,90% of total billed charges for outpatient setting,170.1,90% of total billed charges for outpatient setting,183.33,97% of total billed charges for outpatient setting,N/A,Not Applicable,189,100% of Medicaid WY Fee Schedule for Outpatient setting,98.28,52% of total billed charges for outpatient setting,183.33,97% of total billed charges for outpatient setting,141.75,75% of total billed charges for outpatient setting,181.44,96% of total billed charges for outpatient setting,98.28,52% of total billed charges for outpatient setting,141.75,75% of total billed charges for outpatient setting,141.75,75% of total billed charges for outpatient setting,98.28,189,141.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82043,"Albumin, Random Urine LC",300,110,101.2,92% of total billed charges for outpatient setting,57.20,52% of total billed charges for outpatient setting,102.3,93% of total billed charges for outpatient setting,99,90% of total billed charges for outpatient setting,99,90% of total billed charges for outpatient setting,106.7,97% of total billed charges for outpatient setting,N/A,Not Applicable,110,100% of Medicaid WY Fee Schedule for Outpatient setting,57.20,52% of total billed charges for outpatient setting,106.7,97% of total billed charges for outpatient setting,82.5,75% of total billed charges for outpatient setting,105.6,96% of total billed charges for outpatient setting,57.20,52% of total billed charges for outpatient setting,82.5,75% of total billed charges for outpatient setting,82.5,75% of total billed charges for outpatient setting,57.2,110,82.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82085,Aldolase LC,300,77,70.84,92% of total billed charges for outpatient setting,40.04,52% of total billed charges for outpatient setting,71.61,93% of total billed charges for outpatient setting,69.3,90% of total billed charges for outpatient setting,69.3,90% of total billed charges for outpatient setting,74.69,97% of total billed charges for outpatient setting,N/A,Not Applicable,77,100% of Medicaid WY Fee Schedule for Outpatient setting,40.04,52% of total billed charges for outpatient setting,74.69,97% of total billed charges for outpatient setting,57.75,75% of total billed charges for outpatient setting,73.92,96% of total billed charges for outpatient setting,40.04,52% of total billed charges for outpatient setting,57.75,75% of total billed charges for outpatient setting,57.75,75% of total billed charges for outpatient setting,40.04,77,57.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86003,"Allergen Profile, Mold LC",300,24,22.08,92% of total billed charges for outpatient setting,12.48,52% of total billed charges for outpatient setting,22.32,93% of total billed charges for outpatient setting,21.6,90% of total billed charges for outpatient setting,21.6,90% of total billed charges for outpatient setting,23.28,97% of total billed charges for outpatient setting,N/A,Not Applicable,24,100% of Medicaid WY Fee Schedule for Outpatient setting,12.48,52% of total billed charges for outpatient setting,23.28,97% of total billed charges for outpatient setting,18,75% of total billed charges for outpatient setting,23.04,96% of total billed charges for outpatient setting,12.48,52% of total billed charges for outpatient setting,18,75% of total billed charges for outpatient setting,18,75% of total billed charges for outpatient setting,12.48,24,18
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86003,"Allergen Profile, Shellfish LC",300,24,22.08,92% of total billed charges for outpatient setting,12.48,52% of total billed charges for outpatient setting,22.32,93% of total billed charges for outpatient setting,21.6,90% of total billed charges for outpatient setting,21.6,90% of total billed charges for outpatient setting,23.28,97% of total billed charges for outpatient setting,N/A,Not Applicable,24,100% of Medicaid WY Fee Schedule for Outpatient setting,12.48,52% of total billed charges for outpatient setting,23.28,97% of total billed charges for outpatient setting,18,75% of total billed charges for outpatient setting,23.04,96% of total billed charges for outpatient setting,12.48,52% of total billed charges for outpatient setting,18,75% of total billed charges for outpatient setting,18,75% of total billed charges for outpatient setting,12.48,24,18
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82140,Ammonia Level,300,123,113.16,92% of total billed charges for outpatient setting,63.96,52% of total billed charges for outpatient setting,114.39,93% of total billed charges for outpatient setting,110.7,90% of total billed charges for outpatient setting,110.7,90% of total billed charges for outpatient setting,119.31,97% of total billed charges for outpatient setting,N/A,Not Applicable,123,100% of Medicaid WY Fee Schedule for Outpatient setting,63.96,52% of total billed charges for outpatient setting,119.31,97% of total billed charges for outpatient setting,92.25,75% of total billed charges for outpatient setting,118.08,96% of total billed charges for outpatient setting,63.96,52% of total billed charges for outpatient setting,92.25,75% of total billed charges for outpatient setting,92.25,75% of total billed charges for outpatient setting,63.96,123,92.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82150,Amylase Level,300,165,151.8,92% of total billed charges for outpatient setting,85.80,52% of total billed charges for outpatient setting,153.45,93% of total billed charges for outpatient setting,148.5,90% of total billed charges for outpatient setting,148.5,90% of total billed charges for outpatient setting,160.05,97% of total billed charges for outpatient setting,N/A,Not Applicable,165,100% of Medicaid WY Fee Schedule for Outpatient setting,85.80,52% of total billed charges for outpatient setting,160.05,97% of total billed charges for outpatient setting,123.75,75% of total billed charges for outpatient setting,158.4,96% of total billed charges for outpatient setting,85.80,52% of total billed charges for outpatient setting,123.75,75% of total billed charges for outpatient setting,123.75,75% of total billed charges for outpatient setting,85.8,165,123.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87075,Anaerobic Culture,300,106,97.52,92% of total billed charges for outpatient setting,55.12,52% of total billed charges for outpatient setting,98.58,93% of total billed charges for outpatient setting,95.4,90% of total billed charges for outpatient setting,95.4,90% of total billed charges for outpatient setting,102.82,97% of total billed charges for outpatient setting,N/A,Not Applicable,106,100% of Medicaid WY Fee Schedule for Outpatient setting,55.12,52% of total billed charges for outpatient setting,102.82,97% of total billed charges for outpatient setting,79.5,75% of total billed charges for outpatient setting,101.76,96% of total billed charges for outpatient setting,55.12,52% of total billed charges for outpatient setting,79.5,75% of total billed charges for outpatient setting,79.5,75% of total billed charges for outpatient setting,55.12,106,79.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86850,Antibody Screen Gel,300,109,100.28,92% of total billed charges for outpatient setting,56.68,52% of total billed charges for outpatient setting,101.37,93% of total billed charges for outpatient setting,98.1,90% of total billed charges for outpatient setting,98.1,90% of total billed charges for outpatient setting,105.73,97% of total billed charges for outpatient setting,N/A,Not Applicable,109,100% of Medicaid WY Fee Schedule for Outpatient setting,56.68,52% of total billed charges for outpatient setting,105.73,97% of total billed charges for outpatient setting,81.75,75% of total billed charges for outpatient setting,104.64,96% of total billed charges for outpatient setting,56.68,52% of total billed charges for outpatient setting,81.75,75% of total billed charges for outpatient setting,81.75,75% of total billed charges for outpatient setting,56.68,109,81.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86038,"Antinuclear Antibodies, IFA LC",300,150,138,92% of total billed charges for outpatient setting,78.00,52% of total billed charges for outpatient setting,139.5,93% of total billed charges for outpatient setting,135,90% of total billed charges for outpatient setting,135,90% of total billed charges for outpatient setting,145.5,97% of total billed charges for outpatient setting,N/A,Not Applicable,150,100% of Medicaid WY Fee Schedule for Outpatient setting,78.00,52% of total billed charges for outpatient setting,145.5,97% of total billed charges for outpatient setting,112.5,75% of total billed charges for outpatient setting,144,96% of total billed charges for outpatient setting,78.00,52% of total billed charges for outpatient setting,112.5,75% of total billed charges for outpatient setting,112.5,75% of total billed charges for outpatient setting,78,150,112.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82803,Arterial Blood Gas,300,178,163.76,92% of total billed charges for outpatient setting,92.56,52% of total billed charges for outpatient setting,165.54,93% of total billed charges for outpatient setting,160.2,90% of total billed charges for outpatient setting,160.2,90% of total billed charges for outpatient setting,172.66,97% of total billed charges for outpatient setting,N/A,Not Applicable,178,100% of Medicaid WY Fee Schedule for Outpatient setting,92.56,52% of total billed charges for outpatient setting,172.66,97% of total billed charges for outpatient setting,133.5,75% of total billed charges for outpatient setting,170.88,96% of total billed charges for outpatient setting,92.56,52% of total billed charges for outpatient setting,133.5,75% of total billed charges for outpatient setting,133.5,75% of total billed charges for outpatient setting,92.56,178,133.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84702,Beta hCG Quantitative,300,46,42.32,92% of total billed charges for outpatient setting,23.92,52% of total billed charges for outpatient setting,42.78,93% of total billed charges for outpatient setting,41.4,90% of total billed charges for outpatient setting,41.4,90% of total billed charges for outpatient setting,44.62,97% of total billed charges for outpatient setting,N/A,Not Applicable,46,100% of Medicaid WY Fee Schedule for Outpatient setting,23.92,52% of total billed charges for outpatient setting,44.62,97% of total billed charges for outpatient setting,34.5,75% of total billed charges for outpatient setting,44.16,96% of total billed charges for outpatient setting,23.92,52% of total billed charges for outpatient setting,34.5,75% of total billed charges for outpatient setting,34.5,75% of total billed charges for outpatient setting,23.92,46,34.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82232,"Beta -2 Microglobulin, Serum LC",300,203,186.76,92% of total billed charges for outpatient setting,105.56,52% of total billed charges for outpatient setting,188.79,93% of total billed charges for outpatient setting,182.7,90% of total billed charges for outpatient setting,182.7,90% of total billed charges for outpatient setting,196.91,97% of total billed charges for outpatient setting,N/A,Not Applicable,203,100% of Medicaid WY Fee Schedule for Outpatient setting,105.56,52% of total billed charges for outpatient setting,196.91,97% of total billed charges for outpatient setting,152.25,75% of total billed charges for outpatient setting,194.88,96% of total billed charges for outpatient setting,105.56,52% of total billed charges for outpatient setting,152.25,75% of total billed charges for outpatient setting,152.25,75% of total billed charges for outpatient setting,105.56,203,152.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82248,Bilirubin Direct,300,32,29.44,92% of total billed charges for outpatient setting,16.64,52% of total billed charges for outpatient setting,29.76,93% of total billed charges for outpatient setting,28.8,90% of total billed charges for outpatient setting,28.8,90% of total billed charges for outpatient setting,31.04,97% of total billed charges for outpatient setting,N/A,Not Applicable,32,100% of Medicaid WY Fee Schedule for Outpatient setting,16.64,52% of total billed charges for outpatient setting,31.04,97% of total billed charges for outpatient setting,24,75% of total billed charges for outpatient setting,30.72,96% of total billed charges for outpatient setting,16.64,52% of total billed charges for outpatient setting,24,75% of total billed charges for outpatient setting,24,75% of total billed charges for outpatient setting,16.64,32,24
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82247,Bilirubin Total,300,23,21.16,92% of total billed charges for outpatient setting,11.96,52% of total billed charges for outpatient setting,21.39,93% of total billed charges for outpatient setting,20.7,90% of total billed charges for outpatient setting,20.7,90% of total billed charges for outpatient setting,22.31,97% of total billed charges for outpatient setting,N/A,Not Applicable,23,100% of Medicaid WY Fee Schedule for Outpatient setting,11.96,52% of total billed charges for outpatient setting,22.31,97% of total billed charges for outpatient setting,17.25,75% of total billed charges for outpatient setting,22.08,96% of total billed charges for outpatient setting,11.96,52% of total billed charges for outpatient setting,17.25,75% of total billed charges for outpatient setting,17.25,75% of total billed charges for outpatient setting,11.96,23,17.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87799,BKV Quant PCR (Plasma) LC,300,431,396.52,92% of total billed charges for outpatient setting,224.12,52% of total billed charges for outpatient setting,400.83,93% of total billed charges for outpatient setting,387.9,90% of total billed charges for outpatient setting,387.9,90% of total billed charges for outpatient setting,418.07,97% of total billed charges for outpatient setting,N/A,Not Applicable,431,100% of Medicaid WY Fee Schedule for Outpatient setting,224.12,52% of total billed charges for outpatient setting,418.07,97% of total billed charges for outpatient setting,323.25,75% of total billed charges for outpatient setting,413.76,96% of total billed charges for outpatient setting,224.12,52% of total billed charges for outpatient setting,323.25,75% of total billed charges for outpatient setting,323.25,75% of total billed charges for outpatient setting,224.12,431,323.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87040,Blood Culture,300,143,131.56,92% of total billed charges for outpatient setting,74.36,52% of total billed charges for outpatient setting,132.99,93% of total billed charges for outpatient setting,128.7,90% of total billed charges for outpatient setting,128.7,90% of total billed charges for outpatient setting,138.71,97% of total billed charges for outpatient setting,N/A,Not Applicable,143,100% of Medicaid WY Fee Schedule for Outpatient setting,74.36,52% of total billed charges for outpatient setting,138.71,97% of total billed charges for outpatient setting,107.25,75% of total billed charges for outpatient setting,137.28,96% of total billed charges for outpatient setting,74.36,52% of total billed charges for outpatient setting,107.25,75% of total billed charges for outpatient setting,107.25,75% of total billed charges for outpatient setting,74.36,143,107.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82803,Blood Gas Arterial,300,178,163.76,92% of total billed charges for outpatient setting,92.56,52% of total billed charges for outpatient setting,165.54,93% of total billed charges for outpatient setting,160.2,90% of total billed charges for outpatient setting,160.2,90% of total billed charges for outpatient setting,172.66,97% of total billed charges for outpatient setting,N/A,Not Applicable,178,100% of Medicaid WY Fee Schedule for Outpatient setting,92.56,52% of total billed charges for outpatient setting,172.66,97% of total billed charges for outpatient setting,133.5,75% of total billed charges for outpatient setting,170.88,96% of total billed charges for outpatient setting,92.56,52% of total billed charges for outpatient setting,133.5,75% of total billed charges for outpatient setting,133.5,75% of total billed charges for outpatient setting,92.56,178,133.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87070,Body Fluid Culture,300,163,149.96,92% of total billed charges for outpatient setting,84.76,52% of total billed charges for outpatient setting,151.59,93% of total billed charges for outpatient setting,146.7,90% of total billed charges for outpatient setting,146.7,90% of total billed charges for outpatient setting,158.11,97% of total billed charges for outpatient setting,N/A,Not Applicable,163,100% of Medicaid WY Fee Schedule for Outpatient setting,84.76,52% of total billed charges for outpatient setting,158.11,97% of total billed charges for outpatient setting,122.25,75% of total billed charges for outpatient setting,156.48,96% of total billed charges for outpatient setting,84.76,52% of total billed charges for outpatient setting,122.25,75% of total billed charges for outpatient setting,122.25,75% of total billed charges for outpatient setting,84.76,163,122.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82075,Breath Alcohol,300,53,48.76,92% of total billed charges for outpatient setting,27.56,52% of total billed charges for outpatient setting,49.29,93% of total billed charges for outpatient setting,47.7,90% of total billed charges for outpatient setting,47.7,90% of total billed charges for outpatient setting,51.41,97% of total billed charges for outpatient setting,N/A,Not Applicable,53,100% of Medicaid WY Fee Schedule for Outpatient setting,27.56,52% of total billed charges for outpatient setting,51.41,97% of total billed charges for outpatient setting,39.75,75% of total billed charges for outpatient setting,50.88,96% of total billed charges for outpatient setting,27.56,52% of total billed charges for outpatient setting,39.75,75% of total billed charges for outpatient setting,39.75,75% of total billed charges for outpatient setting,27.56,53,39.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87493,C difficile Toxin Gene NAA LC,300,207,190.44,92% of total billed charges for outpatient setting,107.64,52% of total billed charges for outpatient setting,192.51,93% of total billed charges for outpatient setting,186.3,90% of total billed charges for outpatient setting,186.3,90% of total billed charges for outpatient setting,200.79,97% of total billed charges for outpatient setting,N/A,Not Applicable,207,100% of Medicaid WY Fee Schedule for Outpatient setting,107.64,52% of total billed charges for outpatient setting,200.79,97% of total billed charges for outpatient setting,155.25,75% of total billed charges for outpatient setting,198.72,96% of total billed charges for outpatient setting,107.64,52% of total billed charges for outpatient setting,155.25,75% of total billed charges for outpatient setting,155.25,75% of total billed charges for outpatient setting,107.64,207,155.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86301,CA 19-9 LC,300,129,118.68,92% of total billed charges for outpatient setting,67.08,52% of total billed charges for outpatient setting,119.97,93% of total billed charges for outpatient setting,116.1,90% of total billed charges for outpatient setting,116.1,90% of total billed charges for outpatient setting,125.13,97% of total billed charges for outpatient setting,N/A,Not Applicable,129,100% of Medicaid WY Fee Schedule for Outpatient setting,67.08,52% of total billed charges for outpatient setting,125.13,97% of total billed charges for outpatient setting,96.75,75% of total billed charges for outpatient setting,123.84,96% of total billed charges for outpatient setting,67.08,52% of total billed charges for outpatient setting,96.75,75% of total billed charges for outpatient setting,96.75,75% of total billed charges for outpatient setting,67.08,129,96.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86300,CA 27.29 LC,300,215,197.8,92% of total billed charges for outpatient setting,111.80,52% of total billed charges for outpatient setting,199.95,93% of total billed charges for outpatient setting,193.5,90% of total billed charges for outpatient setting,193.5,90% of total billed charges for outpatient setting,208.55,97% of total billed charges for outpatient setting,N/A,Not Applicable,215,100% of Medicaid WY Fee Schedule for Outpatient setting,111.80,52% of total billed charges for outpatient setting,208.55,97% of total billed charges for outpatient setting,161.25,75% of total billed charges for outpatient setting,206.4,96% of total billed charges for outpatient setting,111.80,52% of total billed charges for outpatient setting,161.25,75% of total billed charges for outpatient setting,161.25,75% of total billed charges for outpatient setting,111.8,215,161.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82330,"Calcium, Ionized, Serum LC",300,185,170.2,92% of total billed charges for outpatient setting,96.20,52% of total billed charges for outpatient setting,172.05,93% of total billed charges for outpatient setting,166.5,90% of total billed charges for outpatient setting,166.5,90% of total billed charges for outpatient setting,179.45,97% of total billed charges for outpatient setting,N/A,Not Applicable,185,100% of Medicaid WY Fee Schedule for Outpatient setting,96.20,52% of total billed charges for outpatient setting,179.45,97% of total billed charges for outpatient setting,138.75,75% of total billed charges for outpatient setting,177.6,96% of total billed charges for outpatient setting,96.20,52% of total billed charges for outpatient setting,138.75,75% of total billed charges for outpatient setting,138.75,75% of total billed charges for outpatient setting,96.2,185,138.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82340,"Calcium, Random Urine LC",300,149,137.08,92% of total billed charges for outpatient setting,77.48,52% of total billed charges for outpatient setting,138.57,93% of total billed charges for outpatient setting,134.1,90% of total billed charges for outpatient setting,134.1,90% of total billed charges for outpatient setting,144.53,97% of total billed charges for outpatient setting,N/A,Not Applicable,149,100% of Medicaid WY Fee Schedule for Outpatient setting,77.48,52% of total billed charges for outpatient setting,144.53,97% of total billed charges for outpatient setting,111.75,75% of total billed charges for outpatient setting,143.04,96% of total billed charges for outpatient setting,77.48,52% of total billed charges for outpatient setting,111.75,75% of total billed charges for outpatient setting,111.75,75% of total billed charges for outpatient setting,77.48,149,111.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83993,"Calprotectin, Fecal LC",300,269,247.48,92% of total billed charges for outpatient setting,139.88,52% of total billed charges for outpatient setting,250.17,93% of total billed charges for outpatient setting,242.1,90% of total billed charges for outpatient setting,242.1,90% of total billed charges for outpatient setting,260.93,97% of total billed charges for outpatient setting,N/A,Not Applicable,269,100% of Medicaid WY Fee Schedule for Outpatient setting,139.88,52% of total billed charges for outpatient setting,260.93,97% of total billed charges for outpatient setting,201.75,75% of total billed charges for outpatient setting,258.24,96% of total billed charges for outpatient setting,139.88,52% of total billed charges for outpatient setting,201.75,75% of total billed charges for outpatient setting,201.75,75% of total billed charges for outpatient setting,139.88,269,201.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86304,Cancer Antigen (CA) 125 LC,300,129,118.68,92% of total billed charges for outpatient setting,67.08,52% of total billed charges for outpatient setting,119.97,93% of total billed charges for outpatient setting,116.1,90% of total billed charges for outpatient setting,116.1,90% of total billed charges for outpatient setting,125.13,97% of total billed charges for outpatient setting,N/A,Not Applicable,129,100% of Medicaid WY Fee Schedule for Outpatient setting,67.08,52% of total billed charges for outpatient setting,125.13,97% of total billed charges for outpatient setting,96.75,75% of total billed charges for outpatient setting,123.84,96% of total billed charges for outpatient setting,67.08,52% of total billed charges for outpatient setting,96.75,75% of total billed charges for outpatient setting,96.75,75% of total billed charges for outpatient setting,67.08,129,96.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82378,CEA LC,300,154,141.68,92% of total billed charges for outpatient setting,80.08,52% of total billed charges for outpatient setting,143.22,93% of total billed charges for outpatient setting,138.6,90% of total billed charges for outpatient setting,138.6,90% of total billed charges for outpatient setting,149.38,97% of total billed charges for outpatient setting,N/A,Not Applicable,154,100% of Medicaid WY Fee Schedule for Outpatient setting,80.08,52% of total billed charges for outpatient setting,149.38,97% of total billed charges for outpatient setting,115.5,75% of total billed charges for outpatient setting,147.84,96% of total billed charges for outpatient setting,80.08,52% of total billed charges for outpatient setting,115.5,75% of total billed charges for outpatient setting,115.5,75% of total billed charges for outpatient setting,80.08,154,115.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87491,Chlamydia trachomatis Culture LC,300,189,173.88,92% of total billed charges for outpatient setting,98.28,52% of total billed charges for outpatient setting,175.77,93% of total billed charges for outpatient setting,170.1,90% of total billed charges for outpatient setting,170.1,90% of total billed charges for outpatient setting,183.33,97% of total billed charges for outpatient setting,N/A,Not Applicable,189,100% of Medicaid WY Fee Schedule for Outpatient setting,98.28,52% of total billed charges for outpatient setting,183.33,97% of total billed charges for outpatient setting,141.75,75% of total billed charges for outpatient setting,181.44,96% of total billed charges for outpatient setting,98.28,52% of total billed charges for outpatient setting,141.75,75% of total billed charges for outpatient setting,141.75,75% of total billed charges for outpatient setting,98.28,189,141.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82550,CK,300,78,71.76,92% of total billed charges for outpatient setting,40.56,52% of total billed charges for outpatient setting,72.54,93% of total billed charges for outpatient setting,70.2,90% of total billed charges for outpatient setting,70.2,90% of total billed charges for outpatient setting,75.66,97% of total billed charges for outpatient setting,N/A,Not Applicable,78,100% of Medicaid WY Fee Schedule for Outpatient setting,40.56,52% of total billed charges for outpatient setting,75.66,97% of total billed charges for outpatient setting,58.5,75% of total billed charges for outpatient setting,74.88,96% of total billed charges for outpatient setting,40.56,52% of total billed charges for outpatient setting,58.5,75% of total billed charges for outpatient setting,58.5,75% of total billed charges for outpatient setting,40.56,78,58.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87324,Clostridium Difficile,300,122,112.24,92% of total billed charges for outpatient setting,63.44,52% of total billed charges for outpatient setting,113.46,93% of total billed charges for outpatient setting,109.8,90% of total billed charges for outpatient setting,109.8,90% of total billed charges for outpatient setting,118.34,97% of total billed charges for outpatient setting,N/A,Not Applicable,122,100% of Medicaid WY Fee Schedule for Outpatient setting,63.44,52% of total billed charges for outpatient setting,118.34,97% of total billed charges for outpatient setting,91.5,75% of total billed charges for outpatient setting,117.12,96% of total billed charges for outpatient setting,63.44,52% of total billed charges for outpatient setting,91.5,75% of total billed charges for outpatient setting,91.5,75% of total billed charges for outpatient setting,63.44,122,91.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,36415,Collection Venous Draw,999,,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,N/A,N/A
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86160,"Complement C3, Serum LC",300,233,214.36,92% of total billed charges for outpatient setting,121.16,52% of total billed charges for outpatient setting,216.69,93% of total billed charges for outpatient setting,209.7,90% of total billed charges for outpatient setting,209.7,90% of total billed charges for outpatient setting,226.01,97% of total billed charges for outpatient setting,N/A,Not Applicable,233,100% of Medicaid WY Fee Schedule for Outpatient setting,121.16,52% of total billed charges for outpatient setting,226.01,97% of total billed charges for outpatient setting,174.75,75% of total billed charges for outpatient setting,223.68,96% of total billed charges for outpatient setting,121.16,52% of total billed charges for outpatient setting,174.75,75% of total billed charges for outpatient setting,174.75,75% of total billed charges for outpatient setting,121.16,233,174.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86160,"Complement C4, Serum LC",300,233,214.36,92% of total billed charges for outpatient setting,121.16,52% of total billed charges for outpatient setting,216.69,93% of total billed charges for outpatient setting,209.7,90% of total billed charges for outpatient setting,209.7,90% of total billed charges for outpatient setting,226.01,97% of total billed charges for outpatient setting,N/A,Not Applicable,233,100% of Medicaid WY Fee Schedule for Outpatient setting,121.16,52% of total billed charges for outpatient setting,226.01,97% of total billed charges for outpatient setting,174.75,75% of total billed charges for outpatient setting,223.68,96% of total billed charges for outpatient setting,121.16,52% of total billed charges for outpatient setting,174.75,75% of total billed charges for outpatient setting,174.75,75% of total billed charges for outpatient setting,121.16,233,174.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82525,"Copper, Serum LC",300,113,103.96,92% of total billed charges for outpatient setting,58.76,52% of total billed charges for outpatient setting,105.09,93% of total billed charges for outpatient setting,101.7,90% of total billed charges for outpatient setting,101.7,90% of total billed charges for outpatient setting,109.61,97% of total billed charges for outpatient setting,N/A,Not Applicable,113,100% of Medicaid WY Fee Schedule for Outpatient setting,58.76,52% of total billed charges for outpatient setting,109.61,97% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,108.48,96% of total billed charges for outpatient setting,58.76,52% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,58.76,113,84.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82530,"Cortisol, Urinary Free LC",300,55,50.6,92% of total billed charges for outpatient setting,28.60,52% of total billed charges for outpatient setting,51.15,93% of total billed charges for outpatient setting,49.5,90% of total billed charges for outpatient setting,49.5,90% of total billed charges for outpatient setting,53.35,97% of total billed charges for outpatient setting,N/A,Not Applicable,55,100% of Medicaid WY Fee Schedule for Outpatient setting,28.60,52% of total billed charges for outpatient setting,53.35,97% of total billed charges for outpatient setting,41.25,75% of total billed charges for outpatient setting,52.8,96% of total billed charges for outpatient setting,28.60,52% of total billed charges for outpatient setting,41.25,75% of total billed charges for outpatient setting,41.25,75% of total billed charges for outpatient setting,28.6,55,41.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86140,C-Reactive Protein,300,126,115.92,92% of total billed charges for outpatient setting,65.52,52% of total billed charges for outpatient setting,117.18,93% of total billed charges for outpatient setting,113.4,90% of total billed charges for outpatient setting,113.4,90% of total billed charges for outpatient setting,122.22,97% of total billed charges for outpatient setting,N/A,Not Applicable,126,100% of Medicaid WY Fee Schedule for Outpatient setting,65.52,52% of total billed charges for outpatient setting,122.22,97% of total billed charges for outpatient setting,94.5,75% of total billed charges for outpatient setting,120.96,96% of total billed charges for outpatient setting,65.52,52% of total billed charges for outpatient setting,94.5,75% of total billed charges for outpatient setting,94.5,75% of total billed charges for outpatient setting,65.52,126,94.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82570,"Creatine, 24-Hour Urine LC",300,113,103.96,92% of total billed charges for outpatient setting,58.76,52% of total billed charges for outpatient setting,105.09,93% of total billed charges for outpatient setting,101.7,90% of total billed charges for outpatient setting,101.7,90% of total billed charges for outpatient setting,109.61,97% of total billed charges for outpatient setting,N/A,Not Applicable,113,100% of Medicaid WY Fee Schedule for Outpatient setting,58.76,52% of total billed charges for outpatient setting,109.61,97% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,108.48,96% of total billed charges for outpatient setting,58.76,52% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,58.76,113,84.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82570,"Creatinine, Random U LC",300,113,103.96,92% of total billed charges for outpatient setting,58.76,52% of total billed charges for outpatient setting,105.09,93% of total billed charges for outpatient setting,101.7,90% of total billed charges for outpatient setting,101.7,90% of total billed charges for outpatient setting,109.61,97% of total billed charges for outpatient setting,N/A,Not Applicable,113,100% of Medicaid WY Fee Schedule for Outpatient setting,58.76,52% of total billed charges for outpatient setting,109.61,97% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,108.48,96% of total billed charges for outpatient setting,58.76,52% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,58.76,113,84.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,85379,D-Dimer,300,218,200.56,92% of total billed charges for outpatient setting,113.36,52% of total billed charges for outpatient setting,202.74,93% of total billed charges for outpatient setting,196.2,90% of total billed charges for outpatient setting,196.2,90% of total billed charges for outpatient setting,211.46,97% of total billed charges for outpatient setting,N/A,Not Applicable,218,100% of Medicaid WY Fee Schedule for Outpatient setting,113.36,52% of total billed charges for outpatient setting,211.46,97% of total billed charges for outpatient setting,163.5,75% of total billed charges for outpatient setting,209.28,96% of total billed charges for outpatient setting,113.36,52% of total billed charges for outpatient setting,163.5,75% of total billed charges for outpatient setting,163.5,75% of total billed charges for outpatient setting,113.36,218,163.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82626,"DHEA, Serum LC",300,76,69.92,92% of total billed charges for outpatient setting,39.52,52% of total billed charges for outpatient setting,70.68,93% of total billed charges for outpatient setting,68.4,90% of total billed charges for outpatient setting,68.4,90% of total billed charges for outpatient setting,73.72,97% of total billed charges for outpatient setting,N/A,Not Applicable,76,100% of Medicaid WY Fee Schedule for Outpatient setting,39.52,52% of total billed charges for outpatient setting,73.72,97% of total billed charges for outpatient setting,57,75% of total billed charges for outpatient setting,72.96,96% of total billed charges for outpatient setting,39.52,52% of total billed charges for outpatient setting,57,75% of total billed charges for outpatient setting,57,75% of total billed charges for outpatient setting,39.52,76,57
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,80162,Digoxin Level,300,88,80.96,92% of total billed charges for outpatient setting,45.76,52% of total billed charges for outpatient setting,81.84,93% of total billed charges for outpatient setting,79.2,90% of total billed charges for outpatient setting,79.2,90% of total billed charges for outpatient setting,85.36,97% of total billed charges for outpatient setting,N/A,Not Applicable,88,100% of Medicaid WY Fee Schedule for Outpatient setting,45.76,52% of total billed charges for outpatient setting,85.36,97% of total billed charges for outpatient setting,66,75% of total billed charges for outpatient setting,84.48,96% of total billed charges for outpatient setting,45.76,52% of total billed charges for outpatient setting,66,75% of total billed charges for outpatient setting,66,75% of total billed charges for outpatient setting,45.76,88,66
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,80307,Drug Screen Urine,300,131,120.52,92% of total billed charges for outpatient setting,68.12,52% of total billed charges for outpatient setting,121.83,93% of total billed charges for outpatient setting,117.9,90% of total billed charges for outpatient setting,117.9,90% of total billed charges for outpatient setting,127.07,97% of total billed charges for outpatient setting,N/A,Not Applicable,131,100% of Medicaid WY Fee Schedule for Outpatient setting,68.12,52% of total billed charges for outpatient setting,127.07,97% of total billed charges for outpatient setting,98.25,75% of total billed charges for outpatient setting,125.76,96% of total billed charges for outpatient setting,68.12,52% of total billed charges for outpatient setting,98.25,75% of total billed charges for outpatient setting,98.25,75% of total billed charges for outpatient setting,68.12,131,98.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87798,Epstein-Barr Virus PCR LC,300,375,345,92% of total billed charges for outpatient setting,195.00,52% of total billed charges for outpatient setting,348.75,93% of total billed charges for outpatient setting,337.5,90% of total billed charges for outpatient setting,337.5,90% of total billed charges for outpatient setting,363.75,97% of total billed charges for outpatient setting,N/A,Not Applicable,375,100% of Medicaid WY Fee Schedule for Outpatient setting,195.00,52% of total billed charges for outpatient setting,363.75,97% of total billed charges for outpatient setting,281.25,75% of total billed charges for outpatient setting,360,96% of total billed charges for outpatient setting,195.00,52% of total billed charges for outpatient setting,281.25,75% of total billed charges for outpatient setting,281.25,75% of total billed charges for outpatient setting,195,375,281.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82668,"Erythropoietin (EPO), Serum LC",300,125,115,92% of total billed charges for outpatient setting,65.00,52% of total billed charges for outpatient setting,116.25,93% of total billed charges for outpatient setting,112.5,90% of total billed charges for outpatient setting,112.5,90% of total billed charges for outpatient setting,121.25,97% of total billed charges for outpatient setting,N/A,Not Applicable,125,100% of Medicaid WY Fee Schedule for Outpatient setting,65.00,52% of total billed charges for outpatient setting,121.25,97% of total billed charges for outpatient setting,93.75,75% of total billed charges for outpatient setting,120,96% of total billed charges for outpatient setting,65.00,52% of total billed charges for outpatient setting,93.75,75% of total billed charges for outpatient setting,93.75,75% of total billed charges for outpatient setting,65,125,93.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,85651,ESR,300,70,64.4,92% of total billed charges for outpatient setting,36.40,52% of total billed charges for outpatient setting,65.1,93% of total billed charges for outpatient setting,63,90% of total billed charges for outpatient setting,63,90% of total billed charges for outpatient setting,67.9,97% of total billed charges for outpatient setting,N/A,Not Applicable,70,100% of Medicaid WY Fee Schedule for Outpatient setting,36.40,52% of total billed charges for outpatient setting,67.9,97% of total billed charges for outpatient setting,52.5,75% of total billed charges for outpatient setting,67.2,96% of total billed charges for outpatient setting,36.40,52% of total billed charges for outpatient setting,52.5,75% of total billed charges for outpatient setting,52.5,75% of total billed charges for outpatient setting,36.4,70,52.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82670,Estradiol LC,300,317,291.64,92% of total billed charges for outpatient setting,164.84,52% of total billed charges for outpatient setting,294.81,93% of total billed charges for outpatient setting,285.3,90% of total billed charges for outpatient setting,285.3,90% of total billed charges for outpatient setting,307.49,97% of total billed charges for outpatient setting,N/A,Not Applicable,317,100% of Medicaid WY Fee Schedule for Outpatient setting,164.84,52% of total billed charges for outpatient setting,307.49,97% of total billed charges for outpatient setting,237.75,75% of total billed charges for outpatient setting,304.32,96% of total billed charges for outpatient setting,164.84,52% of total billed charges for outpatient setting,237.75,75% of total billed charges for outpatient setting,237.75,75% of total billed charges for outpatient setting,164.84,317,237.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82728,"Ferritin, Serum LC",300,142,130.64,92% of total billed charges for outpatient setting,73.84,52% of total billed charges for outpatient setting,132.06,93% of total billed charges for outpatient setting,127.8,90% of total billed charges for outpatient setting,127.8,90% of total billed charges for outpatient setting,137.74,97% of total billed charges for outpatient setting,N/A,Not Applicable,142,100% of Medicaid WY Fee Schedule for Outpatient setting,73.84,52% of total billed charges for outpatient setting,137.74,97% of total billed charges for outpatient setting,106.5,75% of total billed charges for outpatient setting,136.32,96% of total billed charges for outpatient setting,73.84,52% of total billed charges for outpatient setting,106.5,75% of total billed charges for outpatient setting,106.5,75% of total billed charges for outpatient setting,73.84,142,106.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,85384,Fibrinogen Level,300,153,140.76,92% of total billed charges for outpatient setting,79.56,52% of total billed charges for outpatient setting,142.29,93% of total billed charges for outpatient setting,137.7,90% of total billed charges for outpatient setting,137.7,90% of total billed charges for outpatient setting,148.41,97% of total billed charges for outpatient setting,N/A,Not Applicable,153,100% of Medicaid WY Fee Schedule for Outpatient setting,79.56,52% of total billed charges for outpatient setting,148.41,97% of total billed charges for outpatient setting,114.75,75% of total billed charges for outpatient setting,146.88,96% of total billed charges for outpatient setting,79.56,52% of total billed charges for outpatient setting,114.75,75% of total billed charges for outpatient setting,114.75,75% of total billed charges for outpatient setting,79.56,153,114.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82746,Folate Level,300,130,119.6,92% of total billed charges for outpatient setting,67.60,52% of total billed charges for outpatient setting,120.9,93% of total billed charges for outpatient setting,117,90% of total billed charges for outpatient setting,117,90% of total billed charges for outpatient setting,126.1,97% of total billed charges for outpatient setting,N/A,Not Applicable,130,100% of Medicaid WY Fee Schedule for Outpatient setting,67.60,52% of total billed charges for outpatient setting,126.1,97% of total billed charges for outpatient setting,97.5,75% of total billed charges for outpatient setting,124.8,96% of total billed charges for outpatient setting,67.60,52% of total billed charges for outpatient setting,97.5,75% of total billed charges for outpatient setting,97.5,75% of total billed charges for outpatient setting,67.6,130,97.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83521,"Free K+L Lt Chains, Qn, S LC",300,70,64.4,92% of total billed charges for outpatient setting,36.40,52% of total billed charges for outpatient setting,65.1,93% of total billed charges for outpatient setting,63,90% of total billed charges for outpatient setting,63,90% of total billed charges for outpatient setting,67.9,97% of total billed charges for outpatient setting,N/A,Not Applicable,70,100% of Medicaid WY Fee Schedule for Outpatient setting,36.40,52% of total billed charges for outpatient setting,67.9,97% of total billed charges for outpatient setting,52.5,75% of total billed charges for outpatient setting,67.2,96% of total billed charges for outpatient setting,36.40,52% of total billed charges for outpatient setting,52.5,75% of total billed charges for outpatient setting,52.5,75% of total billed charges for outpatient setting,36.4,70,52.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84439,Free T4 Level,300,151,138.92,92% of total billed charges for outpatient setting,78.52,52% of total billed charges for outpatient setting,140.43,93% of total billed charges for outpatient setting,135.9,90% of total billed charges for outpatient setting,135.9,90% of total billed charges for outpatient setting,146.47,97% of total billed charges for outpatient setting,N/A,Not Applicable,151,100% of Medicaid WY Fee Schedule for Outpatient setting,78.52,52% of total billed charges for outpatient setting,146.47,97% of total billed charges for outpatient setting,113.25,75% of total billed charges for outpatient setting,144.96,96% of total billed charges for outpatient setting,78.52,52% of total billed charges for outpatient setting,113.25,75% of total billed charges for outpatient setting,113.25,75% of total billed charges for outpatient setting,78.52,151,113.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83001,"FSH, Serum LC",300,172,158.24,92% of total billed charges for outpatient setting,89.44,52% of total billed charges for outpatient setting,159.96,93% of total billed charges for outpatient setting,154.8,90% of total billed charges for outpatient setting,154.8,90% of total billed charges for outpatient setting,166.84,97% of total billed charges for outpatient setting,N/A,Not Applicable,172,100% of Medicaid WY Fee Schedule for Outpatient setting,89.44,52% of total billed charges for outpatient setting,166.84,97% of total billed charges for outpatient setting,129,75% of total billed charges for outpatient setting,165.12,96% of total billed charges for outpatient setting,89.44,52% of total billed charges for outpatient setting,129,75% of total billed charges for outpatient setting,129,75% of total billed charges for outpatient setting,89.44,172,129
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87507,"GI Profile, Stool, PCR LC",300,874,804.08,92% of total billed charges for outpatient setting,454.48,52% of total billed charges for outpatient setting,812.82,93% of total billed charges for outpatient setting,786.6,90% of total billed charges for outpatient setting,786.6,90% of total billed charges for outpatient setting,847.78,97% of total billed charges for outpatient setting,N/A,Not Applicable,874,100% of Medicaid WY Fee Schedule for Outpatient setting,454.48,52% of total billed charges for outpatient setting,847.78,97% of total billed charges for outpatient setting,655.5,75% of total billed charges for outpatient setting,839.04,96% of total billed charges for outpatient setting,454.48,52% of total billed charges for outpatient setting,655.5,75% of total billed charges for outpatient setting,655.5,75% of total billed charges for outpatient setting,454.48,874,655.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87329,"Giardia lamblia Ag, EIA LC",300,88,80.96,92% of total billed charges for outpatient setting,45.76,52% of total billed charges for outpatient setting,81.84,93% of total billed charges for outpatient setting,79.2,90% of total billed charges for outpatient setting,79.2,90% of total billed charges for outpatient setting,85.36,97% of total billed charges for outpatient setting,N/A,Not Applicable,88,100% of Medicaid WY Fee Schedule for Outpatient setting,45.76,52% of total billed charges for outpatient setting,85.36,97% of total billed charges for outpatient setting,66,75% of total billed charges for outpatient setting,84.48,96% of total billed charges for outpatient setting,45.76,52% of total billed charges for outpatient setting,66,75% of total billed charges for outpatient setting,66,75% of total billed charges for outpatient setting,45.76,88,66
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82950,Glucose Tolerance 1 Hr - 50gm,300,59,54.28,92% of total billed charges for outpatient setting,30.68,52% of total billed charges for outpatient setting,54.87,93% of total billed charges for outpatient setting,53.1,90% of total billed charges for outpatient setting,53.1,90% of total billed charges for outpatient setting,57.23,97% of total billed charges for outpatient setting,N/A,Not Applicable,59,100% of Medicaid WY Fee Schedule for Outpatient setting,30.68,52% of total billed charges for outpatient setting,57.23,97% of total billed charges for outpatient setting,44.25,75% of total billed charges for outpatient setting,56.64,96% of total billed charges for outpatient setting,30.68,52% of total billed charges for outpatient setting,44.25,75% of total billed charges for outpatient setting,44.25,75% of total billed charges for outpatient setting,30.68,59,44.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82951,Glucose Tolerance 3 Hr - 100gm,300,141,129.72,92% of total billed charges for outpatient setting,73.32,52% of total billed charges for outpatient setting,131.13,93% of total billed charges for outpatient setting,126.9,90% of total billed charges for outpatient setting,126.9,90% of total billed charges for outpatient setting,136.77,97% of total billed charges for outpatient setting,N/A,Not Applicable,141,100% of Medicaid WY Fee Schedule for Outpatient setting,73.32,52% of total billed charges for outpatient setting,136.77,97% of total billed charges for outpatient setting,105.75,75% of total billed charges for outpatient setting,135.36,96% of total billed charges for outpatient setting,73.32,52% of total billed charges for outpatient setting,105.75,75% of total billed charges for outpatient setting,105.75,75% of total billed charges for outpatient setting,73.32,141,105.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87338,"H. pylori Stool Ag, EIA LC",300,203,186.76,92% of total billed charges for outpatient setting,105.56,52% of total billed charges for outpatient setting,188.79,93% of total billed charges for outpatient setting,182.7,90% of total billed charges for outpatient setting,182.7,90% of total billed charges for outpatient setting,196.91,97% of total billed charges for outpatient setting,N/A,Not Applicable,203,100% of Medicaid WY Fee Schedule for Outpatient setting,105.56,52% of total billed charges for outpatient setting,196.91,97% of total billed charges for outpatient setting,152.25,75% of total billed charges for outpatient setting,194.88,96% of total billed charges for outpatient setting,105.56,52% of total billed charges for outpatient setting,152.25,75% of total billed charges for outpatient setting,152.25,75% of total billed charges for outpatient setting,105.56,203,152.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83010,Haptoglobin LC,300,76,69.92,92% of total billed charges for outpatient setting,39.52,52% of total billed charges for outpatient setting,70.68,93% of total billed charges for outpatient setting,68.4,90% of total billed charges for outpatient setting,68.4,90% of total billed charges for outpatient setting,73.72,97% of total billed charges for outpatient setting,N/A,Not Applicable,76,100% of Medicaid WY Fee Schedule for Outpatient setting,39.52,52% of total billed charges for outpatient setting,73.72,97% of total billed charges for outpatient setting,57,75% of total billed charges for outpatient setting,72.96,96% of total billed charges for outpatient setting,39.52,52% of total billed charges for outpatient setting,57,75% of total billed charges for outpatient setting,57,75% of total billed charges for outpatient setting,39.52,76,57
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84702,HCG Tumor Marker LC,300,46,42.32,92% of total billed charges for outpatient setting,23.92,52% of total billed charges for outpatient setting,42.78,93% of total billed charges for outpatient setting,41.4,90% of total billed charges for outpatient setting,41.4,90% of total billed charges for outpatient setting,44.62,97% of total billed charges for outpatient setting,N/A,Not Applicable,46,100% of Medicaid WY Fee Schedule for Outpatient setting,23.92,52% of total billed charges for outpatient setting,44.62,97% of total billed charges for outpatient setting,34.5,75% of total billed charges for outpatient setting,44.16,96% of total billed charges for outpatient setting,23.92,52% of total billed charges for outpatient setting,34.5,75% of total billed charges for outpatient setting,34.5,75% of total billed charges for outpatient setting,23.92,46,34.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87902,HCV Genotyping Non Reflex LC,300,773,711.16,92% of total billed charges for outpatient setting,401.96,52% of total billed charges for outpatient setting,718.89,93% of total billed charges for outpatient setting,695.7,90% of total billed charges for outpatient setting,695.7,90% of total billed charges for outpatient setting,749.81,97% of total billed charges for outpatient setting,N/A,Not Applicable,773,100% of Medicaid WY Fee Schedule for Outpatient setting,401.96,52% of total billed charges for outpatient setting,749.81,97% of total billed charges for outpatient setting,579.75,75% of total billed charges for outpatient setting,742.08,96% of total billed charges for outpatient setting,401.96,52% of total billed charges for outpatient setting,579.75,75% of total billed charges for outpatient setting,579.75,75% of total billed charges for outpatient setting,401.96,773,579.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,85018,Hematocrit,300,26,23.92,92% of total billed charges for outpatient setting,13.52,52% of total billed charges for outpatient setting,24.18,93% of total billed charges for outpatient setting,23.4,90% of total billed charges for outpatient setting,23.4,90% of total billed charges for outpatient setting,25.22,97% of total billed charges for outpatient setting,N/A,Not Applicable,26,100% of Medicaid WY Fee Schedule for Outpatient setting,13.52,52% of total billed charges for outpatient setting,25.22,97% of total billed charges for outpatient setting,19.5,75% of total billed charges for outpatient setting,24.96,96% of total billed charges for outpatient setting,13.52,52% of total billed charges for outpatient setting,19.5,75% of total billed charges for outpatient setting,19.5,75% of total billed charges for outpatient setting,13.52,26,19.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83036,Hemoglobin A1c,300,10.83,9.96,92% of total billed charges for outpatient setting,5.63,52% of total billed charges for outpatient setting,10.07,93% of total billed charges for outpatient setting,9.75,90% of total billed charges for outpatient setting,9.75,90% of total billed charges for outpatient setting,10.51,97% of total billed charges for outpatient setting,N/A,Not Applicable,10.83,100% of Medicaid WY Fee Schedule for Outpatient setting,5.63,52% of total billed charges for outpatient setting,10.51,97% of total billed charges for outpatient setting,8.12,75% of total billed charges for outpatient setting,10.4,96% of total billed charges for outpatient setting,5.63,52% of total billed charges for outpatient setting,8.12,75% of total billed charges for outpatient setting,8.12,75% of total billed charges for outpatient setting,5.63,10.83,8.1225
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86709,"Hep A Ab, IgM LC",300,105,96.6,92% of total billed charges for outpatient setting,54.60,52% of total billed charges for outpatient setting,97.65,93% of total billed charges for outpatient setting,94.5,90% of total billed charges for outpatient setting,94.5,90% of total billed charges for outpatient setting,101.85,97% of total billed charges for outpatient setting,N/A,Not Applicable,105,100% of Medicaid WY Fee Schedule for Outpatient setting,54.60,52% of total billed charges for outpatient setting,101.85,97% of total billed charges for outpatient setting,78.75,75% of total billed charges for outpatient setting,100.8,96% of total billed charges for outpatient setting,54.60,52% of total billed charges for outpatient setting,78.75,75% of total billed charges for outpatient setting,78.75,75% of total billed charges for outpatient setting,54.6,105,78.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86708,"Hep A Ab, Total LC",300,132,121.44,92% of total billed charges for outpatient setting,68.64,52% of total billed charges for outpatient setting,122.76,93% of total billed charges for outpatient setting,118.8,90% of total billed charges for outpatient setting,118.8,90% of total billed charges for outpatient setting,128.04,97% of total billed charges for outpatient setting,N/A,Not Applicable,132,100% of Medicaid WY Fee Schedule for Outpatient setting,68.64,52% of total billed charges for outpatient setting,128.04,97% of total billed charges for outpatient setting,99,75% of total billed charges for outpatient setting,126.72,96% of total billed charges for outpatient setting,68.64,52% of total billed charges for outpatient setting,99,75% of total billed charges for outpatient setting,99,75% of total billed charges for outpatient setting,68.64,132,99
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86704,Hep B Core Ab Surf Ab Quant LC,300,55,50.6,92% of total billed charges for outpatient setting,28.60,52% of total billed charges for outpatient setting,51.15,93% of total billed charges for outpatient setting,49.5,90% of total billed charges for outpatient setting,49.5,90% of total billed charges for outpatient setting,53.35,97% of total billed charges for outpatient setting,N/A,Not Applicable,55,100% of Medicaid WY Fee Schedule for Outpatient setting,28.60,52% of total billed charges for outpatient setting,53.35,97% of total billed charges for outpatient setting,41.25,75% of total billed charges for outpatient setting,52.8,96% of total billed charges for outpatient setting,28.60,52% of total billed charges for outpatient setting,41.25,75% of total billed charges for outpatient setting,41.25,75% of total billed charges for outpatient setting,28.6,55,41.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86707,Hep Be Ab LC,300,59,54.28,92% of total billed charges for outpatient setting,30.68,52% of total billed charges for outpatient setting,54.87,93% of total billed charges for outpatient setting,53.1,90% of total billed charges for outpatient setting,53.1,90% of total billed charges for outpatient setting,57.23,97% of total billed charges for outpatient setting,N/A,Not Applicable,59,100% of Medicaid WY Fee Schedule for Outpatient setting,30.68,52% of total billed charges for outpatient setting,57.23,97% of total billed charges for outpatient setting,44.25,75% of total billed charges for outpatient setting,56.64,96% of total billed charges for outpatient setting,30.68,52% of total billed charges for outpatient setting,44.25,75% of total billed charges for outpatient setting,44.25,75% of total billed charges for outpatient setting,30.68,59,44.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87350,Hep Be Ag LC,300,59,54.28,92% of total billed charges for outpatient setting,30.68,52% of total billed charges for outpatient setting,54.87,93% of total billed charges for outpatient setting,53.1,90% of total billed charges for outpatient setting,53.1,90% of total billed charges for outpatient setting,57.23,97% of total billed charges for outpatient setting,N/A,Not Applicable,59,100% of Medicaid WY Fee Schedule for Outpatient setting,30.68,52% of total billed charges for outpatient setting,57.23,97% of total billed charges for outpatient setting,44.25,75% of total billed charges for outpatient setting,56.64,96% of total billed charges for outpatient setting,30.68,52% of total billed charges for outpatient setting,44.25,75% of total billed charges for outpatient setting,44.25,75% of total billed charges for outpatient setting,30.68,59,44.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,85520,Heparin Anti-Xa LC,300,150,138,92% of total billed charges for outpatient setting,78.00,52% of total billed charges for outpatient setting,139.5,93% of total billed charges for outpatient setting,135,90% of total billed charges for outpatient setting,135,90% of total billed charges for outpatient setting,145.5,97% of total billed charges for outpatient setting,N/A,Not Applicable,150,100% of Medicaid WY Fee Schedule for Outpatient setting,78.00,52% of total billed charges for outpatient setting,145.5,97% of total billed charges for outpatient setting,112.5,75% of total billed charges for outpatient setting,144,96% of total billed charges for outpatient setting,78.00,52% of total billed charges for outpatient setting,112.5,75% of total billed charges for outpatient setting,112.5,75% of total billed charges for outpatient setting,78,150,112.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86317,Hepatitis B Surf Ab Quant LC,300,37,34.04,92% of total billed charges for outpatient setting,19.24,52% of total billed charges for outpatient setting,34.41,93% of total billed charges for outpatient setting,33.3,90% of total billed charges for outpatient setting,33.3,90% of total billed charges for outpatient setting,35.89,97% of total billed charges for outpatient setting,N/A,Not Applicable,37,100% of Medicaid WY Fee Schedule for Outpatient setting,19.24,52% of total billed charges for outpatient setting,35.89,97% of total billed charges for outpatient setting,27.75,75% of total billed charges for outpatient setting,35.52,96% of total billed charges for outpatient setting,19.24,52% of total billed charges for outpatient setting,27.75,75% of total billed charges for outpatient setting,27.75,75% of total billed charges for outpatient setting,19.24,37,27.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87340,Hepatitis B Surface Antigen,300,98,90.16,92% of total billed charges for outpatient setting,50.96,52% of total billed charges for outpatient setting,91.14,93% of total billed charges for outpatient setting,88.2,90% of total billed charges for outpatient setting,88.2,90% of total billed charges for outpatient setting,95.06,97% of total billed charges for outpatient setting,N/A,Not Applicable,98,100% of Medicaid WY Fee Schedule for Outpatient setting,50.96,52% of total billed charges for outpatient setting,95.06,97% of total billed charges for outpatient setting,73.5,75% of total billed charges for outpatient setting,94.08,96% of total billed charges for outpatient setting,50.96,52% of total billed charges for outpatient setting,73.5,75% of total billed charges for outpatient setting,73.5,75% of total billed charges for outpatient setting,50.96,98,73.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86803,Hepatitis C Antibody TC,300,97,89.24,92% of total billed charges for outpatient setting,50.44,52% of total billed charges for outpatient setting,90.21,93% of total billed charges for outpatient setting,87.3,90% of total billed charges for outpatient setting,87.3,90% of total billed charges for outpatient setting,94.09,97% of total billed charges for outpatient setting,N/A,Not Applicable,97,100% of Medicaid WY Fee Schedule for Outpatient setting,50.44,52% of total billed charges for outpatient setting,94.09,97% of total billed charges for outpatient setting,72.75,75% of total billed charges for outpatient setting,93.12,96% of total billed charges for outpatient setting,50.44,52% of total billed charges for outpatient setting,72.75,75% of total billed charges for outpatient setting,72.75,75% of total billed charges for outpatient setting,50.44,97,72.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86703,HIV 1/2 Ab Scrn,300,113,103.96,92% of total billed charges for outpatient setting,58.76,52% of total billed charges for outpatient setting,105.09,93% of total billed charges for outpatient setting,101.7,90% of total billed charges for outpatient setting,101.7,90% of total billed charges for outpatient setting,109.61,97% of total billed charges for outpatient setting,N/A,Not Applicable,113,100% of Medicaid WY Fee Schedule for Outpatient setting,58.76,52% of total billed charges for outpatient setting,109.61,97% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,108.48,96% of total billed charges for outpatient setting,58.76,52% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,84.75,75% of total billed charges for outpatient setting,58.76,113,84.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86695,"HSV 1 IgG, Type Spec LC",300,82,75.44,92% of total billed charges for outpatient setting,42.64,52% of total billed charges for outpatient setting,76.26,93% of total billed charges for outpatient setting,73.8,90% of total billed charges for outpatient setting,73.8,90% of total billed charges for outpatient setting,79.54,97% of total billed charges for outpatient setting,N/A,Not Applicable,82,100% of Medicaid WY Fee Schedule for Outpatient setting,42.64,52% of total billed charges for outpatient setting,79.54,97% of total billed charges for outpatient setting,61.5,75% of total billed charges for outpatient setting,78.72,96% of total billed charges for outpatient setting,42.64,52% of total billed charges for outpatient setting,61.5,75% of total billed charges for outpatient setting,61.5,75% of total billed charges for outpatient setting,42.64,82,61.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87529,HSV 1/2 PCR LC,300,203,186.76,92% of total billed charges for outpatient setting,105.56,52% of total billed charges for outpatient setting,188.79,93% of total billed charges for outpatient setting,182.7,90% of total billed charges for outpatient setting,182.7,90% of total billed charges for outpatient setting,196.91,97% of total billed charges for outpatient setting,N/A,Not Applicable,203,100% of Medicaid WY Fee Schedule for Outpatient setting,105.56,52% of total billed charges for outpatient setting,196.91,97% of total billed charges for outpatient setting,152.25,75% of total billed charges for outpatient setting,194.88,96% of total billed charges for outpatient setting,105.56,52% of total billed charges for outpatient setting,152.25,75% of total billed charges for outpatient setting,152.25,75% of total billed charges for outpatient setting,105.56,203,152.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86696,"HSV-2 Type Spec Ab, IgG w/Rflx LC",300,104,95.68,92% of total billed charges for outpatient setting,54.08,52% of total billed charges for outpatient setting,96.72,93% of total billed charges for outpatient setting,93.6,90% of total billed charges for outpatient setting,93.6,90% of total billed charges for outpatient setting,100.88,97% of total billed charges for outpatient setting,N/A,Not Applicable,104,100% of Medicaid WY Fee Schedule for Outpatient setting,54.08,52% of total billed charges for outpatient setting,100.88,97% of total billed charges for outpatient setting,78,75% of total billed charges for outpatient setting,99.84,96% of total billed charges for outpatient setting,54.08,52% of total billed charges for outpatient setting,78,75% of total billed charges for outpatient setting,78,75% of total billed charges for outpatient setting,54.08,104,78
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82784,"Immunoglobulin A, Qn, Serum LC",300,90,82.8,92% of total billed charges for outpatient setting,46.80,52% of total billed charges for outpatient setting,83.7,93% of total billed charges for outpatient setting,81,90% of total billed charges for outpatient setting,81,90% of total billed charges for outpatient setting,87.3,97% of total billed charges for outpatient setting,N/A,Not Applicable,90,100% of Medicaid WY Fee Schedule for Outpatient setting,46.80,52% of total billed charges for outpatient setting,87.3,97% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,86.4,96% of total billed charges for outpatient setting,46.80,52% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,46.8,90,67.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82785,"Immunoglobulin E, Total LC",300,80,73.6,92% of total billed charges for outpatient setting,41.60,52% of total billed charges for outpatient setting,74.4,93% of total billed charges for outpatient setting,72,90% of total billed charges for outpatient setting,72,90% of total billed charges for outpatient setting,77.6,97% of total billed charges for outpatient setting,N/A,Not Applicable,80,100% of Medicaid WY Fee Schedule for Outpatient setting,41.60,52% of total billed charges for outpatient setting,77.6,97% of total billed charges for outpatient setting,60,75% of total billed charges for outpatient setting,76.8,96% of total billed charges for outpatient setting,41.60,52% of total billed charges for outpatient setting,60,75% of total billed charges for outpatient setting,60,75% of total billed charges for outpatient setting,41.6,80,60
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82785,"Immunoglobulin E, Ttl LC",300,80,73.6,92% of total billed charges for outpatient setting,41.60,52% of total billed charges for outpatient setting,74.4,93% of total billed charges for outpatient setting,72,90% of total billed charges for outpatient setting,72,90% of total billed charges for outpatient setting,77.6,97% of total billed charges for outpatient setting,N/A,Not Applicable,80,100% of Medicaid WY Fee Schedule for Outpatient setting,41.60,52% of total billed charges for outpatient setting,77.6,97% of total billed charges for outpatient setting,60,75% of total billed charges for outpatient setting,76.8,96% of total billed charges for outpatient setting,41.60,52% of total billed charges for outpatient setting,60,75% of total billed charges for outpatient setting,60,75% of total billed charges for outpatient setting,41.6,80,60
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82784,"Immunoglobulin G, Qn, Serum LC",300,90,82.8,92% of total billed charges for outpatient setting,46.80,52% of total billed charges for outpatient setting,83.7,93% of total billed charges for outpatient setting,81,90% of total billed charges for outpatient setting,81,90% of total billed charges for outpatient setting,87.3,97% of total billed charges for outpatient setting,N/A,Not Applicable,90,100% of Medicaid WY Fee Schedule for Outpatient setting,46.80,52% of total billed charges for outpatient setting,87.3,97% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,86.4,96% of total billed charges for outpatient setting,46.80,52% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,46.8,90,67.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82784,"Immunoglobulin M, Qn, Serum LC",300,90,82.8,92% of total billed charges for outpatient setting,46.80,52% of total billed charges for outpatient setting,83.7,93% of total billed charges for outpatient setting,81,90% of total billed charges for outpatient setting,81,90% of total billed charges for outpatient setting,87.3,97% of total billed charges for outpatient setting,N/A,Not Applicable,90,100% of Medicaid WY Fee Schedule for Outpatient setting,46.80,52% of total billed charges for outpatient setting,87.3,97% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,86.4,96% of total billed charges for outpatient setting,46.80,52% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,67.5,75% of total billed charges for outpatient setting,46.8,90,67.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83525,Insulin LC,300,188,172.96,92% of total billed charges for outpatient setting,97.76,52% of total billed charges for outpatient setting,174.84,93% of total billed charges for outpatient setting,169.2,90% of total billed charges for outpatient setting,169.2,90% of total billed charges for outpatient setting,182.36,97% of total billed charges for outpatient setting,N/A,Not Applicable,188,100% of Medicaid WY Fee Schedule for Outpatient setting,97.76,52% of total billed charges for outpatient setting,182.36,97% of total billed charges for outpatient setting,141,75% of total billed charges for outpatient setting,180.48,96% of total billed charges for outpatient setting,97.76,52% of total billed charges for outpatient setting,141,75% of total billed charges for outpatient setting,141,75% of total billed charges for outpatient setting,97.76,188,141
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83540,Iron Level,300,104,95.68,92% of total billed charges for outpatient setting,54.08,52% of total billed charges for outpatient setting,96.72,93% of total billed charges for outpatient setting,93.6,90% of total billed charges for outpatient setting,93.6,90% of total billed charges for outpatient setting,100.88,97% of total billed charges for outpatient setting,N/A,Not Applicable,104,100% of Medicaid WY Fee Schedule for Outpatient setting,54.08,52% of total billed charges for outpatient setting,100.88,97% of total billed charges for outpatient setting,78,75% of total billed charges for outpatient setting,99.84,96% of total billed charges for outpatient setting,54.08,52% of total billed charges for outpatient setting,78,75% of total billed charges for outpatient setting,78,75% of total billed charges for outpatient setting,54.08,104,78
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,81270,"JAK2 Mutation Analysis, Qual LC",300,463,425.96,92% of total billed charges for outpatient setting,240.76,52% of total billed charges for outpatient setting,430.59,93% of total billed charges for outpatient setting,416.7,90% of total billed charges for outpatient setting,416.7,90% of total billed charges for outpatient setting,449.11,97% of total billed charges for outpatient setting,N/A,Not Applicable,463,100% of Medicaid WY Fee Schedule for Outpatient setting,240.76,52% of total billed charges for outpatient setting,449.11,97% of total billed charges for outpatient setting,347.25,75% of total billed charges for outpatient setting,444.48,96% of total billed charges for outpatient setting,240.76,52% of total billed charges for outpatient setting,347.25,75% of total billed charges for outpatient setting,347.25,75% of total billed charges for outpatient setting,240.76,463,347.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83615,Lactate Dehydrogenase,300,77,70.84,92% of total billed charges for outpatient setting,40.04,52% of total billed charges for outpatient setting,71.61,93% of total billed charges for outpatient setting,69.3,90% of total billed charges for outpatient setting,69.3,90% of total billed charges for outpatient setting,74.69,97% of total billed charges for outpatient setting,N/A,Not Applicable,77,100% of Medicaid WY Fee Schedule for Outpatient setting,40.04,52% of total billed charges for outpatient setting,74.69,97% of total billed charges for outpatient setting,57.75,75% of total billed charges for outpatient setting,73.92,96% of total billed charges for outpatient setting,40.04,52% of total billed charges for outpatient setting,57.75,75% of total billed charges for outpatient setting,57.75,75% of total billed charges for outpatient setting,40.04,77,57.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83605,Lactic Acid,300,38,34.96,92% of total billed charges for outpatient setting,19.76,52% of total billed charges for outpatient setting,35.34,93% of total billed charges for outpatient setting,34.2,90% of total billed charges for outpatient setting,34.2,90% of total billed charges for outpatient setting,36.86,97% of total billed charges for outpatient setting,N/A,Not Applicable,38,100% of Medicaid WY Fee Schedule for Outpatient setting,19.76,52% of total billed charges for outpatient setting,36.86,97% of total billed charges for outpatient setting,28.5,75% of total billed charges for outpatient setting,36.48,96% of total billed charges for outpatient setting,19.76,52% of total billed charges for outpatient setting,28.5,75% of total billed charges for outpatient setting,28.5,75% of total billed charges for outpatient setting,19.76,38,28.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,80177,"Levetiracetam (Keppra), S LC",300,135,124.2,92% of total billed charges for outpatient setting,70.20,52% of total billed charges for outpatient setting,125.55,93% of total billed charges for outpatient setting,121.5,90% of total billed charges for outpatient setting,121.5,90% of total billed charges for outpatient setting,130.95,97% of total billed charges for outpatient setting,N/A,Not Applicable,135,100% of Medicaid WY Fee Schedule for Outpatient setting,70.20,52% of total billed charges for outpatient setting,130.95,97% of total billed charges for outpatient setting,101.25,75% of total billed charges for outpatient setting,129.6,96% of total billed charges for outpatient setting,70.20,52% of total billed charges for outpatient setting,101.25,75% of total billed charges for outpatient setting,101.25,75% of total billed charges for outpatient setting,70.2,135,101.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83690,Lipase Level,300,163,149.96,92% of total billed charges for outpatient setting,84.76,52% of total billed charges for outpatient setting,151.59,93% of total billed charges for outpatient setting,146.7,90% of total billed charges for outpatient setting,146.7,90% of total billed charges for outpatient setting,158.11,97% of total billed charges for outpatient setting,N/A,Not Applicable,163,100% of Medicaid WY Fee Schedule for Outpatient setting,84.76,52% of total billed charges for outpatient setting,158.11,97% of total billed charges for outpatient setting,122.25,75% of total billed charges for outpatient setting,156.48,96% of total billed charges for outpatient setting,84.76,52% of total billed charges for outpatient setting,122.25,75% of total billed charges for outpatient setting,122.25,75% of total billed charges for outpatient setting,84.76,163,122.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,80178,Lithium Lvl,300,82,75.44,92% of total billed charges for outpatient setting,42.64,52% of total billed charges for outpatient setting,76.26,93% of total billed charges for outpatient setting,73.8,90% of total billed charges for outpatient setting,73.8,90% of total billed charges for outpatient setting,79.54,97% of total billed charges for outpatient setting,N/A,Not Applicable,82,100% of Medicaid WY Fee Schedule for Outpatient setting,42.64,52% of total billed charges for outpatient setting,79.54,97% of total billed charges for outpatient setting,61.5,75% of total billed charges for outpatient setting,78.72,96% of total billed charges for outpatient setting,42.64,52% of total billed charges for outpatient setting,61.5,75% of total billed charges for outpatient setting,61.5,75% of total billed charges for outpatient setting,42.64,82,61.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83002,"Luteinizing Hormone (LH), S LC",300,172,158.24,92% of total billed charges for outpatient setting,89.44,52% of total billed charges for outpatient setting,159.96,93% of total billed charges for outpatient setting,154.8,90% of total billed charges for outpatient setting,154.8,90% of total billed charges for outpatient setting,166.84,97% of total billed charges for outpatient setting,N/A,Not Applicable,172,100% of Medicaid WY Fee Schedule for Outpatient setting,89.44,52% of total billed charges for outpatient setting,166.84,97% of total billed charges for outpatient setting,129,75% of total billed charges for outpatient setting,165.12,96% of total billed charges for outpatient setting,89.44,52% of total billed charges for outpatient setting,129,75% of total billed charges for outpatient setting,129,75% of total billed charges for outpatient setting,89.44,172,129
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86618,Lyme Disease Serology w/Reflex LC,300,134,123.28,92% of total billed charges for outpatient setting,69.68,52% of total billed charges for outpatient setting,124.62,93% of total billed charges for outpatient setting,120.6,90% of total billed charges for outpatient setting,120.6,90% of total billed charges for outpatient setting,129.98,97% of total billed charges for outpatient setting,N/A,Not Applicable,134,100% of Medicaid WY Fee Schedule for Outpatient setting,69.68,52% of total billed charges for outpatient setting,129.98,97% of total billed charges for outpatient setting,100.5,75% of total billed charges for outpatient setting,128.64,96% of total billed charges for outpatient setting,69.68,52% of total billed charges for outpatient setting,100.5,75% of total billed charges for outpatient setting,100.5,75% of total billed charges for outpatient setting,69.68,134,100.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83735,Magnesium Level,300,78,71.76,92% of total billed charges for outpatient setting,40.56,52% of total billed charges for outpatient setting,72.54,93% of total billed charges for outpatient setting,70.2,90% of total billed charges for outpatient setting,70.2,90% of total billed charges for outpatient setting,75.66,97% of total billed charges for outpatient setting,N/A,Not Applicable,78,100% of Medicaid WY Fee Schedule for Outpatient setting,40.56,52% of total billed charges for outpatient setting,75.66,97% of total billed charges for outpatient setting,58.5,75% of total billed charges for outpatient setting,74.88,96% of total billed charges for outpatient setting,40.56,52% of total billed charges for outpatient setting,58.5,75% of total billed charges for outpatient setting,58.5,75% of total billed charges for outpatient setting,40.56,78,58.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87070,MRSA Culture,300,163,149.96,92% of total billed charges for outpatient setting,84.76,52% of total billed charges for outpatient setting,151.59,93% of total billed charges for outpatient setting,146.7,90% of total billed charges for outpatient setting,146.7,90% of total billed charges for outpatient setting,158.11,97% of total billed charges for outpatient setting,N/A,Not Applicable,163,100% of Medicaid WY Fee Schedule for Outpatient setting,84.76,52% of total billed charges for outpatient setting,158.11,97% of total billed charges for outpatient setting,122.25,75% of total billed charges for outpatient setting,156.48,96% of total billed charges for outpatient setting,84.76,52% of total billed charges for outpatient setting,122.25,75% of total billed charges for outpatient setting,122.25,75% of total billed charges for outpatient setting,84.76,163,122.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86735,"Mumps Antibodies, IgG LC",300,89,81.88,92% of total billed charges for outpatient setting,46.28,52% of total billed charges for outpatient setting,82.77,93% of total billed charges for outpatient setting,80.1,90% of total billed charges for outpatient setting,80.1,90% of total billed charges for outpatient setting,86.33,97% of total billed charges for outpatient setting,N/A,Not Applicable,89,100% of Medicaid WY Fee Schedule for Outpatient setting,46.28,52% of total billed charges for outpatient setting,86.33,97% of total billed charges for outpatient setting,66.75,75% of total billed charges for outpatient setting,85.44,96% of total billed charges for outpatient setting,46.28,52% of total billed charges for outpatient setting,66.75,75% of total billed charges for outpatient setting,66.75,75% of total billed charges for outpatient setting,46.28,89,66.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82270,Occult Blood Screen,300,67,61.64,92% of total billed charges for outpatient setting,34.84,52% of total billed charges for outpatient setting,62.31,93% of total billed charges for outpatient setting,60.3,90% of total billed charges for outpatient setting,60.3,90% of total billed charges for outpatient setting,64.99,97% of total billed charges for outpatient setting,N/A,Not Applicable,67,100% of Medicaid WY Fee Schedule for Outpatient setting,34.84,52% of total billed charges for outpatient setting,64.99,97% of total billed charges for outpatient setting,50.25,75% of total billed charges for outpatient setting,64.32,96% of total billed charges for outpatient setting,34.84,52% of total billed charges for outpatient setting,50.25,75% of total billed charges for outpatient setting,50.25,75% of total billed charges for outpatient setting,34.84,67,50.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87177,Ova + Parasite Status LC,300,222,204.24,92% of total billed charges for outpatient setting,115.44,52% of total billed charges for outpatient setting,206.46,93% of total billed charges for outpatient setting,199.8,90% of total billed charges for outpatient setting,199.8,90% of total billed charges for outpatient setting,215.34,97% of total billed charges for outpatient setting,N/A,Not Applicable,222,100% of Medicaid WY Fee Schedule for Outpatient setting,115.44,52% of total billed charges for outpatient setting,215.34,97% of total billed charges for outpatient setting,166.5,75% of total billed charges for outpatient setting,213.12,96% of total billed charges for outpatient setting,115.44,52% of total billed charges for outpatient setting,166.5,75% of total billed charges for outpatient setting,166.5,75% of total billed charges for outpatient setting,115.44,222,166.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82653,"Pancreatic Elastase, Fecal LC",300,100,92,92% of total billed charges for outpatient setting,52.00,52% of total billed charges for outpatient setting,93,93% of total billed charges for outpatient setting,90,90% of total billed charges for outpatient setting,90,90% of total billed charges for outpatient setting,97,97% of total billed charges for outpatient setting,N/A,Not Applicable,100,100% of Medicaid WY Fee Schedule for Outpatient setting,52.00,52% of total billed charges for outpatient setting,97,97% of total billed charges for outpatient setting,75,75% of total billed charges for outpatient setting,96,96% of total billed charges for outpatient setting,52.00,52% of total billed charges for outpatient setting,75,75% of total billed charges for outpatient setting,75,75% of total billed charges for outpatient setting,52,100,75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84100,Phosphorus Level,300,17,15.64,92% of total billed charges for outpatient setting,8.84,52% of total billed charges for outpatient setting,15.81,93% of total billed charges for outpatient setting,15.3,90% of total billed charges for outpatient setting,15.3,90% of total billed charges for outpatient setting,16.49,97% of total billed charges for outpatient setting,N/A,Not Applicable,17,100% of Medicaid WY Fee Schedule for Outpatient setting,8.84,52% of total billed charges for outpatient setting,16.49,97% of total billed charges for outpatient setting,12.75,75% of total billed charges for outpatient setting,16.32,96% of total billed charges for outpatient setting,8.84,52% of total billed charges for outpatient setting,12.75,75% of total billed charges for outpatient setting,12.75,75% of total billed charges for outpatient setting,8.84,17,12.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84105,"Phosphorus, Random Urine LC",300,133,122.36,92% of total billed charges for outpatient setting,69.16,52% of total billed charges for outpatient setting,123.69,93% of total billed charges for outpatient setting,119.7,90% of total billed charges for outpatient setting,119.7,90% of total billed charges for outpatient setting,129.01,97% of total billed charges for outpatient setting,N/A,Not Applicable,133,100% of Medicaid WY Fee Schedule for Outpatient setting,69.16,52% of total billed charges for outpatient setting,129.01,97% of total billed charges for outpatient setting,99.75,75% of total billed charges for outpatient setting,127.68,96% of total billed charges for outpatient setting,69.16,52% of total billed charges for outpatient setting,99.75,75% of total billed charges for outpatient setting,99.75,75% of total billed charges for outpatient setting,69.16,133,99.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84132,Potassium Lvl,300,39,35.88,92% of total billed charges for outpatient setting,20.28,52% of total billed charges for outpatient setting,36.27,93% of total billed charges for outpatient setting,35.1,90% of total billed charges for outpatient setting,35.1,90% of total billed charges for outpatient setting,37.83,97% of total billed charges for outpatient setting,N/A,Not Applicable,39,100% of Medicaid WY Fee Schedule for Outpatient setting,20.28,52% of total billed charges for outpatient setting,37.83,97% of total billed charges for outpatient setting,29.25,75% of total billed charges for outpatient setting,37.44,96% of total billed charges for outpatient setting,20.28,52% of total billed charges for outpatient setting,29.25,75% of total billed charges for outpatient setting,29.25,75% of total billed charges for outpatient setting,20.28,39,29.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84134,Prealbumin LC,300,74,68.08,92% of total billed charges for outpatient setting,38.48,52% of total billed charges for outpatient setting,68.82,93% of total billed charges for outpatient setting,66.6,90% of total billed charges for outpatient setting,66.6,90% of total billed charges for outpatient setting,71.78,97% of total billed charges for outpatient setting,N/A,Not Applicable,74,100% of Medicaid WY Fee Schedule for Outpatient setting,38.48,52% of total billed charges for outpatient setting,71.78,97% of total billed charges for outpatient setting,55.5,75% of total billed charges for outpatient setting,71.04,96% of total billed charges for outpatient setting,38.48,52% of total billed charges for outpatient setting,55.5,75% of total billed charges for outpatient setting,55.5,75% of total billed charges for outpatient setting,38.48,74,55.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84145,Procalcitonin LC,300,223,205.16,92% of total billed charges for outpatient setting,115.96,52% of total billed charges for outpatient setting,207.39,93% of total billed charges for outpatient setting,200.7,90% of total billed charges for outpatient setting,200.7,90% of total billed charges for outpatient setting,216.31,97% of total billed charges for outpatient setting,N/A,Not Applicable,223,100% of Medicaid WY Fee Schedule for Outpatient setting,115.96,52% of total billed charges for outpatient setting,216.31,97% of total billed charges for outpatient setting,167.25,75% of total billed charges for outpatient setting,214.08,96% of total billed charges for outpatient setting,115.96,52% of total billed charges for outpatient setting,167.25,75% of total billed charges for outpatient setting,167.25,75% of total billed charges for outpatient setting,115.96,223,167.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84144,Progesterone LC,300,63,57.96,92% of total billed charges for outpatient setting,32.76,52% of total billed charges for outpatient setting,58.59,93% of total billed charges for outpatient setting,56.7,90% of total billed charges for outpatient setting,56.7,90% of total billed charges for outpatient setting,61.11,97% of total billed charges for outpatient setting,N/A,Not Applicable,63,100% of Medicaid WY Fee Schedule for Outpatient setting,32.76,52% of total billed charges for outpatient setting,61.11,97% of total billed charges for outpatient setting,47.25,75% of total billed charges for outpatient setting,60.48,96% of total billed charges for outpatient setting,32.76,52% of total billed charges for outpatient setting,47.25,75% of total billed charges for outpatient setting,47.25,75% of total billed charges for outpatient setting,32.76,63,47.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84146,Prolactin LC,300,183,168.36,92% of total billed charges for outpatient setting,95.16,52% of total billed charges for outpatient setting,170.19,93% of total billed charges for outpatient setting,164.7,90% of total billed charges for outpatient setting,164.7,90% of total billed charges for outpatient setting,177.51,97% of total billed charges for outpatient setting,N/A,Not Applicable,183,100% of Medicaid WY Fee Schedule for Outpatient setting,95.16,52% of total billed charges for outpatient setting,177.51,97% of total billed charges for outpatient setting,137.25,75% of total billed charges for outpatient setting,175.68,96% of total billed charges for outpatient setting,95.16,52% of total billed charges for outpatient setting,137.25,75% of total billed charges for outpatient setting,137.25,75% of total billed charges for outpatient setting,95.16,183,137.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84155,Protein Total,300,37,34.04,92% of total billed charges for outpatient setting,19.24,52% of total billed charges for outpatient setting,34.41,93% of total billed charges for outpatient setting,33.3,90% of total billed charges for outpatient setting,33.3,90% of total billed charges for outpatient setting,35.89,97% of total billed charges for outpatient setting,N/A,Not Applicable,37,100% of Medicaid WY Fee Schedule for Outpatient setting,19.24,52% of total billed charges for outpatient setting,35.89,97% of total billed charges for outpatient setting,27.75,75% of total billed charges for outpatient setting,35.52,96% of total billed charges for outpatient setting,19.24,52% of total billed charges for outpatient setting,27.75,75% of total billed charges for outpatient setting,27.75,75% of total billed charges for outpatient setting,19.24,37,27.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84156,"Protein Total, Qn, 24hr Ur LC",300,120,110.4,92% of total billed charges for outpatient setting,62.40,52% of total billed charges for outpatient setting,111.6,93% of total billed charges for outpatient setting,108,90% of total billed charges for outpatient setting,108,90% of total billed charges for outpatient setting,116.4,97% of total billed charges for outpatient setting,N/A,Not Applicable,120,100% of Medicaid WY Fee Schedule for Outpatient setting,62.40,52% of total billed charges for outpatient setting,116.4,97% of total billed charges for outpatient setting,90,75% of total billed charges for outpatient setting,115.2,96% of total billed charges for outpatient setting,62.40,52% of total billed charges for outpatient setting,90,75% of total billed charges for outpatient setting,90,75% of total billed charges for outpatient setting,62.4,120,90
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84153,PSA Diagnostic,300,56,51.52,92% of total billed charges for outpatient setting,29.12,52% of total billed charges for outpatient setting,52.08,93% of total billed charges for outpatient setting,50.4,90% of total billed charges for outpatient setting,50.4,90% of total billed charges for outpatient setting,54.32,97% of total billed charges for outpatient setting,34.16,100% of LHI Fee Schedule for Outpatient setting,56,100% of Medicaid WY Fee Schedule for Outpatient setting,29.12,52% of total billed charges for outpatient setting,54.32,97% of total billed charges for outpatient setting,42,75% of total billed charges for outpatient setting,53.76,96% of total billed charges for outpatient setting,29.12,52% of total billed charges for outpatient setting,42,75% of total billed charges for outpatient setting,42,75% of total billed charges for outpatient setting,29.12,56,42
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84153,PSA Screen,300,56,51.52,92% of total billed charges for outpatient setting,29.12,52% of total billed charges for outpatient setting,52.08,93% of total billed charges for outpatient setting,50.4,90% of total billed charges for outpatient setting,50.4,90% of total billed charges for outpatient setting,54.32,97% of total billed charges for outpatient setting,34.16,100% of LHI Fee Schedule for Outpatient setting,56,100% of Medicaid WY Fee Schedule for Outpatient setting,29.12,52% of total billed charges for outpatient setting,54.32,97% of total billed charges for outpatient setting,42,75% of total billed charges for outpatient setting,53.76,96% of total billed charges for outpatient setting,29.12,52% of total billed charges for outpatient setting,42,75% of total billed charges for outpatient setting,42,75% of total billed charges for outpatient setting,29.12,56,42
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83970,"PTH, Intact LC",300,277,254.84,92% of total billed charges for outpatient setting,144.04,52% of total billed charges for outpatient setting,257.61,93% of total billed charges for outpatient setting,249.3,90% of total billed charges for outpatient setting,249.3,90% of total billed charges for outpatient setting,268.69,97% of total billed charges for outpatient setting,N/A,Not Applicable,277,100% of Medicaid WY Fee Schedule for Outpatient setting,144.04,52% of total billed charges for outpatient setting,268.69,97% of total billed charges for outpatient setting,207.75,75% of total billed charges for outpatient setting,265.92,96% of total billed charges for outpatient setting,144.04,52% of total billed charges for outpatient setting,207.75,75% of total billed charges for outpatient setting,207.75,75% of total billed charges for outpatient setting,144.04,277,207.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86480,QuantiFERON-TB Gold Plus LC,300,186,171.12,92% of total billed charges for outpatient setting,96.72,52% of total billed charges for outpatient setting,172.98,93% of total billed charges for outpatient setting,167.4,90% of total billed charges for outpatient setting,167.4,90% of total billed charges for outpatient setting,180.42,97% of total billed charges for outpatient setting,N/A,Not Applicable,186,100% of Medicaid WY Fee Schedule for Outpatient setting,96.72,52% of total billed charges for outpatient setting,180.42,97% of total billed charges for outpatient setting,139.5,75% of total billed charges for outpatient setting,178.56,96% of total billed charges for outpatient setting,96.72,52% of total billed charges for outpatient setting,139.5,75% of total billed charges for outpatient setting,139.5,75% of total billed charges for outpatient setting,96.72,186,139.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84244,"Renin Activity, Plasma LC",300,66,60.72,92% of total billed charges for outpatient setting,34.32,52% of total billed charges for outpatient setting,61.38,93% of total billed charges for outpatient setting,59.4,90% of total billed charges for outpatient setting,59.4,90% of total billed charges for outpatient setting,64.02,97% of total billed charges for outpatient setting,N/A,Not Applicable,66,100% of Medicaid WY Fee Schedule for Outpatient setting,34.32,52% of total billed charges for outpatient setting,64.02,97% of total billed charges for outpatient setting,49.5,75% of total billed charges for outpatient setting,63.36,96% of total billed charges for outpatient setting,34.32,52% of total billed charges for outpatient setting,49.5,75% of total billed charges for outpatient setting,49.5,75% of total billed charges for outpatient setting,34.32,66,49.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87637,Respiratory Panel 2.1 (BioFire),352,5320,4894.4,92% of total billed charges for outpatient setting,2766.40,52% of total billed charges for outpatient setting,4947.6,93% of total billed charges for outpatient setting,4788,90% of total billed charges for outpatient setting,4788,90% of total billed charges for outpatient setting,5160.4,97% of total billed charges for outpatient setting,N/A,Not Applicable,5320,100% of Medicaid WY Fee Schedule for Outpatient setting,2766.40,52% of total billed charges for outpatient setting,5160.4,97% of total billed charges for outpatient setting,3990,75% of total billed charges for outpatient setting,5107.2,96% of total billed charges for outpatient setting,2766.40,52% of total billed charges for outpatient setting,3990,75% of total billed charges for outpatient setting,3990,75% of total billed charges for outpatient setting,2766.4,5320,3990
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86431,Rheumatoid Arthritis Factor LC,300,54,49.68,92% of total billed charges for outpatient setting,28.08,52% of total billed charges for outpatient setting,50.22,93% of total billed charges for outpatient setting,48.6,90% of total billed charges for outpatient setting,48.6,90% of total billed charges for outpatient setting,52.38,97% of total billed charges for outpatient setting,N/A,Not Applicable,54,100% of Medicaid WY Fee Schedule for Outpatient setting,28.08,52% of total billed charges for outpatient setting,52.38,97% of total billed charges for outpatient setting,40.5,75% of total billed charges for outpatient setting,51.84,96% of total billed charges for outpatient setting,28.08,52% of total billed charges for outpatient setting,40.5,75% of total billed charges for outpatient setting,40.5,75% of total billed charges for outpatient setting,28.08,54,40.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86762,Rubella IgG,300,100,92,92% of total billed charges for outpatient setting,52.00,52% of total billed charges for outpatient setting,93,93% of total billed charges for outpatient setting,90,90% of total billed charges for outpatient setting,90,90% of total billed charges for outpatient setting,97,97% of total billed charges for outpatient setting,N/A,Not Applicable,100,100% of Medicaid WY Fee Schedule for Outpatient setting,52.00,52% of total billed charges for outpatient setting,97,97% of total billed charges for outpatient setting,75,75% of total billed charges for outpatient setting,96,96% of total billed charges for outpatient setting,52.00,52% of total billed charges for outpatient setting,75,75% of total billed charges for outpatient setting,75,75% of total billed charges for outpatient setting,52,100,75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86765,"Rubeola Antibodies, IgG LC",300,55,50.6,92% of total billed charges for outpatient setting,28.60,52% of total billed charges for outpatient setting,51.15,93% of total billed charges for outpatient setting,49.5,90% of total billed charges for outpatient setting,49.5,90% of total billed charges for outpatient setting,53.35,97% of total billed charges for outpatient setting,N/A,Not Applicable,55,100% of Medicaid WY Fee Schedule for Outpatient setting,28.60,52% of total billed charges for outpatient setting,53.35,97% of total billed charges for outpatient setting,41.25,75% of total billed charges for outpatient setting,52.8,96% of total billed charges for outpatient setting,28.60,52% of total billed charges for outpatient setting,41.25,75% of total billed charges for outpatient setting,41.25,75% of total billed charges for outpatient setting,28.6,55,41.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84295,Sodium Level,300,37,34.04,92% of total billed charges for outpatient setting,19.24,52% of total billed charges for outpatient setting,34.41,93% of total billed charges for outpatient setting,33.3,90% of total billed charges for outpatient setting,33.3,90% of total billed charges for outpatient setting,35.89,97% of total billed charges for outpatient setting,N/A,Not Applicable,37,100% of Medicaid WY Fee Schedule for Outpatient setting,19.24,52% of total billed charges for outpatient setting,35.89,97% of total billed charges for outpatient setting,27.75,75% of total billed charges for outpatient setting,35.52,96% of total billed charges for outpatient setting,19.24,52% of total billed charges for outpatient setting,27.75,75% of total billed charges for outpatient setting,27.75,75% of total billed charges for outpatient setting,19.24,37,27.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84300,"Sodium, 24 hr Urine LC",300,100,92,92% of total billed charges for outpatient setting,52.00,52% of total billed charges for outpatient setting,93,93% of total billed charges for outpatient setting,90,90% of total billed charges for outpatient setting,90,90% of total billed charges for outpatient setting,97,97% of total billed charges for outpatient setting,N/A,Not Applicable,100,100% of Medicaid WY Fee Schedule for Outpatient setting,52.00,52% of total billed charges for outpatient setting,97,97% of total billed charges for outpatient setting,75,75% of total billed charges for outpatient setting,96,96% of total billed charges for outpatient setting,52.00,52% of total billed charges for outpatient setting,75,75% of total billed charges for outpatient setting,75,75% of total billed charges for outpatient setting,52,100,75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87045,Stool Culture,300,180,165.6,92% of total billed charges for outpatient setting,93.60,52% of total billed charges for outpatient setting,167.4,93% of total billed charges for outpatient setting,162,90% of total billed charges for outpatient setting,162,90% of total billed charges for outpatient setting,174.6,97% of total billed charges for outpatient setting,N/A,Not Applicable,180,100% of Medicaid WY Fee Schedule for Outpatient setting,93.60,52% of total billed charges for outpatient setting,174.6,97% of total billed charges for outpatient setting,135,75% of total billed charges for outpatient setting,172.8,96% of total billed charges for outpatient setting,93.60,52% of total billed charges for outpatient setting,135,75% of total billed charges for outpatient setting,135,75% of total billed charges for outpatient setting,93.6,180,135
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87880,Strep A Screen POCT,352,3186,2931.12,92% of total billed charges for outpatient setting,1656.72,52% of total billed charges for outpatient setting,2962.98,93% of total billed charges for outpatient setting,2867.4,90% of total billed charges for outpatient setting,2867.4,90% of total billed charges for outpatient setting,3090.42,97% of total billed charges for outpatient setting,N/A,Not Applicable,3186,100% of Medicaid WY Fee Schedule for Outpatient setting,1656.72,52% of total billed charges for outpatient setting,3090.42,97% of total billed charges for outpatient setting,2389.5,75% of total billed charges for outpatient setting,3058.56,96% of total billed charges for outpatient setting,1656.72,52% of total billed charges for outpatient setting,2389.5,75% of total billed charges for outpatient setting,2389.5,75% of total billed charges for outpatient setting,1656.72,3186,2389.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84481,T3 Free,300,159,146.28,92% of total billed charges for outpatient setting,82.68,52% of total billed charges for outpatient setting,147.87,93% of total billed charges for outpatient setting,143.1,90% of total billed charges for outpatient setting,143.1,90% of total billed charges for outpatient setting,154.23,97% of total billed charges for outpatient setting,N/A,Not Applicable,159,100% of Medicaid WY Fee Schedule for Outpatient setting,82.68,52% of total billed charges for outpatient setting,154.23,97% of total billed charges for outpatient setting,119.25,75% of total billed charges for outpatient setting,152.64,96% of total billed charges for outpatient setting,82.68,52% of total billed charges for outpatient setting,119.25,75% of total billed charges for outpatient setting,119.25,75% of total billed charges for outpatient setting,82.68,159,119.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,80197,"Tacrolimus (FK506), Blood LC/MS LC",300,327,300.84,92% of total billed charges for outpatient setting,170.04,52% of total billed charges for outpatient setting,304.11,93% of total billed charges for outpatient setting,294.3,90% of total billed charges for outpatient setting,294.3,90% of total billed charges for outpatient setting,317.19,97% of total billed charges for outpatient setting,N/A,Not Applicable,327,100% of Medicaid WY Fee Schedule for Outpatient setting,170.04,52% of total billed charges for outpatient setting,317.19,97% of total billed charges for outpatient setting,245.25,75% of total billed charges for outpatient setting,313.92,96% of total billed charges for outpatient setting,170.04,52% of total billed charges for outpatient setting,245.25,75% of total billed charges for outpatient setting,245.25,75% of total billed charges for outpatient setting,170.04,327,245.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84403,Testosterone Level Total,300,247,227.24,92% of total billed charges for outpatient setting,128.44,52% of total billed charges for outpatient setting,229.71,93% of total billed charges for outpatient setting,222.3,90% of total billed charges for outpatient setting,222.3,90% of total billed charges for outpatient setting,239.59,97% of total billed charges for outpatient setting,N/A,Not Applicable,247,100% of Medicaid WY Fee Schedule for Outpatient setting,128.44,52% of total billed charges for outpatient setting,239.59,97% of total billed charges for outpatient setting,185.25,75% of total billed charges for outpatient setting,237.12,96% of total billed charges for outpatient setting,128.44,52% of total billed charges for outpatient setting,185.25,75% of total billed charges for outpatient setting,185.25,75% of total billed charges for outpatient setting,128.44,247,185.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84402,"Testosterone, Free Direct LC",300,200,184,92% of total billed charges for outpatient setting,104.00,52% of total billed charges for outpatient setting,186,93% of total billed charges for outpatient setting,180,90% of total billed charges for outpatient setting,180,90% of total billed charges for outpatient setting,194,97% of total billed charges for outpatient setting,N/A,Not Applicable,200,100% of Medicaid WY Fee Schedule for Outpatient setting,104.00,52% of total billed charges for outpatient setting,194,97% of total billed charges for outpatient setting,150,75% of total billed charges for outpatient setting,192,96% of total billed charges for outpatient setting,104.00,52% of total billed charges for outpatient setting,150,75% of total billed charges for outpatient setting,150,75% of total billed charges for outpatient setting,104,200,150
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,99195,Therapeutic Phlebotomy,300,284,261.28,92% of total billed charges for outpatient setting,147.68,52% of total billed charges for outpatient setting,264.12,93% of total billed charges for outpatient setting,255.6,90% of total billed charges for outpatient setting,255.6,90% of total billed charges for outpatient setting,275.48,97% of total billed charges for outpatient setting,N/A,Not Applicable,284,100% of Medicaid WY Fee Schedule for Outpatient setting,147.68,52% of total billed charges for outpatient setting,275.48,97% of total billed charges for outpatient setting,213,75% of total billed charges for outpatient setting,272.64,96% of total billed charges for outpatient setting,147.68,52% of total billed charges for outpatient setting,213,75% of total billed charges for outpatient setting,213,75% of total billed charges for outpatient setting,147.68,284,213
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86800,Thyroglobulin Antibody LC,300,53,48.76,92% of total billed charges for outpatient setting,27.56,52% of total billed charges for outpatient setting,49.29,93% of total billed charges for outpatient setting,47.7,90% of total billed charges for outpatient setting,47.7,90% of total billed charges for outpatient setting,51.41,97% of total billed charges for outpatient setting,N/A,Not Applicable,53,100% of Medicaid WY Fee Schedule for Outpatient setting,27.56,52% of total billed charges for outpatient setting,51.41,97% of total billed charges for outpatient setting,39.75,75% of total billed charges for outpatient setting,50.88,96% of total billed charges for outpatient setting,27.56,52% of total billed charges for outpatient setting,39.75,75% of total billed charges for outpatient setting,39.75,75% of total billed charges for outpatient setting,27.56,53,39.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86376,Thyroid Peroxidase (TPO) Ab LC,300,111,102.12,92% of total billed charges for outpatient setting,57.72,52% of total billed charges for outpatient setting,103.23,93% of total billed charges for outpatient setting,99.9,90% of total billed charges for outpatient setting,99.9,90% of total billed charges for outpatient setting,107.67,97% of total billed charges for outpatient setting,N/A,Not Applicable,111,100% of Medicaid WY Fee Schedule for Outpatient setting,57.72,52% of total billed charges for outpatient setting,107.67,97% of total billed charges for outpatient setting,83.25,75% of total billed charges for outpatient setting,106.56,96% of total billed charges for outpatient setting,57.72,52% of total billed charges for outpatient setting,83.25,75% of total billed charges for outpatient setting,83.25,75% of total billed charges for outpatient setting,57.72,111,83.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84436,Thyroxine (T4) LC,300,76,69.92,92% of total billed charges for outpatient setting,39.52,52% of total billed charges for outpatient setting,70.68,93% of total billed charges for outpatient setting,68.4,90% of total billed charges for outpatient setting,68.4,90% of total billed charges for outpatient setting,73.72,97% of total billed charges for outpatient setting,N/A,Not Applicable,76,100% of Medicaid WY Fee Schedule for Outpatient setting,39.52,52% of total billed charges for outpatient setting,73.72,97% of total billed charges for outpatient setting,57,75% of total billed charges for outpatient setting,72.96,96% of total billed charges for outpatient setting,39.52,52% of total billed charges for outpatient setting,57,75% of total billed charges for outpatient setting,57,75% of total billed charges for outpatient setting,39.52,76,57
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83550,Total Iron Binding Capacity,300,104,95.68,92% of total billed charges for outpatient setting,54.08,52% of total billed charges for outpatient setting,96.72,93% of total billed charges for outpatient setting,93.6,90% of total billed charges for outpatient setting,93.6,90% of total billed charges for outpatient setting,100.88,97% of total billed charges for outpatient setting,N/A,Not Applicable,104,100% of Medicaid WY Fee Schedule for Outpatient setting,54.08,52% of total billed charges for outpatient setting,100.88,97% of total billed charges for outpatient setting,78,75% of total billed charges for outpatient setting,99.84,96% of total billed charges for outpatient setting,54.08,52% of total billed charges for outpatient setting,78,75% of total billed charges for outpatient setting,78,75% of total billed charges for outpatient setting,54.08,104,78
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84484,Troponin-I,300,131,120.52,92% of total billed charges for outpatient setting,68.12,52% of total billed charges for outpatient setting,121.83,93% of total billed charges for outpatient setting,117.9,90% of total billed charges for outpatient setting,117.9,90% of total billed charges for outpatient setting,127.07,97% of total billed charges for outpatient setting,N/A,Not Applicable,131,100% of Medicaid WY Fee Schedule for Outpatient setting,68.12,52% of total billed charges for outpatient setting,127.07,97% of total billed charges for outpatient setting,98.25,75% of total billed charges for outpatient setting,125.76,96% of total billed charges for outpatient setting,68.12,52% of total billed charges for outpatient setting,98.25,75% of total billed charges for outpatient setting,98.25,75% of total billed charges for outpatient setting,68.12,131,98.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,83520,Tryptase LC,300,237,218.04,92% of total billed charges for outpatient setting,123.24,52% of total billed charges for outpatient setting,220.41,93% of total billed charges for outpatient setting,213.3,90% of total billed charges for outpatient setting,213.3,90% of total billed charges for outpatient setting,229.89,97% of total billed charges for outpatient setting,N/A,Not Applicable,237,100% of Medicaid WY Fee Schedule for Outpatient setting,123.24,52% of total billed charges for outpatient setting,229.89,97% of total billed charges for outpatient setting,177.75,75% of total billed charges for outpatient setting,227.52,96% of total billed charges for outpatient setting,123.24,52% of total billed charges for outpatient setting,177.75,75% of total billed charges for outpatient setting,177.75,75% of total billed charges for outpatient setting,123.24,237,177.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86364,t-Transglutaminase (tTG) IgA LC,300,29,26.68,92% of total billed charges for outpatient setting,15.08,52% of total billed charges for outpatient setting,26.97,93% of total billed charges for outpatient setting,26.1,90% of total billed charges for outpatient setting,26.1,90% of total billed charges for outpatient setting,28.13,97% of total billed charges for outpatient setting,N/A,Not Applicable,29,100% of Medicaid WY Fee Schedule for Outpatient setting,15.08,52% of total billed charges for outpatient setting,28.13,97% of total billed charges for outpatient setting,21.75,75% of total billed charges for outpatient setting,27.84,96% of total billed charges for outpatient setting,15.08,52% of total billed charges for outpatient setting,21.75,75% of total billed charges for outpatient setting,21.75,75% of total billed charges for outpatient setting,15.08,29,21.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,81001,UA w Micro if Ind,300,74,68.08,92% of total billed charges for outpatient setting,38.48,52% of total billed charges for outpatient setting,68.82,93% of total billed charges for outpatient setting,66.6,90% of total billed charges for outpatient setting,66.6,90% of total billed charges for outpatient setting,71.78,97% of total billed charges for outpatient setting,N/A,Not Applicable,74,100% of Medicaid WY Fee Schedule for Outpatient setting,38.48,52% of total billed charges for outpatient setting,71.78,97% of total billed charges for outpatient setting,55.5,75% of total billed charges for outpatient setting,71.04,96% of total billed charges for outpatient setting,38.48,52% of total billed charges for outpatient setting,55.5,75% of total billed charges for outpatient setting,55.5,75% of total billed charges for outpatient setting,38.48,74,55.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84550,Uric Acid,300,61,56.12,92% of total billed charges for outpatient setting,31.72,52% of total billed charges for outpatient setting,56.73,93% of total billed charges for outpatient setting,54.9,90% of total billed charges for outpatient setting,54.9,90% of total billed charges for outpatient setting,59.17,97% of total billed charges for outpatient setting,N/A,Not Applicable,61,100% of Medicaid WY Fee Schedule for Outpatient setting,31.72,52% of total billed charges for outpatient setting,59.17,97% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,58.56,96% of total billed charges for outpatient setting,31.72,52% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,31.72,61,45.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,87086,Urine Culture,300,118,108.56,92% of total billed charges for outpatient setting,61.36,52% of total billed charges for outpatient setting,109.74,93% of total billed charges for outpatient setting,106.2,90% of total billed charges for outpatient setting,106.2,90% of total billed charges for outpatient setting,114.46,97% of total billed charges for outpatient setting,N/A,Not Applicable,118,100% of Medicaid WY Fee Schedule for Outpatient setting,61.36,52% of total billed charges for outpatient setting,114.46,97% of total billed charges for outpatient setting,88.5,75% of total billed charges for outpatient setting,113.28,96% of total billed charges for outpatient setting,61.36,52% of total billed charges for outpatient setting,88.5,75% of total billed charges for outpatient setting,88.5,75% of total billed charges for outpatient setting,61.36,118,88.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,80202,Vancomycin Lvl Trough,300,138,126.96,92% of total billed charges for outpatient setting,71.76,52% of total billed charges for outpatient setting,128.34,93% of total billed charges for outpatient setting,124.2,90% of total billed charges for outpatient setting,124.2,90% of total billed charges for outpatient setting,133.86,97% of total billed charges for outpatient setting,N/A,Not Applicable,138,100% of Medicaid WY Fee Schedule for Outpatient setting,71.76,52% of total billed charges for outpatient setting,133.86,97% of total billed charges for outpatient setting,103.5,75% of total billed charges for outpatient setting,132.48,96% of total billed charges for outpatient setting,71.76,52% of total billed charges for outpatient setting,103.5,75% of total billed charges for outpatient setting,103.5,75% of total billed charges for outpatient setting,71.76,138,103.5
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86787,"Varicella Zoster V Ab, IgG LC",300,168,154.56,92% of total billed charges for outpatient setting,87.36,52% of total billed charges for outpatient setting,156.24,93% of total billed charges for outpatient setting,151.2,90% of total billed charges for outpatient setting,151.2,90% of total billed charges for outpatient setting,162.96,97% of total billed charges for outpatient setting,N/A,Not Applicable,168,100% of Medicaid WY Fee Schedule for Outpatient setting,87.36,52% of total billed charges for outpatient setting,162.96,97% of total billed charges for outpatient setting,126,75% of total billed charges for outpatient setting,161.28,96% of total billed charges for outpatient setting,87.36,52% of total billed charges for outpatient setting,126,75% of total billed charges for outpatient setting,126,75% of total billed charges for outpatient setting,87.36,168,126
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84590,"Vitamin A, Serum LC",300,61,56.12,92% of total billed charges for outpatient setting,31.72,52% of total billed charges for outpatient setting,56.73,93% of total billed charges for outpatient setting,54.9,90% of total billed charges for outpatient setting,54.9,90% of total billed charges for outpatient setting,59.17,97% of total billed charges for outpatient setting,N/A,Not Applicable,61,100% of Medicaid WY Fee Schedule for Outpatient setting,31.72,52% of total billed charges for outpatient setting,59.17,97% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,58.56,96% of total billed charges for outpatient setting,31.72,52% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,31.72,61,45.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84425,"Vitamin B1 (Thiamine), Blood LC",300,144,132.48,92% of total billed charges for outpatient setting,74.88,52% of total billed charges for outpatient setting,133.92,93% of total billed charges for outpatient setting,129.6,90% of total billed charges for outpatient setting,129.6,90% of total billed charges for outpatient setting,139.68,97% of total billed charges for outpatient setting,N/A,Not Applicable,144,100% of Medicaid WY Fee Schedule for Outpatient setting,74.88,52% of total billed charges for outpatient setting,139.68,97% of total billed charges for outpatient setting,108,75% of total billed charges for outpatient setting,138.24,96% of total billed charges for outpatient setting,74.88,52% of total billed charges for outpatient setting,108,75% of total billed charges for outpatient setting,108,75% of total billed charges for outpatient setting,74.88,144,108
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82607,Vitamin B12 Level,300,281,258.52,92% of total billed charges for outpatient setting,146.12,52% of total billed charges for outpatient setting,261.33,93% of total billed charges for outpatient setting,252.9,90% of total billed charges for outpatient setting,252.9,90% of total billed charges for outpatient setting,272.57,97% of total billed charges for outpatient setting,N/A,Not Applicable,281,100% of Medicaid WY Fee Schedule for Outpatient setting,146.12,52% of total billed charges for outpatient setting,272.57,97% of total billed charges for outpatient setting,210.75,75% of total billed charges for outpatient setting,269.76,96% of total billed charges for outpatient setting,146.12,52% of total billed charges for outpatient setting,210.75,75% of total billed charges for outpatient setting,210.75,75% of total billed charges for outpatient setting,146.12,281,210.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82306,Vitamin D 25 Hydroxy Level,300,200,184,92% of total billed charges for outpatient setting,104.00,52% of total billed charges for outpatient setting,186,93% of total billed charges for outpatient setting,180,90% of total billed charges for outpatient setting,180,90% of total billed charges for outpatient setting,194,97% of total billed charges for outpatient setting,N/A,Not Applicable,200,100% of Medicaid WY Fee Schedule for Outpatient setting,104.00,52% of total billed charges for outpatient setting,194,97% of total billed charges for outpatient setting,150,75% of total billed charges for outpatient setting,192,96% of total billed charges for outpatient setting,104.00,52% of total billed charges for outpatient setting,150,75% of total billed charges for outpatient setting,150,75% of total billed charges for outpatient setting,104,200,150
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,82306,Vitamin D 25 Hydroxy LC,300,200,184,92% of total billed charges for outpatient setting,104.00,52% of total billed charges for outpatient setting,186,93% of total billed charges for outpatient setting,180,90% of total billed charges for outpatient setting,180,90% of total billed charges for outpatient setting,194,97% of total billed charges for outpatient setting,N/A,Not Applicable,200,100% of Medicaid WY Fee Schedule for Outpatient setting,104.00,52% of total billed charges for outpatient setting,194,97% of total billed charges for outpatient setting,150,75% of total billed charges for outpatient setting,192,96% of total billed charges for outpatient setting,104.00,52% of total billed charges for outpatient setting,150,75% of total billed charges for outpatient setting,150,75% of total billed charges for outpatient setting,104,200,150
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84446,Vitamin E LC,300,61,56.12,92% of total billed charges for outpatient setting,31.72,52% of total billed charges for outpatient setting,56.73,93% of total billed charges for outpatient setting,54.9,90% of total billed charges for outpatient setting,54.9,90% of total billed charges for outpatient setting,59.17,97% of total billed charges for outpatient setting,N/A,Not Applicable,61,100% of Medicaid WY Fee Schedule for Outpatient setting,31.72,52% of total billed charges for outpatient setting,59.17,97% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,58.56,96% of total billed charges for outpatient setting,31.72,52% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,45.75,75% of total billed charges for outpatient setting,31.72,61,45.75
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86788,"West Nile Virus, IgG LC",300,96,88.32,92% of total billed charges for outpatient setting,49.92,52% of total billed charges for outpatient setting,89.28,93% of total billed charges for outpatient setting,86.4,90% of total billed charges for outpatient setting,86.4,90% of total billed charges for outpatient setting,93.12,97% of total billed charges for outpatient setting,N/A,Not Applicable,96,100% of Medicaid WY Fee Schedule for Outpatient setting,49.92,52% of total billed charges for outpatient setting,93.12,97% of total billed charges for outpatient setting,72,75% of total billed charges for outpatient setting,92.16,96% of total billed charges for outpatient setting,49.92,52% of total billed charges for outpatient setting,72,75% of total billed charges for outpatient setting,72,75% of total billed charges for outpatient setting,49.92,96,72
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,86789,"West Nile Virus, IgM LC",300,103,94.76,92% of total billed charges for outpatient setting,53.56,52% of total billed charges for outpatient setting,95.79,93% of total billed charges for outpatient setting,92.7,90% of total billed charges for outpatient setting,92.7,90% of total billed charges for outpatient setting,99.91,97% of total billed charges for outpatient setting,N/A,Not Applicable,103,100% of Medicaid WY Fee Schedule for Outpatient setting,53.56,52% of total billed charges for outpatient setting,99.91,97% of total billed charges for outpatient setting,77.25,75% of total billed charges for outpatient setting,98.88,96% of total billed charges for outpatient setting,53.56,52% of total billed charges for outpatient setting,77.25,75% of total billed charges for outpatient setting,77.25,75% of total billed charges for outpatient setting,53.56,103,77.25
Outpatient Medical Services,LABORATORY & PATHOLOGY SERVICES,84630,"Zinc, Plasma or Serum LC",300,147,135.24,92% of total billed charges for outpatient setting,76.44,52% of total billed charges for outpatient setting,136.71,93% of total billed charges for outpatient setting,132.3,90% of total billed charges for outpatient setting,132.3,90% of total billed charges for outpatient setting,142.59,97% of total billed charges for outpatient setting,N/A,Not Applicable,147,100% of Medicaid WY Fee Schedule for Outpatient setting,76.44,52% of total billed charges for outpatient setting,142.59,97% of total billed charges for outpatient setting,110.25,75% of total billed charges for outpatient setting,141.12,96% of total billed charges for outpatient setting,76.44,52% of total billed charges for outpatient setting,110.25,75% of total billed charges for outpatient setting,110.25,75% of total billed charges for outpatient setting,76.44,147,110.25
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,62323,Injection DX/Ther SBTS Intrlmnr Lmbr/Sac W/Img Gdn,361,1675,1541,92% of total billed charges for outpatient setting,871.00,52% of total billed charges for outpatient setting,1557.75,93% of total billed charges for outpatient setting,1507.5,90% of total billed charges for outpatient setting,1507.5,90% of total billed charges for outpatient setting,1624.75,97% of total billed charges for outpatient setting,N/A,Not Applicable,1675,100% of Medicaid WY Fee Schedule for Outpatient setting,871.00,52% of total billed charges for outpatient setting,1624.75,97% of total billed charges for outpatient setting,1256.25,75% of total billed charges for outpatient setting,1608,96% of total billed charges for outpatient setting,871.00,52% of total billed charges for outpatient setting,1256.25,75% of total billed charges for outpatient setting,1256.25,75% of total billed charges for outpatient setting,871,1675,1256.25
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,64405,Injection Anesthetic Agent Greater Occipital Nerve,450,1042,958.64,92% of total billed charges for outpatient setting,541.84,52% of total billed charges for outpatient setting,969.06,93% of total billed charges for outpatient setting,937.8,90% of total billed charges for outpatient setting,937.8,90% of total billed charges for outpatient setting,1010.74,97% of total billed charges for outpatient setting,N/A,Not Applicable,1042,100% of Medicaid WY Fee Schedule for Outpatient setting,541.84,52% of total billed charges for outpatient setting,1010.74,97% of total billed charges for outpatient setting,781.5,75% of total billed charges for outpatient setting,1000.32,96% of total billed charges for outpatient setting,541.84,52% of total billed charges for outpatient setting,781.5,75% of total billed charges for outpatient setting,781.5,75% of total billed charges for outpatient setting,541.84,1042,781.5
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,64483,Injection Anes/Strd W/Img Tfrml Edrl Lmbr/Sac 1 Lvl,361,2257,2076.44,92% of total billed charges for outpatient setting,1173.64,52% of total billed charges for outpatient setting,2099.01,93% of total billed charges for outpatient setting,2031.3,90% of total billed charges for outpatient setting,2031.3,90% of total billed charges for outpatient setting,2189.29,97% of total billed charges for outpatient setting,N/A,Not Applicable,2257,100% of Medicaid WY Fee Schedule for Outpatient setting,1173.64,52% of total billed charges for outpatient setting,2189.29,97% of total billed charges for outpatient setting,1692.75,75% of total billed charges for outpatient setting,2166.72,96% of total billed charges for outpatient setting,1173.64,52% of total billed charges for outpatient setting,1692.75,75% of total billed charges for outpatient setting,1692.75,75% of total billed charges for outpatient setting,1173.64,2257,1692.75
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,64484,Injection Anes&/Strd W/Img Tfrml Edrl Lmbr/Sca Ea Lv,361,1061,976.12,92% of total billed charges for outpatient setting,551.72,52% of total billed charges for outpatient setting,986.73,93% of total billed charges for outpatient setting,954.9,90% of total billed charges for outpatient setting,954.9,90% of total billed charges for outpatient setting,1029.17,97% of total billed charges for outpatient setting,N/A,Not Applicable,1061,100% of Medicaid WY Fee Schedule for Outpatient setting,551.72,52% of total billed charges for outpatient setting,1029.17,97% of total billed charges for outpatient setting,795.75,75% of total billed charges for outpatient setting,1018.56,96% of total billed charges for outpatient setting,551.72,52% of total billed charges for outpatient setting,795.75,75% of total billed charges for outpatient setting,795.75,75% of total billed charges for outpatient setting,551.72,1061,795.75
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,64493,Injection Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 1 Lvl,361,1584,1457.28,92% of total billed charges for outpatient setting,823.68,52% of total billed charges for outpatient setting,1473.12,93% of total billed charges for outpatient setting,1425.6,90% of total billed charges for outpatient setting,1425.6,90% of total billed charges for outpatient setting,1536.48,97% of total billed charges for outpatient setting,N/A,Not Applicable,1584,100% of Medicaid WY Fee Schedule for Outpatient setting,823.68,52% of total billed charges for outpatient setting,1536.48,97% of total billed charges for outpatient setting,1188,75% of total billed charges for outpatient setting,1520.64,96% of total billed charges for outpatient setting,823.68,52% of total billed charges for outpatient setting,1188,75% of total billed charges for outpatient setting,1188,75% of total billed charges for outpatient setting,823.68,1584,1188
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,64635,Destruction Neuro Agnt Parverteb Fct Sngl Lmbr/Sacrl,361,2614,2404.88,92% of total billed charges for outpatient setting,1359.28,52% of total billed charges for outpatient setting,2431.02,93% of total billed charges for outpatient setting,2352.6,90% of total billed charges for outpatient setting,2352.6,90% of total billed charges for outpatient setting,2535.58,97% of total billed charges for outpatient setting,N/A,Not Applicable,2614,100% of Medicaid WY Fee Schedule for Outpatient setting,1359.28,52% of total billed charges for outpatient setting,2535.58,97% of total billed charges for outpatient setting,1960.5,75% of total billed charges for outpatient setting,2509.44,96% of total billed charges for outpatient setting,1359.28,52% of total billed charges for outpatient setting,1960.5,75% of total billed charges for outpatient setting,1960.5,75% of total billed charges for outpatient setting,1359.28,2614,1960.5
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,64636,Destruction Neuro Agent Parverteb Fct Addl Lmbr/Scrl,361,1332,1225.44,92% of total billed charges for outpatient setting,692.64,52% of total billed charges for outpatient setting,1238.76,93% of total billed charges for outpatient setting,1198.8,90% of total billed charges for outpatient setting,1198.8,90% of total billed charges for outpatient setting,1292.04,97% of total billed charges for outpatient setting,N/A,Not Applicable,1332,100% of Medicaid WY Fee Schedule for Outpatient setting,692.64,52% of total billed charges for outpatient setting,1292.04,97% of total billed charges for outpatient setting,999,75% of total billed charges for outpatient setting,1278.72,96% of total billed charges for outpatient setting,692.64,52% of total billed charges for outpatient setting,999,75% of total billed charges for outpatient setting,999,75% of total billed charges for outpatient setting,692.64,1332,999
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,EGD Diagnositic,750,1653,1520.76,92% of total billed charges for outpatient setting,859.56,52% of total billed charges for outpatient setting,1537.29,93% of total billed charges for outpatient setting,1487.7,90% of total billed charges for outpatient setting,1487.7,90% of total billed charges for outpatient setting,1603.41,97% of total billed charges for outpatient setting,N/A,Not Applicable,1653,100% of Medicaid WY Fee Schedule for Outpatient setting,859.56,52% of total billed charges for outpatient setting,1603.41,97% of total billed charges for outpatient setting,1239.75,75% of total billed charges for outpatient setting,1586.88,96% of total billed charges for outpatient setting,859.56,52% of total billed charges for outpatient setting,1239.75,75% of total billed charges for outpatient setting,1239.75,75% of total billed charges for outpatient setting,859.56,1653,1239.75
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,EGD With Single Interventions,750,,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,N/A,N/A
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,EGD With Multi/Complex Interventions,750,,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,N/A,N/A
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,Edophagoscopy Diagnostic,750,,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,N/A,N/A
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,Colonoscopy Diagnostic,750,,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,N/A,N/A
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,Colonoscopy with Single Intervention,750,,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,N/A,N/A
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,23420,Reconstruction Rotator Cuff Avulsion Chronic,975,565,519.8,92% of total billed charges for outpatient setting,94.66,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,525.45,93% of total billed charges for outpatient setting,508.5,90% of total billed charges for outpatient setting,508.5,90% of total billed charges for outpatient setting,548.05,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,94.66,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,548.05,97% of total billed charges for outpatient setting,423.75,75% of total billed charges for outpatient setting,542.4,96% of total billed charges for outpatient setting,94.66,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,423.75,75% of total billed charges for outpatient setting,423.75,75% of total billed charges for outpatient setting,94.66,548.05,423.75
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,23473,Revision Total Should Arthroplasty Humeral or Glenoid,975,399,367.08,92% of total billed charges for outpatient setting,164.40,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,371.07,93% of total billed charges for outpatient setting,359.1,90% of total billed charges for outpatient setting,359.1,90% of total billed charges for outpatient setting,387.03,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,164.40,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,387.03,97% of total billed charges for outpatient setting,299.25,75% of total billed charges for outpatient setting,383.04,96% of total billed charges for outpatient setting,164.40,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,299.25,75% of total billed charges for outpatient setting,299.25,75% of total billed charges for outpatient setting,164.40,387.03,299.25
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,27447,Arthroplasty Knee Condyle and Plateau Medial/Lateral,975,983,904.36,92% of total billed charges for outpatient setting,133.20,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,914.19,93% of total billed charges for outpatient setting,884.7,90% of total billed charges for outpatient setting,884.7,90% of total billed charges for outpatient setting,953.51,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,133.20,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,953.51,97% of total billed charges for outpatient setting,737.25,75% of total billed charges for outpatient setting,943.68,96% of total billed charges for outpatient setting,133.20,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,737.25,75% of total billed charges for outpatient setting,737.25,75% of total billed charges for outpatient setting,133.20,953.51,737.25
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,29891,Arthroscopy Ankle Surgical,975,170,156.4,92% of total billed charges for outpatient setting,57.73,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,158.1,93% of total billed charges for outpatient setting,153,90% of total billed charges for outpatient setting,153,90% of total billed charges for outpatient setting,164.9,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,57.73,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,164.9,97% of total billed charges for outpatient setting,127.5,75% of total billed charges for outpatient setting,163.2,96% of total billed charges for outpatient setting,57.73,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,127.5,75% of total billed charges for outpatient setting,127.5,75% of total billed charges for outpatient setting,57.73,164.9,127.5
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,29916,Arthroscopy Hip W/Femoroplasty,975,4025,3703,92% of total billed charges for outpatient setting,99.04,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,3743.25,93% of total billed charges for outpatient setting,3622.5,90% of total billed charges for outpatient setting,3622.5,90% of total billed charges for outpatient setting,3904.25,97% of total billed charges for outpatient setting,N/A,Not Applicable,N/A,Not Applicable,99.04,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,3904.25,97% of total billed charges for outpatient setting,3018.75,75% of total billed charges for outpatient setting,3864,96% of total billed charges for outpatient setting,99.04,115% CMS physician fee schedule which is 100% of the CMS Medicare rate,3018.75,75% of total billed charges for outpatient setting,3018.75,75% of total billed charges for outpatient setting,99.04,3904.25,3018.75
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,OR Level 1 ,360,3909,3596.28,92% of total billed charges for outpatient setting,2032.68,52% of total billed charges for outpatient setting,3635.37,93% of total billed charges for outpatient setting,3518.1,90% of total billed charges for outpatient setting,3518.1,90% of total billed charges for outpatient setting,3791.73,97% of total billed charges for outpatient setting,N/A,Not Applicable,3909,100% of Medicaid WY Fee Schedule for Outpatient setting,2032.68,52% of total billed charges for outpatient setting,3791.73,97% of total billed charges for outpatient setting,2931.75,75% of total billed charges for outpatient setting,3752.64,96% of total billed charges for outpatient setting,2032.68,52% of total billed charges for outpatient setting,2931.75,75% of total billed charges for outpatient setting,2931.75,75% of total billed charges for outpatient setting,2032.68,3909,2931.75
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,OR Level 2,360,,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,N/A,N/A
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,OR Level 3,360,,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,N/A,N/A
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,OR Level 4,360,,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,N/A,N/A
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,OR Level 5,360,,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,N/A,N/A
Outpatient Medical Services,MEDICINE & SURGERY SERVICES,,OR Level 6,360,,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90832,"Psychotherapy, 30 minute",900,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90834,"Psychotherapy, 45 minutes",900,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90837,"Psychotherapy, 60 minutes",900,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90846,"Family psychotherapy, not including patient, 50 minutes",900,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90847,"Family psychotherapy, including patient, 50 min",900,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90853,Group psychotherapy,900,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,81000,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,81002,Automated urinalysis test,300,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45391,Ultrasound examination of lower large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,55700,Biopsy of prostate gland,360,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,360,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59400,"Routine obstetric care for vaginal delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59510,"Routine obstetric care for cesarean delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59610,Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care,720,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,66821,Removal of recurring cataract in lens capsule using laser,360,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,66984,Removal of cataract with insertion of lens,360,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,CARDIOLOGY,93452,Insertion of catheter into left heart for diagnosis,480,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,216,Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities,100,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,460,Spinal fusion except cervical without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,470,Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,473,Cervical spinal fusion without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,743,Uterine and adnexa procedures for non-malignancy without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A