hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|WA,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Astria Sunnyside Hospital,12/4/2024,2.0.0,Astria Sunnyside Hospital,"500 S 11 st Sunnyside, WA 98944-2240",911286274,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Service,Category,Code,Description,Revenue code,Charges,AETNA PLAN,AETNA REIMBURSEMENT METHOD,AETNA MEDICARE PLAN,AETNA MEDICARE REIMBURSEMENT METHOD,AMERIGROUP MEDICAID PLAN,AMERIGROUP MEDICAID REIMBURSEMENT METHOD,BCCHP PLAN,BCCHP REIMBURSEMENT METHOD,CHPW MEDICAID PLAN,CHPW MEDICAID REIMBURSEMENT METHOD,CHPW MEDICARE PLAN,CHPW MEDICARE REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,COORDINATED CARE MEDICAID PLAN,COORDINATED CARE MEDICAID REIMBURSEMENT METHOD,COORDINATED CARE MEDICAID AMBETTER PLAN,COORDINATED CARE MEDICAID AMBETTER REIMBURSEMENT METHOD,FHPW PLAN,FHPW REIMBURSEMENT METHOD,FIRST CHOICE PLAN,FIRST CHOICE REIMBURSEMENT METHOD,GREAT RIVERS PLAN,GREAT RIVERS REIMBURSEMENT METHOD,HEALTH ALLIANCE MEDICARE ADVANTAGE PLAN,HEALTH ALLIANCE MEDICARE ADVANTAGE REIMBURSEMENT METHOD,HEALTHCOMP PLAN,HEALTHCOMP REIMBURSEMENT METHOD,HEALTHCOMP IHS PLAN,HEALTHCOMP IHS REIMBURSEMENT METHOD,HMA IHS MEDICARE PLAN,HMA IHS MEDICARE REIMBURSEMENT METHOD,HUMANA PLAN,HUMANA REIMBURSEMENT METHOD,HUMANA MEDICARE PLAN,HUMANA MEDICARE REIMBURSEMENT METHOD,KAISER PLAN,KAISER REIMBURSEMENT METHOD,KAISER MEDICARE PLAN,KAISER MEDICARE REIMBURSEMENT METHOD,LI PLAN,LI REIMBURSEMENT METHOD,MEDICAID PLAN,MEDICAID REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,MEDICARE ADVANTAGE PLAN,MEDICARE ADVANTAGE REIMBURSEMENT METHOD,MOLINA PLAN,MOLINA REIMBURSEMENT METHOD,MOLINA MEDICARE PLAN,MOLINA MEDICARE REIMBURSEMENT METHOD,PREMERA PLAN,PREMERA REIMBURSEMENT METHOD,PREMERA MEDICARE ADVANTAGE PLAN,PREMERA MEDICARE ADVANTAGE REIMBURSEMENT METHOD,REGENCE PLAN,REGENCE REIMBURSEMENT METHOD,REGENCE MEDICARE PLAN,REGENCE MEDICARE REIMBURSEMENT METHOD,SIGNAL HEALTH MEDICARE PLAN,SIGNAL HEALTH MEDICARE REIMBURSEMENT METHOD,TPSC PLAN,TPSC REIMBURSEMENT METHOD,TRICARE PLAN,TRICARE REIMBURSEMENT METHOD,UHC PLAN,UHC REIMBURSEMENT METHOD,UHC MEDICAID PLAN,UHC MEDICAID REIMBURSEMENT METHOD,UHC MEDICARE PLAN,UHC MEDICARE REIMBURSEMENT METHOD,UMR PLAN,UMR REIMBURSEMENT METHOD,VA PLAN,VA REIMBURSEMENT METHOD,ZENITH PLAN,ZENITH REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,Ambulatory Procedures,93306,TTE W/DOPPLER COMPLETE,483,115,101.2,88% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,115,100% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,29.05,25.26% OF BILLED CHARGES,69,60% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,35.25,30.65% OF BILLED CHARGES,101.2,88% OF BILLED CHARGES,86.25,75% OF BILLED CHARGES,115,100% OF BILLED CHARGES,25.38,22.07% OF BILLED CHARGES,103.5,90%OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,103.5,90% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,90.3,78.52% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,70.61,61.40% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,28.2,24.525%OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,93.61,81.4% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,59.11,51.4% OF BILLED CHARGES,28.49,24.77% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,89.7,78% OF BILLED CHARGES,28.49,24.77% OF BILLED CHARGES,97.75,85% OF BILLED CHARGES,29.05,25.26% OF BILLED CHARGES,132.25,115% OF CMS PHYSICIAN FEES SCHEDULE,97.75,85% OF BILLED CHARGES,28.2,24.525% OF BILLED CHARGES,115,100% OF BILLED CHARGES,25.38,132.25,65.67
Outpatient Medical Services,Radiology,76817,"Ultrasound, pregnant uterus",402,589,518.32,88% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,589,100% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,148.78,25.26% OF BILLED CHARGES,353.4,60% OF BILLED CHARGES,112.53,19.105% OF BILLED CHARGES,180.53,30.65% OF BILLED CHARGES,518.32,88% OF BILLED CHARGES,441.75,75% OF BILLED CHARGES,589,100% OF BILLED CHARGES,129.99,22.07% OF BILLED CHARGES,530.1,90%OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,530.1,90% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,462.48,78.52% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,361.65,61.40% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,144.45,24.525%OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,479.45,81.4% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,302.75,51.4% OF BILLED CHARGES,145.9,24.77% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,459.42,78% OF BILLED CHARGES,145.9,24.77% OF BILLED CHARGES,500.65,85% OF BILLED CHARGES,148.78,25.26% OF BILLED CHARGES,109.37,115% OF CMS PHYSICIAN FEES SCHEDULE,500.65,85% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,589,100% OF BILLED CHARGES,109.37,589,336.32
Outpatient Medical Services,Radiology,76830,AST PELVIC TRANSVAGINAL,402,534,469.92,88% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,534,100% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,134.89,25.26% OF BILLED CHARGES,320.4,60% OF BILLED CHARGES,102.02,19.105% OF BILLED CHARGES,163.67,30.65% OF BILLED CHARGES,469.92,88% OF BILLED CHARGES,400.5,75% OF BILLED CHARGES,534,100% OF BILLED CHARGES,117.85,22.07% OF BILLED CHARGES,480.6,90%OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,480.6,90% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,419.3,78.52% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,327.88,61.40% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,130.96,24.525%OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,434.68,81.4% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,274.48,51.4% OF BILLED CHARGES,132.27,24.77% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,416.52,78% OF BILLED CHARGES,132.27,24.77% OF BILLED CHARGES,453.9,85% OF BILLED CHARGES,134.89,25.26% OF BILLED CHARGES,141.2,115% OF CMS PHYSICIAN FEES SCHEDULE,453.9,85% OF BILLED CHARGES,130.96,24.525% OF BILLED CHARGES,534,100% OF BILLED CHARGES,102.02,534,304.91
Outpatient Medical Services,Radiology,93017,AST Treadmill Stress Test,482,909,799.92,88% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,909,100% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,229.61,25.26% OF BILLED CHARGES,545.4,60% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,278.61,30.65% OF BILLED CHARGES,799.92,88% OF BILLED CHARGES,681.75,75% OF BILLED CHARGES,909,100% OF BILLED CHARGES,200.62,22.07% OF BILLED CHARGES,818.1,90%OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,818.1,90% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,713.75,78.52% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,558.13,61.40% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,222.93,24.525%OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,739.93,81.4% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,467.23,51.4% OF BILLED CHARGES,225.16,24.77% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,709.02,78% OF BILLED CHARGES,225.16,24.77% OF BILLED CHARGES,772.65,85% OF BILLED CHARGES,229.61,25.26% OF BILLED CHARGES,44.8,115% OF CMS PHYSICIAN FEES SCHEDULE,772.65,85% OF BILLED CHARGES,222.93,24.525% OF BILLED CHARGES,909,100% OF BILLED CHARGES,44.8,909,519.04
Outpatient Medical Services,Radiology,77080,BD Bone Density DEXA Axial Skeleton,320,804,707.52,88% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,804,100% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,203.09,25.26% OF BILLED CHARGES,482.4,60% OF BILLED CHARGES,153.6,19.105% OF BILLED CHARGES,246.43,30.65% OF BILLED CHARGES,707.52,88% OF BILLED CHARGES,603,75% OF BILLED CHARGES,804,100% OF BILLED CHARGES,177.44,22.07% OF BILLED CHARGES,723.6,90%OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,723.6,90% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,631.3,78.52% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,493.66,61.40% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,197.18,24.525%OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,654.46,81.4% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,413.26,51.4% OF BILLED CHARGES,199.15,24.77% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,627.12,78% OF BILLED CHARGES,199.15,24.77% OF BILLED CHARGES,683.4,85% OF BILLED CHARGES,203.09,25.26% OF BILLED CHARGES,46.14,115% OF CMS PHYSICIAN FEES SCHEDULE,683.4,85% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,804,100% OF BILLED CHARGES,46.14,804,459.08
Outpatient Medical Services,Radiology,76499,BD Bone Density DEXA Body Composition,320,1006,885.28,88% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,1006,100% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,254.12,25.26% OF BILLED CHARGES,603.6,60% OF BILLED CHARGES,192.2,19.105% OF BILLED CHARGES,308.34,30.65% OF BILLED CHARGES,885.28,88% OF BILLED CHARGES,754.5,75% OF BILLED CHARGES,1006,100% OF BILLED CHARGES,222.02,22.07% OF BILLED CHARGES,905.4,90%OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,905.4,90% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,789.91,78.52% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,617.68,61.40% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,246.72,24.525%OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,818.88,81.4% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,517.08,51.4% OF BILLED CHARGES,249.19,24.77% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,784.68,78% OF BILLED CHARGES,249.19,24.77% OF BILLED CHARGES,855.1,85% OF BILLED CHARGES,254.12,25.26% OF BILLED CHARGES,,NOT REIMBUSABLE,855.1,85% OF BILLED CHARGES,246.72,24.525% OF BILLED CHARGES,1006,100% OF BILLED CHARGES,192.2,1006,574.43
Outpatient Medical Services,Radiology,74170,CT Abdomen w/ + w/o Contrast,352,5398,4750.24,88% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,5398,100% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,1363.53,25.26% OF BILLED CHARGES,3238.8,60% OF BILLED CHARGES,1031.29,19.105% OF BILLED CHARGES,1654.49,30.65% OF BILLED CHARGES,4750.24,88% OF BILLED CHARGES,4048.5,75% OF BILLED CHARGES,5398,100% OF BILLED CHARGES,1191.34,22.07% OF BILLED CHARGES,4858.2,90%OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,4858.2,90% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,4238.51,78.52% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,3314.37,61.40% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,1323.86,24.525%OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,4393.97,81.4% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,2774.57,51.4% OF BILLED CHARGES,1337.08,24.77% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,4210.44,78% OF BILLED CHARGES,1337.08,24.77% OF BILLED CHARGES,4588.3,85% OF BILLED CHARGES,1363.53,25.26% OF BILLED CHARGES,250.82,115% OF CMS PHYSICIAN FEES SCHEDULE,4588.3,85% OF BILLED CHARGES,1323.86,24.525% OF BILLED CHARGES,5398,100% OF BILLED CHARGES,250.82,5398,3082.26
Outpatient Medical Services,Radiology,74160,CT Abdomen w/ Contrast,352,3888,3421.44,88% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,3888,100% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,982.11,25.26% OF BILLED CHARGES,2332.8,60% OF BILLED CHARGES,742.8,19.105% OF BILLED CHARGES,1191.67,30.65% OF BILLED CHARGES,3421.44,88% OF BILLED CHARGES,2916,75% OF BILLED CHARGES,3888,100% OF BILLED CHARGES,858.08,22.07% OF BILLED CHARGES,3499.2,90%OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,3499.2,90% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,3052.86,78.52% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,2387.23,61.40% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,953.53,24.525%OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,3164.83,81.4% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,1998.43,51.4% OF BILLED CHARGES,963.06,24.77% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,3032.64,78% OF BILLED CHARGES,963.06,24.77% OF BILLED CHARGES,3304.8,85% OF BILLED CHARGES,982.11,25.26% OF BILLED CHARGES,245.07,115% OF CMS PHYSICIAN FEES SCHEDULE,3304.8,85% OF BILLED CHARGES,953.53,24.525% OF BILLED CHARGES,3888,100% OF BILLED CHARGES,245.07,3888,2220.05
Outpatient Medical Services,Radiology,74150,CT Abdomen w/o Contrast,352,2819,2480.72,88% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,2819,100% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,712.08,25.26% OF BILLED CHARGES,1691.4,60% OF BILLED CHARGES,538.57,19.105% OF BILLED CHARGES,864.02,30.65% OF BILLED CHARGES,2480.72,88% OF BILLED CHARGES,2114.25,75% OF BILLED CHARGES,2819,100% OF BILLED CHARGES,622.15,22.07% OF BILLED CHARGES,2537.1,90%OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,2537.1,90% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,2213.48,78.52% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,1730.87,61.40% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,691.36,24.525%OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,2294.67,81.4% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,1448.97,51.4% OF BILLED CHARGES,698.27,24.77% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,2198.82,78% OF BILLED CHARGES,698.27,24.77% OF BILLED CHARGES,2396.15,85% OF BILLED CHARGES,712.08,25.26% OF BILLED CHARGES,165.07,115% OF CMS PHYSICIAN FEES SCHEDULE,2396.15,85% OF BILLED CHARGES,691.36,24.525% OF BILLED CHARGES,2819,100% OF BILLED CHARGES,165.07,2819,1609.65
Outpatient Medical Services,Radiology,75635,CT Angio Abdomen Aorta + Iliofemoral,352,1582,1392.16,88% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,1582,100% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,399.61,25.26% OF BILLED CHARGES,949.2,60% OF BILLED CHARGES,302.24,19.105% OF BILLED CHARGES,484.88,30.65% OF BILLED CHARGES,1392.16,88% OF BILLED CHARGES,1186.5,75% OF BILLED CHARGES,1582,100% OF BILLED CHARGES,349.15,22.07% OF BILLED CHARGES,1423.8,90%OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,1423.8,90% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,1242.19,78.52% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,971.35,61.40% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,387.99,24.525%OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,1287.75,81.4% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,813.15,51.4% OF BILLED CHARGES,391.86,24.77% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,1233.96,78% OF BILLED CHARGES,391.86,24.77% OF BILLED CHARGES,1344.7,85% OF BILLED CHARGES,399.61,25.26% OF BILLED CHARGES,296.25,115% OF CMS PHYSICIAN FEES SCHEDULE,1344.7,85% OF BILLED CHARGES,387.99,24.525% OF BILLED CHARGES,1582,100% OF BILLED CHARGES,296.25,1582,903.32
Outpatient Medical Services,Radiology,74175,CT Angio Abdomen,352,7262,6390.56,88% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,7262,100% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,1834.38,25.26% OF BILLED CHARGES,4357.2,60% OF BILLED CHARGES,1387.41,19.105% OF BILLED CHARGES,2225.8,30.65% OF BILLED CHARGES,6390.56,88% OF BILLED CHARGES,5446.5,75% OF BILLED CHARGES,7262,100% OF BILLED CHARGES,1602.72,22.07% OF BILLED CHARGES,6535.8,90%OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,6535.8,90% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,5702.12,78.52% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,4458.87,61.40% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,1781.01,24.525%OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,5911.27,81.4% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,3732.67,51.4% OF BILLED CHARGES,1798.8,24.77% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,5664.36,78% OF BILLED CHARGES,1798.8,24.77% OF BILLED CHARGES,6172.7,85% OF BILLED CHARGES,1834.38,25.26% OF BILLED CHARGES,269.85,115% OF CMS PHYSICIAN FEES SCHEDULE,6172.7,85% OF BILLED CHARGES,1781.01,24.525% OF BILLED CHARGES,7262,100% OF BILLED CHARGES,269.85,7262,4146.60
Outpatient Medical Services,Radiology,71275,CT Angio Chest,352,6729,5921.52,88% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,6729,100% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1699.75,25.26% OF BILLED CHARGES,4037.4,60% OF BILLED CHARGES,1285.58,19.105% OF BILLED CHARGES,2062.44,30.65% OF BILLED CHARGES,5921.52,88% OF BILLED CHARGES,5046.75,75% OF BILLED CHARGES,6729,100% OF BILLED CHARGES,1485.09,22.07% OF BILLED CHARGES,6056.1,90%OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,6056.1,90% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,5283.61,78.52% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,4131.61,61.40% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1650.29,24.525%OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,5477.41,81.4% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,3458.71,51.4% OF BILLED CHARGES,1666.77,24.77% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,5248.62,78% OF BILLED CHARGES,1666.77,24.77% OF BILLED CHARGES,5719.65,85% OF BILLED CHARGES,1699.75,25.26% OF BILLED CHARGES,270.47,115% OF CMS PHYSICIAN FEES SCHEDULE,5719.65,85% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,6729,100% OF BILLED CHARGES,270.47,6729,3842.26
Outpatient Medical Services,Radiology,70496,CT Angio Brain/Head,351,5224,4597.12,88% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,5224,100% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1319.58,25.26% OF BILLED CHARGES,3134.4,60% OF BILLED CHARGES,998.05,19.105% OF BILLED CHARGES,1601.16,30.65% OF BILLED CHARGES,4597.12,88% OF BILLED CHARGES,3918,75% OF BILLED CHARGES,5224,100% OF BILLED CHARGES,1152.94,22.07% OF BILLED CHARGES,4701.6,90%OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,4701.6,90% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,4101.88,78.52% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,3207.54,61.40% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1281.19,24.525%OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,4252.34,81.4% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,2685.14,51.4% OF BILLED CHARGES,1293.98,24.77% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,4074.72,78% OF BILLED CHARGES,1293.98,24.77% OF BILLED CHARGES,4440.4,85% OF BILLED CHARGES,1319.58,25.26% OF BILLED CHARGES,267.16,115% OF CMS PHYSICIAN FEES SCHEDULE,4440.4,85% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,5224,100% OF BILLED CHARGES,267.16,5224,2982.90
Outpatient Medical Services,Radiology,73706,CT Angio Lower Extremity Left,352,4516,3974.08,88% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,4516,100% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,1140.74,25.26% OF BILLED CHARGES,2709.6,60% OF BILLED CHARGES,862.78,19.105% OF BILLED CHARGES,1384.15,30.65% OF BILLED CHARGES,3974.08,88% OF BILLED CHARGES,3387,75% OF BILLED CHARGES,4516,100% OF BILLED CHARGES,996.68,22.07% OF BILLED CHARGES,4064.4,90%OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,4064.4,90% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,3545.96,78.52% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,2772.82,61.40% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,1107.55,24.525%OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,3676.02,81.4% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,2321.22,51.4% OF BILLED CHARGES,1118.61,24.77% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,3522.48,78% OF BILLED CHARGES,1118.61,24.77% OF BILLED CHARGES,3838.6,85% OF BILLED CHARGES,1140.74,25.26% OF BILLED CHARGES,273.49,115% OF CMS PHYSICIAN FEES SCHEDULE,3838.6,85% OF BILLED CHARGES,1107.55,24.525% OF BILLED CHARGES,4516,100% OF BILLED CHARGES,273.49,4516,2578.64
Outpatient Medical Services,Radiology,73706,CT Angio Lower Extremity Right,352,5264,4632.32,88% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,5264,100% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,1329.69,25.26% OF BILLED CHARGES,3158.4,60% OF BILLED CHARGES,1005.69,19.105% OF BILLED CHARGES,1613.42,30.65% OF BILLED CHARGES,4632.32,88% OF BILLED CHARGES,3948,75% OF BILLED CHARGES,5264,100% OF BILLED CHARGES,1161.76,22.07% OF BILLED CHARGES,4737.6,90%OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,4737.6,90% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,4133.29,78.52% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,3232.1,61.40% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,1291,24.525%OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,4284.9,81.4% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,2705.7,51.4% OF BILLED CHARGES,1303.89,24.77% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,4105.92,78% OF BILLED CHARGES,1303.89,24.77% OF BILLED CHARGES,4474.4,85% OF BILLED CHARGES,1329.69,25.26% OF BILLED CHARGES,273.49,115% OF CMS PHYSICIAN FEES SCHEDULE,4474.4,85% OF BILLED CHARGES,1291,24.525% OF BILLED CHARGES,5264,100% OF BILLED CHARGES,273.49,5264,3005.74
Outpatient Medical Services,Radiology,70498,CT Angio Neck,351,5280,4646.4,88% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,5280,100% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,1333.73,25.26% OF BILLED CHARGES,3168,60% OF BILLED CHARGES,1008.74,19.105% OF BILLED CHARGES,1618.32,30.65% OF BILLED CHARGES,4646.4,88% OF BILLED CHARGES,3960,75% OF BILLED CHARGES,5280,100% OF BILLED CHARGES,1165.3,22.07% OF BILLED CHARGES,4752,90%OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,4752,90% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,4145.86,78.52% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,3241.92,61.40% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,1294.92,24.525%OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,4297.92,81.4% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,2713.92,51.4% OF BILLED CHARGES,1307.86,24.77% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,4118.4,78% OF BILLED CHARGES,1307.86,24.77% OF BILLED CHARGES,4488,85% OF BILLED CHARGES,1333.73,25.26% OF BILLED CHARGES,267.16,115% OF CMS PHYSICIAN FEES SCHEDULE,4488,85% OF BILLED CHARGES,1294.92,24.525% OF BILLED CHARGES,5280,100% OF BILLED CHARGES,267.16,5280,3014.88
Outpatient Medical Services,Radiology,72191,CT Angio Pelvis,352,6632,5836.16,88% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,6632,100% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,1675.24,25.26% OF BILLED CHARGES,3979.2,60% OF BILLED CHARGES,1267.04,19.105% OF BILLED CHARGES,2032.71,30.65% OF BILLED CHARGES,5836.16,88% OF BILLED CHARGES,4974,75% OF BILLED CHARGES,6632,100% OF BILLED CHARGES,1463.68,22.07% OF BILLED CHARGES,5968.8,90%OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,5968.8,90% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,5207.45,78.52% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,4072.05,61.40% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,1626.5,24.525%OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,5398.45,81.4% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,3408.85,51.4% OF BILLED CHARGES,1642.75,24.77% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,5172.96,78% OF BILLED CHARGES,1642.75,24.77% OF BILLED CHARGES,5637.2,85% OF BILLED CHARGES,1675.24,25.26% OF BILLED CHARGES,268.82,115% OF CMS PHYSICIAN FEES SCHEDULE,5637.2,85% OF BILLED CHARGES,1626.5,24.525% OF BILLED CHARGES,6632,100% OF BILLED CHARGES,268.82,6632,3786.87
Outpatient Medical Services,Radiology,73206,CT Angio Upper Extremity Left,323,3475,3058,88% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,3475,100% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,877.79,25.26% OF BILLED CHARGES,2085,60% OF BILLED CHARGES,663.9,19.105% OF BILLED CHARGES,1065.09,30.65% OF BILLED CHARGES,3058,88% OF BILLED CHARGES,2606.25,75% OF BILLED CHARGES,3475,100% OF BILLED CHARGES,766.93,22.07% OF BILLED CHARGES,3127.5,90%OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,3127.5,90% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,2728.57,78.52% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,2133.65,61.40% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,852.24,24.525%OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,2828.65,81.4% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,1786.15,51.4% OF BILLED CHARGES,860.76,24.77% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,2710.5,78% OF BILLED CHARGES,860.76,24.77% OF BILLED CHARGES,2953.75,85% OF BILLED CHARGES,877.79,25.26% OF BILLED CHARGES,268.82,115% OF CMS PHYSICIAN FEES SCHEDULE,2953.75,85% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,3475,100% OF BILLED CHARGES,268.82,3475,1984.23
Outpatient Medical Services,Radiology,73206,CT Angio Upper Extremity Right,352,7623,6708.24,88% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,7623,100% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,1925.57,25.26% OF BILLED CHARGES,4573.8,60% OF BILLED CHARGES,1456.37,19.105% OF BILLED CHARGES,2336.45,30.65% OF BILLED CHARGES,6708.24,88% OF BILLED CHARGES,5717.25,75% OF BILLED CHARGES,7623,100% OF BILLED CHARGES,1682.4,22.07% OF BILLED CHARGES,6860.7,90%OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,6860.7,90% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,5985.58,78.52% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,4680.52,61.40% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,1869.54,24.525%OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,6205.12,81.4% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,3918.22,51.4% OF BILLED CHARGES,1888.22,24.77% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,5945.94,78% OF BILLED CHARGES,1888.22,24.77% OF BILLED CHARGES,6479.55,85% OF BILLED CHARGES,1925.57,25.26% OF BILLED CHARGES,268.82,115% OF CMS PHYSICIAN FEES SCHEDULE,6479.55,85% OF BILLED CHARGES,1869.54,24.525% OF BILLED CHARGES,7623,100% OF BILLED CHARGES,268.82,7623,4352.73
Outpatient Medical Services,Radiology,74178,CT Abdomen and Pelvis w/ + w/o Contrast,352,5963,5247.44,88% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,5963,100% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,1506.25,25.26% OF BILLED CHARGES,3577.8,60% OF BILLED CHARGES,1139.23,19.105% OF BILLED CHARGES,1827.66,30.65% OF BILLED CHARGES,5247.44,88% OF BILLED CHARGES,4472.25,75% OF BILLED CHARGES,5963,100% OF BILLED CHARGES,1316.03,22.07% OF BILLED CHARGES,5366.7,90%OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,5366.7,90% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,4682.15,78.52% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,3661.28,61.40% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,1462.43,24.525%OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,4853.88,81.4% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,3064.98,51.4% OF BILLED CHARGES,1477.04,24.77% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,4651.14,78% OF BILLED CHARGES,1477.04,24.77% OF BILLED CHARGES,5068.55,85% OF BILLED CHARGES,1506.25,25.26% OF BILLED CHARGES,413.51,115% OF CMS PHYSICIAN FEES SCHEDULE,5068.55,85% OF BILLED CHARGES,1462.43,24.525% OF BILLED CHARGES,5963,100% OF BILLED CHARGES,413.51,5963,3404.87
Outpatient Medical Services,Radiology,74177,CT Abdomen and Pelvis w/ Contrast,352,4510,3968.8,88% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,4510,100% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,1139.23,25.26% OF BILLED CHARGES,2706,60% OF BILLED CHARGES,861.64,19.105% OF BILLED CHARGES,1382.32,30.65% OF BILLED CHARGES,3968.8,88% OF BILLED CHARGES,3382.5,75% OF BILLED CHARGES,4510,100% OF BILLED CHARGES,995.36,22.07% OF BILLED CHARGES,4059,90%OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,4059,90% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,3541.25,78.52% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,2769.14,61.40% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,1106.08,24.525%OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,3671.14,81.4% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,2318.14,51.4% OF BILLED CHARGES,1117.13,24.77% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,3517.8,78% OF BILLED CHARGES,1117.13,24.77% OF BILLED CHARGES,3833.5,85% OF BILLED CHARGES,1139.23,25.26% OF BILLED CHARGES,368.54,115% OF CMS PHYSICIAN FEES SCHEDULE,3833.5,85% OF BILLED CHARGES,1106.08,24.525% OF BILLED CHARGES,4510,100% OF BILLED CHARGES,368.54,4510,2575.21
Outpatient Medical Services,Radiology,74176,CT Abdomen and Pelvis w/o Contrast,352,3291,2896.08,88% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,3291,100% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,831.31,25.26% OF BILLED CHARGES,1974.6,60% OF BILLED CHARGES,628.75,19.105% OF BILLED CHARGES,1008.69,30.65% OF BILLED CHARGES,2896.08,88% OF BILLED CHARGES,2468.25,75% OF BILLED CHARGES,3291,100% OF BILLED CHARGES,726.32,22.07% OF BILLED CHARGES,2961.9,90%OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,2961.9,90% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,2584.09,78.52% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,2020.67,61.40% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,807.12,24.525%OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,2678.87,81.4% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,1691.57,51.4% OF BILLED CHARGES,815.18,24.77% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,2566.98,78% OF BILLED CHARGES,815.18,24.77% OF BILLED CHARGES,2797.35,85% OF BILLED CHARGES,831.31,25.26% OF BILLED CHARGES,220.94,115% OF CMS PHYSICIAN FEES SCHEDULE,2797.35,85% OF BILLED CHARGES,807.12,24.525% OF BILLED CHARGES,3291,100% OF BILLED CHARGES,220.94,3291,1879.16
Outpatient Medical Services,Radiology,74174,CT Angio Abdomen and Pelvis,352,2291,2016.08,88% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,2291,100% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,578.71,25.26% OF BILLED CHARGES,1374.6,60% OF BILLED CHARGES,437.7,19.105% OF BILLED CHARGES,702.19,30.65% OF BILLED CHARGES,2016.08,88% OF BILLED CHARGES,1718.25,75% OF BILLED CHARGES,2291,100% OF BILLED CHARGES,505.62,22.07% OF BILLED CHARGES,2061.9,90%OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,2061.9,90% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,1798.89,78.52% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,1406.67,61.40% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,561.87,24.525%OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,1864.87,81.4% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,1177.57,51.4% OF BILLED CHARGES,567.48,24.77% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,1786.98,78% OF BILLED CHARGES,567.48,24.77% OF BILLED CHARGES,1947.35,85% OF BILLED CHARGES,578.71,25.26% OF BILLED CHARGES,461.96,115% OF CMS PHYSICIAN FEES SCHEDULE,1947.35,85% OF BILLED CHARGES,561.87,24.525% OF BILLED CHARGES,2291,100% OF BILLED CHARGES,437.7,2291,1308.16
Outpatient Medical Services,Radiology,75574,CT Angio Coronary Artery w/ Ca Score,352,2873,2528.24,88% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,2873,100% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,725.72,25.26% OF BILLED CHARGES,1723.8,60% OF BILLED CHARGES,548.89,19.105% OF BILLED CHARGES,880.57,30.65% OF BILLED CHARGES,2528.24,88% OF BILLED CHARGES,2154.75,75% OF BILLED CHARGES,2873,100% OF BILLED CHARGES,634.07,22.07% OF BILLED CHARGES,2585.7,90%OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,2585.7,90% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,2255.88,78.52% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,1764.02,61.40% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,704.6,24.525%OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,2338.62,81.4% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,1476.72,51.4% OF BILLED CHARGES,711.64,24.77% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,2240.94,78% OF BILLED CHARGES,711.64,24.77% OF BILLED CHARGES,2442.05,85% OF BILLED CHARGES,725.72,25.26% OF BILLED CHARGES,296.75,115% OF CMS PHYSICIAN FEES SCHEDULE,2442.05,85% OF BILLED CHARGES,704.6,24.525% OF BILLED CHARGES,2873,100% OF BILLED CHARGES,296.75,2873,1640.48
Outpatient Medical Services,Radiology,75574,CT Angio Coronary Artery w/o Ca Score,352,6361,5597.68,88% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,6361,100% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,1606.79,25.26% OF BILLED CHARGES,3816.6,60% OF BILLED CHARGES,1215.27,19.105% OF BILLED CHARGES,1949.65,30.65% OF BILLED CHARGES,5597.68,88% OF BILLED CHARGES,4770.75,75% OF BILLED CHARGES,6361,100% OF BILLED CHARGES,1403.87,22.07% OF BILLED CHARGES,5724.9,90%OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,5724.9,90% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,4994.66,78.52% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,3905.65,61.40% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,1560.04,24.525%OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,5177.85,81.4% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,3269.55,51.4% OF BILLED CHARGES,1575.62,24.77% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,4961.58,78% OF BILLED CHARGES,1575.62,24.77% OF BILLED CHARGES,5406.85,85% OF BILLED CHARGES,1606.79,25.26% OF BILLED CHARGES,296.75,115% OF CMS PHYSICIAN FEES SCHEDULE,5406.85,85% OF BILLED CHARGES,1560.04,24.525% OF BILLED CHARGES,6361,100% OF BILLED CHARGES,296.75,6361,3632.13
Outpatient Medical Services,Radiology,73706,CT Angio Lower Extremity Bilateral,352,4787,4212.56,88% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,4787,100% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,1209.2,25.26% OF BILLED CHARGES,2872.2,60% OF BILLED CHARGES,914.56,19.105% OF BILLED CHARGES,1467.22,30.65% OF BILLED CHARGES,4212.56,88% OF BILLED CHARGES,3590.25,75% OF BILLED CHARGES,4787,100% OF BILLED CHARGES,1056.49,22.07% OF BILLED CHARGES,4308.3,90%OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,4308.3,90% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,3758.75,78.52% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,2939.22,61.40% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,1174.01,24.525%OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,3896.62,81.4% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,2460.52,51.4% OF BILLED CHARGES,1185.74,24.77% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,3733.86,78% OF BILLED CHARGES,1185.74,24.77% OF BILLED CHARGES,4068.95,85% OF BILLED CHARGES,1209.2,25.26% OF BILLED CHARGES,273.49,115% OF CMS PHYSICIAN FEES SCHEDULE,4068.95,85% OF BILLED CHARGES,1174.01,24.525% OF BILLED CHARGES,4787,100% OF BILLED CHARGES,273.49,4787,2733.38
Outpatient Medical Services,Radiology,73206,CT Angio Upper Extremity Bilateral,323,6257,5506.16,88% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,6257,100% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,1580.52,25.26% OF BILLED CHARGES,3754.2,60% OF BILLED CHARGES,1195.4,19.105% OF BILLED CHARGES,1917.77,30.65% OF BILLED CHARGES,5506.16,88% OF BILLED CHARGES,4692.75,75% OF BILLED CHARGES,6257,100% OF BILLED CHARGES,1380.92,22.07% OF BILLED CHARGES,5631.3,90%OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,5631.3,90% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,4913,78.52% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,3841.8,61.40% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,1534.53,24.525%OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,5093.2,81.4% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,3216.1,51.4% OF BILLED CHARGES,1549.86,24.77% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,4880.46,78% OF BILLED CHARGES,1549.86,24.77% OF BILLED CHARGES,5318.45,85% OF BILLED CHARGES,1580.52,25.26% OF BILLED CHARGES,268.82,115% OF CMS PHYSICIAN FEES SCHEDULE,5318.45,85% OF BILLED CHARGES,1534.53,24.525% OF BILLED CHARGES,6257,100% OF BILLED CHARGES,268.82,6257,3572.75
Outpatient Medical Services,Radiology,71275,CT Angio Chest/Adbdomen/Pelvis w/ Runoff,352,6729,5921.52,88% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,6729,100% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1699.75,25.26% OF BILLED CHARGES,4037.4,60% OF BILLED CHARGES,1285.58,19.105% OF BILLED CHARGES,2062.44,30.65% OF BILLED CHARGES,5921.52,88% OF BILLED CHARGES,5046.75,75% OF BILLED CHARGES,6729,100% OF BILLED CHARGES,1485.09,22.07% OF BILLED CHARGES,6056.1,90%OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,6056.1,90% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,5283.61,78.52% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,4131.61,61.40% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,1650.29,24.525%OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,5477.41,81.4% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,3458.71,51.4% OF BILLED CHARGES,1666.77,24.77% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,5248.62,78% OF BILLED CHARGES,1666.77,24.77% OF BILLED CHARGES,5719.65,85% OF BILLED CHARGES,1699.75,25.26% OF BILLED CHARGES,270.47,115% OF CMS PHYSICIAN FEES SCHEDULE,5719.65,85% OF BILLED CHARGES,1650.29,24.525% OF BILLED CHARGES,6729,100% OF BILLED CHARGES,270.47,6729,3842.26
Outpatient Medical Services,Radiology,70496,CT Angio Head/Neck,351,5224,4597.12,88% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,5224,100% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1319.58,25.26% OF BILLED CHARGES,3134.4,60% OF BILLED CHARGES,998.05,19.105% OF BILLED CHARGES,1601.16,30.65% OF BILLED CHARGES,4597.12,88% OF BILLED CHARGES,3918,75% OF BILLED CHARGES,5224,100% OF BILLED CHARGES,1152.94,22.07% OF BILLED CHARGES,4701.6,90%OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,4701.6,90% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,4101.88,78.52% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,3207.54,61.40% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,1281.19,24.525%OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,4252.34,81.4% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,2685.14,51.4% OF BILLED CHARGES,1293.98,24.77% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,4074.72,78% OF BILLED CHARGES,1293.98,24.77% OF BILLED CHARGES,4440.4,85% OF BILLED CHARGES,1319.58,25.26% OF BILLED CHARGES,267.16,115% OF CMS PHYSICIAN FEES SCHEDULE,4440.4,85% OF BILLED CHARGES,1281.19,24.525% OF BILLED CHARGES,5224,100% OF BILLED CHARGES,267.16,5224,2982.90
Outpatient Medical Services,Radiology,47000,CT Biopsy Liver,350,2612,2298.56,88% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,659.79,25.26% OF BILLED CHARGES,1567.2,60% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,800.58,30.65% OF BILLED CHARGES,2298.56,88% OF BILLED CHARGES,1959,75% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,576.47,22.07% OF BILLED CHARGES,2350.8,90%OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2350.8,90% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2050.94,78.52% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,1603.77,61.40% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525%OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2126.17,81.4% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,1342.57,51.4% OF BILLED CHARGES,646.99,24.77% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2037.36,78% OF BILLED CHARGES,646.99,24.77% OF BILLED CHARGES,2220.2,85% OF BILLED CHARGES,659.79,25.26% OF BILLED CHARGES,99.08,115% OF CMS PHYSICIAN FEES SCHEDULE,2220.2,85% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,99.08,2612,1491.45
Outpatient Medical Services,Radiology,32408,CT Biopsy Lung/Mediastinum,350,2612,2298.56,88% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,659.79,25.26% OF BILLED CHARGES,1567.2,60% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,800.58,30.65% OF BILLED CHARGES,2298.56,88% OF BILLED CHARGES,1959,75% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,576.47,22.07% OF BILLED CHARGES,2350.8,90%OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2350.8,90% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2050.94,78.52% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,1603.77,61.40% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525%OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2126.17,81.4% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,1342.57,51.4% OF BILLED CHARGES,646.99,24.77% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2037.36,78% OF BILLED CHARGES,646.99,24.77% OF BILLED CHARGES,2220.2,85% OF BILLED CHARGES,659.79,25.26% OF BILLED CHARGES,170.64,115% OF CMS PHYSICIAN FEES SCHEDULE,2220.2,85% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,170.64,2612,1491.45
Outpatient Medical Services,Radiology,48102,CT Biopsy Pancreas,350,2612,2298.56,88% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,659.79,25.26% OF BILLED CHARGES,1567.2,60% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,800.58,30.65% OF BILLED CHARGES,2298.56,88% OF BILLED CHARGES,1959,75% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,576.47,22.07% OF BILLED CHARGES,2350.8,90%OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2350.8,90% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2050.94,78.52% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,1603.77,61.40% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525%OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2126.17,81.4% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,1342.57,51.4% OF BILLED CHARGES,646.99,24.77% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2037.36,78% OF BILLED CHARGES,646.99,24.77% OF BILLED CHARGES,2220.2,85% OF BILLED CHARGES,659.79,25.26% OF BILLED CHARGES,264.89,115% OF CMS PHYSICIAN FEES SCHEDULE,2220.2,85% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,264.89,2612,1491.45
Outpatient Medical Services,Radiology,50200,CT Biopsy Renal,350,2612,2298.56,88% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,659.79,25.26% OF BILLED CHARGES,1567.2,60% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,800.58,30.65% OF BILLED CHARGES,2298.56,88% OF BILLED CHARGES,1959,75% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,576.47,22.07% OF BILLED CHARGES,2350.8,90%OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2350.8,90% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2050.94,78.52% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,1603.77,61.40% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525%OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2126.17,81.4% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,1342.57,51.4% OF BILLED CHARGES,646.99,24.77% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2037.36,78% OF BILLED CHARGES,646.99,24.77% OF BILLED CHARGES,2220.2,85% OF BILLED CHARGES,659.79,25.26% OF BILLED CHARGES,142.91,115% OF CMS PHYSICIAN FEES SCHEDULE,2220.2,85% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,142.91,2612,1491.45
Outpatient Medical Services,Radiology,70470,CT Brain/Head w/ + w/o Contrast,351,3364,2960.32,88% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,3364,100% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,849.75,25.26% OF BILLED CHARGES,2018.4,60% OF BILLED CHARGES,642.69,19.105% OF BILLED CHARGES,1031.07,30.65% OF BILLED CHARGES,2960.32,88% OF BILLED CHARGES,2523,75% OF BILLED CHARGES,3364,100% OF BILLED CHARGES,742.43,22.07% OF BILLED CHARGES,3027.6,90%OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,3027.6,90% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2641.41,78.52% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2065.5,61.40% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525%OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2738.3,81.4% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,1729.1,51.4% OF BILLED CHARGES,833.26,24.77% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2623.92,78% OF BILLED CHARGES,833.26,24.77% OF BILLED CHARGES,2859.4,85% OF BILLED CHARGES,849.75,25.26% OF BILLED CHARGES,210.17,115% OF CMS PHYSICIAN FEES SCHEDULE,2859.4,85% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,3364,100% OF BILLED CHARGES,210.17,3364,1920.84
Outpatient Medical Services,Radiology,70460,CT Brain/Head w/ Contrast,351,3001,2640.88,88% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,3001,100% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,758.05,25.26% OF BILLED CHARGES,1800.6,60% OF BILLED CHARGES,573.34,19.105% OF BILLED CHARGES,919.81,30.65% OF BILLED CHARGES,2640.88,88% OF BILLED CHARGES,2250.75,75% OF BILLED CHARGES,3001,100% OF BILLED CHARGES,662.32,22.07% OF BILLED CHARGES,2700.9,90%OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2700.9,90% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2356.39,78.52% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,1842.61,61.40% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525%OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2442.81,81.4% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,1542.51,51.4% OF BILLED CHARGES,743.35,24.77% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2340.78,78% OF BILLED CHARGES,743.35,24.77% OF BILLED CHARGES,2550.85,85% OF BILLED CHARGES,758.05,25.26% OF BILLED CHARGES,179.47,115% OF CMS PHYSICIAN FEES SCHEDULE,2550.85,85% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,3001,100% OF BILLED CHARGES,179.47,3001,1713.57
Outpatient Medical Services,Radiology,70450,CT Brain/Head w/o Contrast,351,2852,2509.76,88% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,720.42,25.26% OF BILLED CHARGES,1711.2,60% OF BILLED CHARGES,544.87,19.105% OF BILLED CHARGES,874.14,30.65% OF BILLED CHARGES,2509.76,88% OF BILLED CHARGES,2139,75% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,629.44,22.07% OF BILLED CHARGES,2566.8,90%OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2566.8,90% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2239.39,78.52% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,1751.13,61.40% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525%OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2321.53,81.4% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,1465.93,51.4% OF BILLED CHARGES,706.44,24.77% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2224.56,78% OF BILLED CHARGES,706.44,24.77% OF BILLED CHARGES,2424.2,85% OF BILLED CHARGES,720.42,25.26% OF BILLED CHARGES,128.25,115% OF CMS PHYSICIAN FEES SCHEDULE,2424.2,85% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,128.25,2852,1628.49
Outpatient Medical Services,Radiology,71270,CT Chest w/ + w/o Contrast,350,4764,4192.32,88% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1203.39,25.26% OF BILLED CHARGES,2858.4,60% OF BILLED CHARGES,910.16,19.105% OF BILLED CHARGES,1460.17,30.65% OF BILLED CHARGES,4192.32,88% OF BILLED CHARGES,3573,75% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,1051.41,22.07% OF BILLED CHARGES,4287.6,90%OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4287.6,90% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3740.69,78.52% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,2925.1,61.40% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525%OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3877.9,81.4% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,2448.7,51.4% OF BILLED CHARGES,1180.04,24.77% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3715.92,78% OF BILLED CHARGES,1180.04,24.77% OF BILLED CHARGES,4049.4,85% OF BILLED CHARGES,1203.39,25.26% OF BILLED CHARGES,238.15,115% OF CMS PHYSICIAN FEES SCHEDULE,4049.4,85% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,238.15,4764,2720.24
Outpatient Medical Services,Radiology,71260,CT Chest w/ Contrast,350,4485,3946.8,88% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1132.91,25.26% OF BILLED CHARGES,2691,60% OF BILLED CHARGES,856.86,19.105% OF BILLED CHARGES,1374.65,30.65% OF BILLED CHARGES,3946.8,88% OF BILLED CHARGES,3363.75,75% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,989.84,22.07% OF BILLED CHARGES,4036.5,90%OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4036.5,90% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3521.62,78.52% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,2753.79,61.40% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525%OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3650.79,81.4% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,2305.29,51.4% OF BILLED CHARGES,1110.93,24.77% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3498.3,78% OF BILLED CHARGES,1110.93,24.77% OF BILLED CHARGES,3812.25,85% OF BILLED CHARGES,1132.91,25.26% OF BILLED CHARGES,202.43,115% OF CMS PHYSICIAN FEES SCHEDULE,3812.25,85% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,202.43,4485,2560.94
Outpatient Medical Services,Radiology,71250,CT Chest w/o Contrast,350,3137,2760.56,88% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,792.41,25.26% OF BILLED CHARGES,1882.2,60% OF BILLED CHARGES,599.32,19.105% OF BILLED CHARGES,961.49,30.65% OF BILLED CHARGES,2760.56,88% OF BILLED CHARGES,2352.75,75% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,692.34,22.07% OF BILLED CHARGES,2823.3,90%OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2823.3,90% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2463.17,78.52% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,1926.12,61.40% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525%OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2553.52,81.4% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,1612.42,51.4% OF BILLED CHARGES,777.03,24.77% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2446.86,78% OF BILLED CHARGES,777.03,24.77% OF BILLED CHARGES,2666.45,85% OF BILLED CHARGES,792.41,25.26% OF BILLED CHARGES,160.83,115% OF CMS PHYSICIAN FEES SCHEDULE,2666.45,85% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,160.83,3137,1791.23
Outpatient Medical Services,Radiology,71270,CT Chest/Adbomen/Pelvis w/ + w/o Contras,350,4764,4192.32,88% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1203.39,25.26% OF BILLED CHARGES,2858.4,60% OF BILLED CHARGES,910.16,19.105% OF BILLED CHARGES,1460.17,30.65% OF BILLED CHARGES,4192.32,88% OF BILLED CHARGES,3573,75% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,1051.41,22.07% OF BILLED CHARGES,4287.6,90%OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4287.6,90% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3740.69,78.52% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,2925.1,61.40% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525%OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3877.9,81.4% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,2448.7,51.4% OF BILLED CHARGES,1180.04,24.77% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3715.92,78% OF BILLED CHARGES,1180.04,24.77% OF BILLED CHARGES,4049.4,85% OF BILLED CHARGES,1203.39,25.26% OF BILLED CHARGES,238.15,115% OF CMS PHYSICIAN FEES SCHEDULE,4049.4,85% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,238.15,4764,2720.24
Outpatient Medical Services,Radiology,71260,CT Chest/Adbomen/Pelvis w/ Contrast,350,4485,3946.8,88% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1132.91,25.26% OF BILLED CHARGES,2691,60% OF BILLED CHARGES,856.86,19.105% OF BILLED CHARGES,1374.65,30.65% OF BILLED CHARGES,3946.8,88% OF BILLED CHARGES,3363.75,75% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,989.84,22.07% OF BILLED CHARGES,4036.5,90%OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4036.5,90% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3521.62,78.52% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,2753.79,61.40% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525%OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3650.79,81.4% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,2305.29,51.4% OF BILLED CHARGES,1110.93,24.77% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3498.3,78% OF BILLED CHARGES,1110.93,24.77% OF BILLED CHARGES,3812.25,85% OF BILLED CHARGES,1132.91,25.26% OF BILLED CHARGES,202.43,115% OF CMS PHYSICIAN FEES SCHEDULE,3812.25,85% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,202.43,4485,2560.94
Outpatient Medical Services,Radiology,71250,CT Chest/Adbomen/Pelvis w/o Contrast,350,3137,2760.56,88% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,792.41,25.26% OF BILLED CHARGES,1882.2,60% OF BILLED CHARGES,599.32,19.105% OF BILLED CHARGES,961.49,30.65% OF BILLED CHARGES,2760.56,88% OF BILLED CHARGES,2352.75,75% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,692.34,22.07% OF BILLED CHARGES,2823.3,90%OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2823.3,90% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2463.17,78.52% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,1926.12,61.40% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525%OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2553.52,81.4% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,1612.42,51.4% OF BILLED CHARGES,777.03,24.77% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2446.86,78% OF BILLED CHARGES,777.03,24.77% OF BILLED CHARGES,2666.45,85% OF BILLED CHARGES,792.41,25.26% OF BILLED CHARGES,160.83,115% OF CMS PHYSICIAN FEES SCHEDULE,2666.45,85% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,160.83,3137,1791.23
Outpatient Medical Services,Radiology,71270,CT Chest/Abdomen w/ + w/o Contrast,350,4764,4192.32,88% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1203.39,25.26% OF BILLED CHARGES,2858.4,60% OF BILLED CHARGES,910.16,19.105% OF BILLED CHARGES,1460.17,30.65% OF BILLED CHARGES,4192.32,88% OF BILLED CHARGES,3573,75% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,1051.41,22.07% OF BILLED CHARGES,4287.6,90%OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4287.6,90% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3740.69,78.52% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,2925.1,61.40% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525%OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3877.9,81.4% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,2448.7,51.4% OF BILLED CHARGES,1180.04,24.77% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3715.92,78% OF BILLED CHARGES,1180.04,24.77% OF BILLED CHARGES,4049.4,85% OF BILLED CHARGES,1203.39,25.26% OF BILLED CHARGES,238.15,115% OF CMS PHYSICIAN FEES SCHEDULE,4049.4,85% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,238.15,4764,2720.24
Outpatient Medical Services,Radiology,71260,CT Chest/Abdomen w/ Contrast,350,4485,3946.8,88% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1132.91,25.26% OF BILLED CHARGES,2691,60% OF BILLED CHARGES,856.86,19.105% OF BILLED CHARGES,1374.65,30.65% OF BILLED CHARGES,3946.8,88% OF BILLED CHARGES,3363.75,75% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,989.84,22.07% OF BILLED CHARGES,4036.5,90%OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4036.5,90% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3521.62,78.52% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,2753.79,61.40% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525%OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3650.79,81.4% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,2305.29,51.4% OF BILLED CHARGES,1110.93,24.77% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3498.3,78% OF BILLED CHARGES,1110.93,24.77% OF BILLED CHARGES,3812.25,85% OF BILLED CHARGES,1132.91,25.26% OF BILLED CHARGES,202.43,115% OF CMS PHYSICIAN FEES SCHEDULE,3812.25,85% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,202.43,4485,2560.94
Outpatient Medical Services,Radiology,71250,CT Chest/Abdomen w/o Contrast,350,3137,2760.56,88% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,792.41,25.26% OF BILLED CHARGES,1882.2,60% OF BILLED CHARGES,599.32,19.105% OF BILLED CHARGES,961.49,30.65% OF BILLED CHARGES,2760.56,88% OF BILLED CHARGES,2352.75,75% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,692.34,22.07% OF BILLED CHARGES,2823.3,90%OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2823.3,90% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2463.17,78.52% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,1926.12,61.40% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525%OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2553.52,81.4% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,1612.42,51.4% OF BILLED CHARGES,777.03,24.77% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2446.86,78% OF BILLED CHARGES,777.03,24.77% OF BILLED CHARGES,2666.45,85% OF BILLED CHARGES,792.41,25.26% OF BILLED CHARGES,160.83,115% OF CMS PHYSICIAN FEES SCHEDULE,2666.45,85% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,160.83,3137,1791.23
Outpatient Medical Services,Radiology,10030,CT Drain Soft Tissue Fluid w/Cath Perc,350,6330,5570.4,88% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,6330,100% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,1598.96,25.26% OF BILLED CHARGES,3798,60% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,1940.15,30.65% OF BILLED CHARGES,5570.4,88% OF BILLED CHARGES,4747.5,75% OF BILLED CHARGES,6330,100% OF BILLED CHARGES,1397.03,22.07% OF BILLED CHARGES,5697,90%OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,5697,90% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,4970.32,78.52% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,3886.62,61.40% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,1552.43,24.525%OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,5152.62,81.4% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,3253.62,51.4% OF BILLED CHARGES,1567.94,24.77% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,4937.4,78% OF BILLED CHARGES,1567.94,24.77% OF BILLED CHARGES,5380.5,85% OF BILLED CHARGES,1598.96,25.26% OF BILLED CHARGES,151.77,115% OF CMS PHYSICIAN FEES SCHEDULE,5380.5,85% OF BILLED CHARGES,1552.43,24.525% OF BILLED CHARGES,6330,100% OF BILLED CHARGES,151.77,6330,3614.43
Outpatient Medical Services,Radiology,75989,CT Drain Visceral Fluid w/Cath Perc,350,2417,2126.96,88% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,2417,100% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,610.53,25.26% OF BILLED CHARGES,1450.2,60% OF BILLED CHARGES,461.77,19.105% OF BILLED CHARGES,740.81,30.65% OF BILLED CHARGES,2126.96,88% OF BILLED CHARGES,1812.75,75% OF BILLED CHARGES,2417,100% OF BILLED CHARGES,533.43,22.07% OF BILLED CHARGES,2175.3,90%OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,2175.3,90% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,1897.83,78.52% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,1484.04,61.40% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,592.77,24.525%OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,1967.44,81.4% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,1242.34,51.4% OF BILLED CHARGES,598.69,24.77% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,1885.26,78% OF BILLED CHARGES,598.69,24.77% OF BILLED CHARGES,2054.45,85% OF BILLED CHARGES,610.53,25.26% OF BILLED CHARGES,130.65,115% OF CMS PHYSICIAN FEES SCHEDULE,2054.45,85% OF BILLED CHARGES,592.77,24.525% OF BILLED CHARGES,2417,100% OF BILLED CHARGES,130.65,2417,1380.11
Outpatient Medical Services,Radiology,77012,CT Guided Needle Placement,350,2375,2090,88% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,2375,100% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,599.93,25.26% OF BILLED CHARGES,1425,60% OF BILLED CHARGES,453.74,19.105% OF BILLED CHARGES,727.94,30.65% OF BILLED CHARGES,2090,88% OF BILLED CHARGES,1781.25,75% OF BILLED CHARGES,2375,100% OF BILLED CHARGES,524.16,22.07% OF BILLED CHARGES,2137.5,90%OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,2137.5,90% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,1864.85,78.52% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,1458.25,61.40% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,582.47,24.525%OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,1933.25,81.4% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,1220.75,51.4% OF BILLED CHARGES,588.29,24.77% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,1852.5,78% OF BILLED CHARGES,588.29,24.77% OF BILLED CHARGES,2018.75,85% OF BILLED CHARGES,599.93,25.26% OF BILLED CHARGES,163.21,115% OF CMS PHYSICIAN FEES SCHEDULE,2018.75,85% OF BILLED CHARGES,582.47,24.525% OF BILLED CHARGES,2375,100% OF BILLED CHARGES,163.21,2375,1356.13
Outpatient Medical Services,Radiology,50593,CT Guided Cryoablation,350,22273,19600.24,88% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,16738,100% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,5626.16,25.26% OF BILLED CHARGES,13363.8,60% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,6826.67,30.65% OF BILLED CHARGES,19600.24,88% OF BILLED CHARGES,16704.75,75% OF BILLED CHARGES,22273,100% OF BILLED CHARGES,4915.65,22.07% OF BILLED CHARGES,20045.7,90%OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,20045.7,90% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,17488.76,78.52% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,13675.62,61.40% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,5462.45,24.525%OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,18130.22,81.4% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,11448.32,51.4% OF BILLED CHARGES,5517.02,24.77% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,17372.94,78% OF BILLED CHARGES,5517.02,24.77% OF BILLED CHARGES,18932.05,85% OF BILLED CHARGES,5626.16,25.26% OF BILLED CHARGES,513.51,115% OF CMS PHYSICIAN FEES SCHEDULE,18932.05,85% OF BILLED CHARGES,5462.45,24.525% OF BILLED CHARGES,22273,100% OF BILLED CHARGES,513.51,22273,12717.88
Outpatient Medical Services,Radiology,38222,CT Guided Bone Marrow Biopsy,761,810,712.8,88% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,810,100% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,204.61,25.26% OF BILLED CHARGES,,NOT REIMBUSABLE,198.65,24.525% OF BILLED CHARGES,248.27,30.65% OF BILLED CHARGES,712.8,88% OF BILLED CHARGES,607.5,75% OF BILLED CHARGES,810,100% OF BILLED CHARGES,178.77,22.07% OF BILLED CHARGES,729,90%OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,729,90% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,636.01,78.52% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,497.34,61.40% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,198.65,24.525%OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,659.34,81.4% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,416.34,51.4% OF BILLED CHARGES,200.64,24.77% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,631.8,78% OF BILLED CHARGES,200.64,24.77% OF BILLED CHARGES,688.5,85% OF BILLED CHARGES,204.61,25.26% OF BILLED CHARGES,85.47,115% OF CMS PHYSICIAN FEES SCHEDULE,688.5,85% OF BILLED CHARGES,198.65,24.525% OF BILLED CHARGES,810,100% OF BILLED CHARGES,85.47,810,462.51
Outpatient Medical Services,Radiology,75572,CT Heart + Eval w/ Contrast,352,4577,4027.76,88% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,4577,100% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,1156.15,25.26% OF BILLED CHARGES,2746.2,60% OF BILLED CHARGES,874.44,19.105% OF BILLED CHARGES,1402.85,30.65% OF BILLED CHARGES,4027.76,88% OF BILLED CHARGES,3432.75,75% OF BILLED CHARGES,4577,100% OF BILLED CHARGES,1010.14,22.07% OF BILLED CHARGES,4119.3,90%OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,4119.3,90% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,3593.86,78.52% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,2810.28,61.40% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,1122.51,24.525%OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,3725.68,81.4% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,2352.58,51.4% OF BILLED CHARGES,1133.72,24.77% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,3570.06,78% OF BILLED CHARGES,1133.72,24.77% OF BILLED CHARGES,3890.45,85% OF BILLED CHARGES,1156.15,25.26% OF BILLED CHARGES,275.47,115% OF CMS PHYSICIAN FEES SCHEDULE,3890.45,85% OF BILLED CHARGES,1122.51,24.525% OF BILLED CHARGES,4577,100% OF BILLED CHARGES,275.47,4577,2613.47
Outpatient Medical Services,Radiology,75573,CT Heart Congenital + Eval w/ Contrast,352,2135,1878.8,88% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,2135,100% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,539.3,25.26% OF BILLED CHARGES,1281,60% OF BILLED CHARGES,407.89,19.105% OF BILLED CHARGES,654.38,30.65% OF BILLED CHARGES,1878.8,88% OF BILLED CHARGES,1601.25,75% OF BILLED CHARGES,2135,100% OF BILLED CHARGES,471.19,22.07% OF BILLED CHARGES,1921.5,90%OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,1921.5,90% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,1676.4,78.52% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,1310.89,61.40% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,523.61,24.525%OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,1737.89,81.4% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,1097.39,51.4% OF BILLED CHARGES,528.84,24.77% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,1665.3,78% OF BILLED CHARGES,528.84,24.77% OF BILLED CHARGES,1814.75,85% OF BILLED CHARGES,539.3,25.26% OF BILLED CHARGES,304.05,115% OF CMS PHYSICIAN FEES SCHEDULE,1814.75,85% OF BILLED CHARGES,523.61,24.525% OF BILLED CHARGES,2135,100% OF BILLED CHARGES,304.05,2135,1219.09
Outpatient Medical Services,Radiology,75571,CT Heart Calcium Scoring,352,1044,918.72,88% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,1044,100% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,263.71,25.26% OF BILLED CHARGES,626.4,60% OF BILLED CHARGES,199.46,19.105% OF BILLED CHARGES,319.99,30.65% OF BILLED CHARGES,918.72,88% OF BILLED CHARGES,783,75% OF BILLED CHARGES,1044,100% OF BILLED CHARGES,230.41,22.07% OF BILLED CHARGES,939.6,90%OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,939.6,90% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,819.75,78.52% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,641.02,61.40% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,256.04,24.525%OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,849.82,81.4% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,536.62,51.4% OF BILLED CHARGES,258.6,24.77% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,814.32,78% OF BILLED CHARGES,258.6,24.77% OF BILLED CHARGES,887.4,85% OF BILLED CHARGES,263.71,25.26% OF BILLED CHARGES,121.03,115% OF CMS PHYSICIAN FEES SCHEDULE,887.4,85% OF BILLED CHARGES,256.04,24.525% OF BILLED CHARGES,1044,100% OF BILLED CHARGES,121.03,1044,596.12
Outpatient Medical Services,Radiology,70470,CT Head/Neck w/ + w/o Contrast,351,3364,2960.32,88% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,3364,100% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,849.75,25.26% OF BILLED CHARGES,2018.4,60% OF BILLED CHARGES,642.69,19.105% OF BILLED CHARGES,1031.07,30.65% OF BILLED CHARGES,2960.32,88% OF BILLED CHARGES,2523,75% OF BILLED CHARGES,3364,100% OF BILLED CHARGES,742.43,22.07% OF BILLED CHARGES,3027.6,90%OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,3027.6,90% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2641.41,78.52% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2065.5,61.40% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525%OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2738.3,81.4% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,1729.1,51.4% OF BILLED CHARGES,833.26,24.77% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2623.92,78% OF BILLED CHARGES,833.26,24.77% OF BILLED CHARGES,2859.4,85% OF BILLED CHARGES,849.75,25.26% OF BILLED CHARGES,210.17,115% OF CMS PHYSICIAN FEES SCHEDULE,2859.4,85% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,3364,100% OF BILLED CHARGES,210.17,3364,1920.84
Outpatient Medical Services,Radiology,70460,CT Head/Neck w/ Contrast,351,3001,2640.88,88% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,3001,100% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,758.05,25.26% OF BILLED CHARGES,1800.6,60% OF BILLED CHARGES,573.34,19.105% OF BILLED CHARGES,919.81,30.65% OF BILLED CHARGES,2640.88,88% OF BILLED CHARGES,2250.75,75% OF BILLED CHARGES,3001,100% OF BILLED CHARGES,662.32,22.07% OF BILLED CHARGES,2700.9,90%OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2700.9,90% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2356.39,78.52% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,1842.61,61.40% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525%OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2442.81,81.4% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,1542.51,51.4% OF BILLED CHARGES,743.35,24.77% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2340.78,78% OF BILLED CHARGES,743.35,24.77% OF BILLED CHARGES,2550.85,85% OF BILLED CHARGES,758.05,25.26% OF BILLED CHARGES,179.47,115% OF CMS PHYSICIAN FEES SCHEDULE,2550.85,85% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,3001,100% OF BILLED CHARGES,179.47,3001,1713.57
Outpatient Medical Services,Radiology,70450,CT Head/Neck w/o Contrast,351,2852,2509.76,88% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,720.42,25.26% OF BILLED CHARGES,1711.2,60% OF BILLED CHARGES,544.87,19.105% OF BILLED CHARGES,874.14,30.65% OF BILLED CHARGES,2509.76,88% OF BILLED CHARGES,2139,75% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,629.44,22.07% OF BILLED CHARGES,2566.8,90%OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2566.8,90% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2239.39,78.52% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,1751.13,61.40% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525%OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2321.53,81.4% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,1465.93,51.4% OF BILLED CHARGES,706.44,24.77% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2224.56,78% OF BILLED CHARGES,706.44,24.77% OF BILLED CHARGES,2424.2,85% OF BILLED CHARGES,720.42,25.26% OF BILLED CHARGES,128.25,115% OF CMS PHYSICIAN FEES SCHEDULE,2424.2,85% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,128.25,2852,1628.49
Outpatient Medical Services,Radiology,70470,CT Head/Orbits w/ + w/o Contrast,351,3364,2960.32,88% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,3364,100% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,849.75,25.26% OF BILLED CHARGES,2018.4,60% OF BILLED CHARGES,642.69,19.105% OF BILLED CHARGES,1031.07,30.65% OF BILLED CHARGES,2960.32,88% OF BILLED CHARGES,2523,75% OF BILLED CHARGES,3364,100% OF BILLED CHARGES,742.43,22.07% OF BILLED CHARGES,3027.6,90%OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,3027.6,90% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2641.41,78.52% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2065.5,61.40% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,825.02,24.525%OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2738.3,81.4% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,1729.1,51.4% OF BILLED CHARGES,833.26,24.77% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,2623.92,78% OF BILLED CHARGES,833.26,24.77% OF BILLED CHARGES,2859.4,85% OF BILLED CHARGES,849.75,25.26% OF BILLED CHARGES,210.17,115% OF CMS PHYSICIAN FEES SCHEDULE,2859.4,85% OF BILLED CHARGES,825.02,24.525% OF BILLED CHARGES,3364,100% OF BILLED CHARGES,210.17,3364,1920.84
Outpatient Medical Services,Radiology,70460,CT Head/Orbits w/ Contrast,351,3001,2640.88,88% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,3001,100% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,758.05,25.26% OF BILLED CHARGES,1800.6,60% OF BILLED CHARGES,573.34,19.105% OF BILLED CHARGES,919.81,30.65% OF BILLED CHARGES,2640.88,88% OF BILLED CHARGES,2250.75,75% OF BILLED CHARGES,3001,100% OF BILLED CHARGES,662.32,22.07% OF BILLED CHARGES,2700.9,90%OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2700.9,90% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2356.39,78.52% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,1842.61,61.40% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,736,24.525%OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2442.81,81.4% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,1542.51,51.4% OF BILLED CHARGES,743.35,24.77% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,2340.78,78% OF BILLED CHARGES,743.35,24.77% OF BILLED CHARGES,2550.85,85% OF BILLED CHARGES,758.05,25.26% OF BILLED CHARGES,179.47,115% OF CMS PHYSICIAN FEES SCHEDULE,2550.85,85% OF BILLED CHARGES,736,24.525% OF BILLED CHARGES,3001,100% OF BILLED CHARGES,179.47,3001,1713.57
Outpatient Medical Services,Radiology,70450,CT Head/Orbits w/o Contrast,351,2852,2509.76,88% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,720.42,25.26% OF BILLED CHARGES,1711.2,60% OF BILLED CHARGES,544.87,19.105% OF BILLED CHARGES,874.14,30.65% OF BILLED CHARGES,2509.76,88% OF BILLED CHARGES,2139,75% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,629.44,22.07% OF BILLED CHARGES,2566.8,90%OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2566.8,90% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2239.39,78.52% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,1751.13,61.40% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525%OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2321.53,81.4% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,1465.93,51.4% OF BILLED CHARGES,706.44,24.77% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2224.56,78% OF BILLED CHARGES,706.44,24.77% OF BILLED CHARGES,2424.2,85% OF BILLED CHARGES,720.42,25.26% OF BILLED CHARGES,128.25,115% OF CMS PHYSICIAN FEES SCHEDULE,2424.2,85% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,128.25,2852,1628.49
Outpatient Medical Services,Radiology,73701,CT Lower Extremity w/ Contrast Bilat,352,6307,5550.16,88% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,6307,100% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,1593.15,25.26% OF BILLED CHARGES,3784.2,60% OF BILLED CHARGES,1204.95,19.105% OF BILLED CHARGES,1933.1,30.65% OF BILLED CHARGES,5550.16,88% OF BILLED CHARGES,4730.25,75% OF BILLED CHARGES,6307,100% OF BILLED CHARGES,1391.95,22.07% OF BILLED CHARGES,5676.3,90%OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,5676.3,90% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,4952.26,78.52% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,3872.5,61.40% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,1546.79,24.525%OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,5133.9,81.4% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,3241.8,51.4% OF BILLED CHARGES,1562.24,24.77% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,4919.46,78% OF BILLED CHARGES,1562.24,24.77% OF BILLED CHARGES,5360.95,85% OF BILLED CHARGES,1593.15,25.26% OF BILLED CHARGES,202.04,115% OF CMS PHYSICIAN FEES SCHEDULE,5360.95,85% OF BILLED CHARGES,1546.79,24.525% OF BILLED CHARGES,6307,100% OF BILLED CHARGES,202.04,6307,3601.30
Outpatient Medical Services,Radiology,73701,CT Lower Extremity w/ Contrast Left,352,3475,3058,88% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,3475,100% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,877.79,25.26% OF BILLED CHARGES,2085,60% OF BILLED CHARGES,663.9,19.105% OF BILLED CHARGES,1065.09,30.65% OF BILLED CHARGES,3058,88% OF BILLED CHARGES,2606.25,75% OF BILLED CHARGES,3475,100% OF BILLED CHARGES,766.93,22.07% OF BILLED CHARGES,3127.5,90%OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,3127.5,90% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,2728.57,78.52% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,2133.65,61.40% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,852.24,24.525%OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,2828.65,81.4% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,1786.15,51.4% OF BILLED CHARGES,860.76,24.77% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,2710.5,78% OF BILLED CHARGES,860.76,24.77% OF BILLED CHARGES,2953.75,85% OF BILLED CHARGES,877.79,25.26% OF BILLED CHARGES,202.04,115% OF CMS PHYSICIAN FEES SCHEDULE,2953.75,85% OF BILLED CHARGES,852.24,24.525% OF BILLED CHARGES,3475,100% OF BILLED CHARGES,202.04,3475,1984.23
Outpatient Medical Services,Radiology,73701,CT Lower Extremity w/ Contrast Right,352,7353,6470.64,88% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,7353,100% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1857.37,25.26% OF BILLED CHARGES,4411.8,60% OF BILLED CHARGES,1404.79,19.105% OF BILLED CHARGES,2253.69,30.65% OF BILLED CHARGES,6470.64,88% OF BILLED CHARGES,5514.75,75% OF BILLED CHARGES,7353,100% OF BILLED CHARGES,1622.81,22.07% OF BILLED CHARGES,6617.7,90%OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,6617.7,90% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,5773.58,78.52% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,4514.74,61.40% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525%OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,5985.34,81.4% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,3779.44,51.4% OF BILLED CHARGES,1821.34,24.77% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,5735.34,78% OF BILLED CHARGES,1821.34,24.77% OF BILLED CHARGES,6250.05,85% OF BILLED CHARGES,1857.37,25.26% OF BILLED CHARGES,202.04,115% OF CMS PHYSICIAN FEES SCHEDULE,6250.05,85% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,7353,100% OF BILLED CHARGES,202.04,7353,4198.56
Outpatient Medical Services,Radiology,73702,CT Lower Extremity w/+w/o Contrast Bilat,352,7725,6798,88% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,7725,100% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,1951.34,25.26% OF BILLED CHARGES,4635,60% OF BILLED CHARGES,1475.86,19.105% OF BILLED CHARGES,2367.71,30.65% OF BILLED CHARGES,6798,88% OF BILLED CHARGES,5793.75,75% OF BILLED CHARGES,7725,100% OF BILLED CHARGES,1704.91,22.07% OF BILLED CHARGES,6952.5,90%OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,6952.5,90% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,6065.67,78.52% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,4743.15,61.40% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,1894.56,24.525%OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,6288.15,81.4% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,3970.65,51.4% OF BILLED CHARGES,1913.48,24.77% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,6025.5,78% OF BILLED CHARGES,1913.48,24.77% OF BILLED CHARGES,6566.25,85% OF BILLED CHARGES,1951.34,25.26% OF BILLED CHARGES,236.99,115% OF CMS PHYSICIAN FEES SCHEDULE,6566.25,85% OF BILLED CHARGES,1894.56,24.525% OF BILLED CHARGES,7725,100% OF BILLED CHARGES,236.99,7725,4410.98
Outpatient Medical Services,Radiology,73702,CT Lower Extremity w/+w/o Contrast Left,352,3903,3434.64,88% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3903,100% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,985.9,25.26% OF BILLED CHARGES,2341.8,60% OF BILLED CHARGES,745.67,19.105% OF BILLED CHARGES,1196.27,30.65% OF BILLED CHARGES,3434.64,88% OF BILLED CHARGES,2927.25,75% OF BILLED CHARGES,3903,100% OF BILLED CHARGES,861.39,22.07% OF BILLED CHARGES,3512.7,90%OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3512.7,90% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3064.64,78.52% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,2396.44,61.40% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,957.21,24.525%OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3177.04,81.4% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,2006.14,51.4% OF BILLED CHARGES,966.77,24.77% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3044.34,78% OF BILLED CHARGES,966.77,24.77% OF BILLED CHARGES,3317.55,85% OF BILLED CHARGES,985.9,25.26% OF BILLED CHARGES,236.99,115% OF CMS PHYSICIAN FEES SCHEDULE,3317.55,85% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3903,100% OF BILLED CHARGES,236.99,3903,2228.61
Outpatient Medical Services,Radiology,73702,CT Lower Extremity w/+w/o Contrast Right,352,3903,3434.64,88% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3903,100% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,985.9,25.26% OF BILLED CHARGES,2341.8,60% OF BILLED CHARGES,745.67,19.105% OF BILLED CHARGES,1196.27,30.65% OF BILLED CHARGES,3434.64,88% OF BILLED CHARGES,2927.25,75% OF BILLED CHARGES,3903,100% OF BILLED CHARGES,861.39,22.07% OF BILLED CHARGES,3512.7,90%OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3512.7,90% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3064.64,78.52% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,2396.44,61.40% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,957.21,24.525%OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3177.04,81.4% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,2006.14,51.4% OF BILLED CHARGES,966.77,24.77% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3044.34,78% OF BILLED CHARGES,966.77,24.77% OF BILLED CHARGES,3317.55,85% OF BILLED CHARGES,985.9,25.26% OF BILLED CHARGES,236.99,115% OF CMS PHYSICIAN FEES SCHEDULE,3317.55,85% OF BILLED CHARGES,957.21,24.525% OF BILLED CHARGES,3903,100% OF BILLED CHARGES,236.99,3903,2228.61
Outpatient Medical Services,Radiology,73700,CT Lower Extremity w/o Contrast Bilat,352,5008,4407.04,88% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,5008,100% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,1265.02,25.26% OF BILLED CHARGES,3004.8,60% OF BILLED CHARGES,956.78,19.105% OF BILLED CHARGES,1534.95,30.65% OF BILLED CHARGES,4407.04,88% OF BILLED CHARGES,3756,75% OF BILLED CHARGES,5008,100% OF BILLED CHARGES,1105.27,22.07% OF BILLED CHARGES,4507.2,90%OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,4507.2,90% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,3932.28,78.52% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,3074.91,61.40% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,1228.21,24.525%OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,4076.51,81.4% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,2574.11,51.4% OF BILLED CHARGES,1240.48,24.77% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,3906.24,78% OF BILLED CHARGES,1240.48,24.77% OF BILLED CHARGES,4256.8,85% OF BILLED CHARGES,1265.02,25.26% OF BILLED CHARGES,156.64,115% OF CMS PHYSICIAN FEES SCHEDULE,4256.8,85% OF BILLED CHARGES,1228.21,24.525% OF BILLED CHARGES,5008,100% OF BILLED CHARGES,156.64,5008,2859.57
Outpatient Medical Services,Radiology,73700,CT Lower Extremity w/o Contrast Left,352,5838,5137.44,88% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1474.68,25.26% OF BILLED CHARGES,3502.8,60% OF BILLED CHARGES,1115.35,19.105% OF BILLED CHARGES,1789.35,30.65% OF BILLED CHARGES,5137.44,88% OF BILLED CHARGES,4378.5,75% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,1288.45,22.07% OF BILLED CHARGES,5254.2,90%OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5254.2,90% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4584,78.52% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,3584.53,61.40% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525%OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4752.13,81.4% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,3000.73,51.4% OF BILLED CHARGES,1446.07,24.77% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4553.64,78% OF BILLED CHARGES,1446.07,24.77% OF BILLED CHARGES,4962.3,85% OF BILLED CHARGES,1474.68,25.26% OF BILLED CHARGES,156.64,115% OF CMS PHYSICIAN FEES SCHEDULE,4962.3,85% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,156.64,5838,3333.50
Outpatient Medical Services,Radiology,73700,CT Lower Extremity w/o Contrast Right,352,5838,5137.44,88% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1474.68,25.26% OF BILLED CHARGES,3502.8,60% OF BILLED CHARGES,1115.35,19.105% OF BILLED CHARGES,1789.35,30.65% OF BILLED CHARGES,5137.44,88% OF BILLED CHARGES,4378.5,75% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,1288.45,22.07% OF BILLED CHARGES,5254.2,90%OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5254.2,90% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4584,78.52% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,3584.53,61.40% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525%OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4752.13,81.4% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,3000.73,51.4% OF BILLED CHARGES,1446.07,24.77% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4553.64,78% OF BILLED CHARGES,1446.07,24.77% OF BILLED CHARGES,4962.3,85% OF BILLED CHARGES,1474.68,25.26% OF BILLED CHARGES,156.64,115% OF CMS PHYSICIAN FEES SCHEDULE,4962.3,85% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,156.64,5838,3333.50
Outpatient Medical Services,Radiology,76380,CT Limited or Localized F/U Study,350,2241,1972.08,88% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,2241,100% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,566.08,25.26% OF BILLED CHARGES,1344.6,60% OF BILLED CHARGES,428.14,19.105% OF BILLED CHARGES,686.87,30.65% OF BILLED CHARGES,1972.08,88% OF BILLED CHARGES,1680.75,75% OF BILLED CHARGES,2241,100% OF BILLED CHARGES,494.59,22.07% OF BILLED CHARGES,2016.9,90%OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,2016.9,90% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,1759.63,78.52% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,1375.97,61.40% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,549.61,24.525%OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,1824.17,81.4% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,1151.87,51.4% OF BILLED CHARGES,555.1,24.77% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,1747.98,78% OF BILLED CHARGES,555.1,24.77% OF BILLED CHARGES,1904.85,85% OF BILLED CHARGES,566.08,25.26% OF BILLED CHARGES,136.15,115% OF CMS PHYSICIAN FEES SCHEDULE,1904.85,85% OF BILLED CHARGES,549.61,24.525% OF BILLED CHARGES,2241,100% OF BILLED CHARGES,136.15,2241,1279.61
Outpatient Medical Services,Radiology,71271,CT Low Dose Lung Screening,350,1154,1015.52,88% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,1154,100% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,291.5,25.26% OF BILLED CHARGES,692.4,60% OF BILLED CHARGES,220.47,19.105% OF BILLED CHARGES,353.7,30.65% OF BILLED CHARGES,1015.52,88% OF BILLED CHARGES,865.5,75% OF BILLED CHARGES,1154,100% OF BILLED CHARGES,254.69,22.07% OF BILLED CHARGES,1038.6,90%OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,1038.6,90% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,906.12,78.52% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,708.56,61.40% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,283.02,24.525%OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,939.36,81.4% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,593.16,51.4% OF BILLED CHARGES,285.85,24.77% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,900.12,78% OF BILLED CHARGES,285.85,24.77% OF BILLED CHARGES,980.9,85% OF BILLED CHARGES,291.5,25.26% OF BILLED CHARGES,166.31,115% OF CMS PHYSICIAN FEES SCHEDULE,980.9,85% OF BILLED CHARGES,283.02,24.525% OF BILLED CHARGES,1154,100% OF BILLED CHARGES,166.31,1154,658.93
Outpatient Medical Services,Radiology,70488,CT Maxillofacial w/ + w/o Contrast,351,4186,3683.68,88% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,4186,100% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,1057.38,25.26% OF BILLED CHARGES,2511.6,60% OF BILLED CHARGES,799.74,19.105% OF BILLED CHARGES,1283.01,30.65% OF BILLED CHARGES,3683.68,88% OF BILLED CHARGES,3139.5,75% OF BILLED CHARGES,4186,100% OF BILLED CHARGES,923.85,22.07% OF BILLED CHARGES,3767.4,90%OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,3767.4,90% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,3286.85,78.52% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,2570.2,61.40% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,1026.62,24.525%OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,3407.4,81.4% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,2151.6,51.4% OF BILLED CHARGES,1036.87,24.77% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,3265.08,78% OF BILLED CHARGES,1036.87,24.77% OF BILLED CHARGES,3558.1,85% OF BILLED CHARGES,1057.38,25.26% OF BILLED CHARGES,223.31,115% OF CMS PHYSICIAN FEES SCHEDULE,3558.1,85% OF BILLED CHARGES,1026.62,24.525% OF BILLED CHARGES,4186,100% OF BILLED CHARGES,223.31,4186,2390.21
Outpatient Medical Services,Radiology,70487,CT Maxillofacial w/ Contrast,351,4006,3525.28,88% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,4006,100% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,1011.92,25.26% OF BILLED CHARGES,2403.6,60% OF BILLED CHARGES,765.35,19.105% OF BILLED CHARGES,1227.84,30.65% OF BILLED CHARGES,3525.28,88% OF BILLED CHARGES,3004.5,75% OF BILLED CHARGES,4006,100% OF BILLED CHARGES,884.12,22.07% OF BILLED CHARGES,3605.4,90%OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,3605.4,90% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,3145.51,78.52% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,2459.68,61.40% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,982.47,24.525%OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,3260.88,81.4% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,2059.08,51.4% OF BILLED CHARGES,992.29,24.77% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,3124.68,78% OF BILLED CHARGES,992.29,24.77% OF BILLED CHARGES,3405.1,85% OF BILLED CHARGES,1011.92,25.26% OF BILLED CHARGES,184.16,115% OF CMS PHYSICIAN FEES SCHEDULE,3405.1,85% OF BILLED CHARGES,982.47,24.525% OF BILLED CHARGES,4006,100% OF BILLED CHARGES,184.16,4006,2287.43
Outpatient Medical Services,Radiology,70486,CT Maxillofacial w/o Contrast,351,2603,2290.64,88% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2603,100% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,657.52,25.26% OF BILLED CHARGES,1561.8,60% OF BILLED CHARGES,497.3,19.105% OF BILLED CHARGES,797.82,30.65% OF BILLED CHARGES,2290.64,88% OF BILLED CHARGES,1952.25,75% OF BILLED CHARGES,2603,100% OF BILLED CHARGES,574.48,22.07% OF BILLED CHARGES,2342.7,90%OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2342.7,90% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2043.88,78.52% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,1598.24,61.40% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,638.39,24.525%OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2118.84,81.4% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,1337.94,51.4% OF BILLED CHARGES,644.76,24.77% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2030.34,78% OF BILLED CHARGES,644.76,24.77% OF BILLED CHARGES,2212.55,85% OF BILLED CHARGES,657.52,25.26% OF BILLED CHARGES,155.33,115% OF CMS PHYSICIAN FEES SCHEDULE,2212.55,85% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2603,100% OF BILLED CHARGES,155.33,2603,1486.31
Outpatient Medical Services,Radiology,70492,CT Neck Soft Tissue w/ + w/o Contrast,351,3445,3031.6,88% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,3445,100% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,870.21,25.26% OF BILLED CHARGES,2067,60% OF BILLED CHARGES,658.17,19.105% OF BILLED CHARGES,1055.89,30.65% OF BILLED CHARGES,3031.6,88% OF BILLED CHARGES,2583.75,75% OF BILLED CHARGES,3445,100% OF BILLED CHARGES,760.31,22.07% OF BILLED CHARGES,3100.5,90%OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,3100.5,90% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2705.01,78.52% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2115.23,61.40% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525%OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2804.23,81.4% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,1770.73,51.4% OF BILLED CHARGES,853.33,24.77% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2687.1,78% OF BILLED CHARGES,853.33,24.77% OF BILLED CHARGES,2928.25,85% OF BILLED CHARGES,870.21,25.26% OF BILLED CHARGES,267.77,115% OF CMS PHYSICIAN FEES SCHEDULE,2928.25,85% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,3445,100% OF BILLED CHARGES,267.77,3445,1967.10
Outpatient Medical Services,Radiology,70491,CT Neck Soft Tissue w/ Contrast,351,3441,3028.08,88% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,869.2,25.26% OF BILLED CHARGES,2064.6,60% OF BILLED CHARGES,657.4,19.105% OF BILLED CHARGES,1054.67,30.65% OF BILLED CHARGES,3028.08,88% OF BILLED CHARGES,2580.75,75% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,759.43,22.07% OF BILLED CHARGES,3096.9,90%OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3096.9,90% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2701.87,78.52% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2112.77,61.40% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525%OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2800.97,81.4% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,1768.67,51.4% OF BILLED CHARGES,852.34,24.77% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2683.98,78% OF BILLED CHARGES,852.34,24.77% OF BILLED CHARGES,2924.85,85% OF BILLED CHARGES,869.2,25.26% OF BILLED CHARGES,223.17,115% OF CMS PHYSICIAN FEES SCHEDULE,2924.85,85% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,223.17,3441,1964.81
Outpatient Medical Services,Radiology,70490,CT Neck Soft Tissue w/o Contrast,351,2749,2419.12,88% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2749,100% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,694.4,25.26% OF BILLED CHARGES,1649.4,60% OF BILLED CHARGES,525.2,19.105% OF BILLED CHARGES,842.57,30.65% OF BILLED CHARGES,2419.12,88% OF BILLED CHARGES,2061.75,75% OF BILLED CHARGES,2749,100% OF BILLED CHARGES,606.7,22.07% OF BILLED CHARGES,2474.1,90%OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2474.1,90% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2158.51,78.52% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,1687.89,61.40% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525%OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2237.69,81.4% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,1412.99,51.4% OF BILLED CHARGES,680.93,24.77% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2144.22,78% OF BILLED CHARGES,680.93,24.77% OF BILLED CHARGES,2336.65,85% OF BILLED CHARGES,694.4,25.26% OF BILLED CHARGES,181.18,115% OF CMS PHYSICIAN FEES SCHEDULE,2336.65,85% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2749,100% OF BILLED CHARGES,181.18,2749,1569.68
Outpatient Medical Services,Radiology,70492,CT Neck/Chest w/ + w/o Contrast,350,3445,3031.6,88% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,3445,100% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,870.21,25.26% OF BILLED CHARGES,2067,60% OF BILLED CHARGES,658.17,19.105% OF BILLED CHARGES,1055.89,30.65% OF BILLED CHARGES,3031.6,88% OF BILLED CHARGES,2583.75,75% OF BILLED CHARGES,3445,100% OF BILLED CHARGES,760.31,22.07% OF BILLED CHARGES,3100.5,90%OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,3100.5,90% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2705.01,78.52% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2115.23,61.40% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525%OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2804.23,81.4% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,1770.73,51.4% OF BILLED CHARGES,853.33,24.77% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2687.1,78% OF BILLED CHARGES,853.33,24.77% OF BILLED CHARGES,2928.25,85% OF BILLED CHARGES,870.21,25.26% OF BILLED CHARGES,267.77,115% OF CMS PHYSICIAN FEES SCHEDULE,2928.25,85% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,3445,100% OF BILLED CHARGES,267.77,3445,1967.10
Outpatient Medical Services,Radiology,70491,CT Neck/Chest w/ Contrast,351,3441,3028.08,88% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,869.2,25.26% OF BILLED CHARGES,2064.6,60% OF BILLED CHARGES,657.4,19.105% OF BILLED CHARGES,1054.67,30.65% OF BILLED CHARGES,3028.08,88% OF BILLED CHARGES,2580.75,75% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,759.43,22.07% OF BILLED CHARGES,3096.9,90%OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3096.9,90% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2701.87,78.52% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2112.77,61.40% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525%OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2800.97,81.4% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,1768.67,51.4% OF BILLED CHARGES,852.34,24.77% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2683.98,78% OF BILLED CHARGES,852.34,24.77% OF BILLED CHARGES,2924.85,85% OF BILLED CHARGES,869.2,25.26% OF BILLED CHARGES,223.17,115% OF CMS PHYSICIAN FEES SCHEDULE,2924.85,85% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,223.17,3441,1964.81
Outpatient Medical Services,Radiology,70490,CT Neck/Chest w/o Contrast,351,2749,2419.12,88% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2749,100% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,694.4,25.26% OF BILLED CHARGES,1649.4,60% OF BILLED CHARGES,525.2,19.105% OF BILLED CHARGES,842.57,30.65% OF BILLED CHARGES,2419.12,88% OF BILLED CHARGES,2061.75,75% OF BILLED CHARGES,2749,100% OF BILLED CHARGES,606.7,22.07% OF BILLED CHARGES,2474.1,90%OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2474.1,90% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2158.51,78.52% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,1687.89,61.40% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525%OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2237.69,81.4% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,1412.99,51.4% OF BILLED CHARGES,680.93,24.77% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2144.22,78% OF BILLED CHARGES,680.93,24.77% OF BILLED CHARGES,2336.65,85% OF BILLED CHARGES,694.4,25.26% OF BILLED CHARGES,181.18,115% OF CMS PHYSICIAN FEES SCHEDULE,2336.65,85% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2749,100% OF BILLED CHARGES,181.18,2749,1569.68
Outpatient Medical Services,Radiology,70492,CT Neck/Chest/Abdomen/Pelvis w/ + w/o Co,351,3445,3031.6,88% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,3445,100% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,870.21,25.26% OF BILLED CHARGES,2067,60% OF BILLED CHARGES,658.17,19.105% OF BILLED CHARGES,1055.89,30.65% OF BILLED CHARGES,3031.6,88% OF BILLED CHARGES,2583.75,75% OF BILLED CHARGES,3445,100% OF BILLED CHARGES,760.31,22.07% OF BILLED CHARGES,3100.5,90%OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,3100.5,90% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2705.01,78.52% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2115.23,61.40% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,844.89,24.525%OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2804.23,81.4% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,1770.73,51.4% OF BILLED CHARGES,853.33,24.77% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,2687.1,78% OF BILLED CHARGES,853.33,24.77% OF BILLED CHARGES,2928.25,85% OF BILLED CHARGES,870.21,25.26% OF BILLED CHARGES,267.77,115% OF CMS PHYSICIAN FEES SCHEDULE,2928.25,85% OF BILLED CHARGES,844.89,24.525% OF BILLED CHARGES,3445,100% OF BILLED CHARGES,267.77,3445,1967.10
Outpatient Medical Services,Radiology,70491,CT Neck/Chest/Abdomen/Pelvis w/ Contrast,351,3441,3028.08,88% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,869.2,25.26% OF BILLED CHARGES,2064.6,60% OF BILLED CHARGES,657.4,19.105% OF BILLED CHARGES,1054.67,30.65% OF BILLED CHARGES,3028.08,88% OF BILLED CHARGES,2580.75,75% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,759.43,22.07% OF BILLED CHARGES,3096.9,90%OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3096.9,90% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2701.87,78.52% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2112.77,61.40% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525%OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2800.97,81.4% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,1768.67,51.4% OF BILLED CHARGES,852.34,24.77% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2683.98,78% OF BILLED CHARGES,852.34,24.77% OF BILLED CHARGES,2924.85,85% OF BILLED CHARGES,869.2,25.26% OF BILLED CHARGES,223.17,115% OF CMS PHYSICIAN FEES SCHEDULE,2924.85,85% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,223.17,3441,1964.81
Outpatient Medical Services,Radiology,70490,CT Neck/Chest/Abdomen/Pelvis w/o Contras,351,2749,2419.12,88% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2749,100% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,694.4,25.26% OF BILLED CHARGES,1649.4,60% OF BILLED CHARGES,525.2,19.105% OF BILLED CHARGES,842.57,30.65% OF BILLED CHARGES,2419.12,88% OF BILLED CHARGES,2061.75,75% OF BILLED CHARGES,2749,100% OF BILLED CHARGES,606.7,22.07% OF BILLED CHARGES,2474.1,90%OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2474.1,90% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2158.51,78.52% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,1687.89,61.40% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,674.19,24.525%OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2237.69,81.4% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,1412.99,51.4% OF BILLED CHARGES,680.93,24.77% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2144.22,78% OF BILLED CHARGES,680.93,24.77% OF BILLED CHARGES,2336.65,85% OF BILLED CHARGES,694.4,25.26% OF BILLED CHARGES,181.18,115% OF CMS PHYSICIAN FEES SCHEDULE,2336.65,85% OF BILLED CHARGES,674.19,24.525% OF BILLED CHARGES,2749,100% OF BILLED CHARGES,181.18,2749,1569.68
Outpatient Medical Services,Radiology,72194,CT Pelvis w/ + w/o Contrast,352,4764,4192.32,88% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1203.39,25.26% OF BILLED CHARGES,2858.4,60% OF BILLED CHARGES,910.16,19.105% OF BILLED CHARGES,1460.17,30.65% OF BILLED CHARGES,4192.32,88% OF BILLED CHARGES,3573,75% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,1051.41,22.07% OF BILLED CHARGES,4287.6,90%OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4287.6,90% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3740.69,78.52% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,2925.1,61.40% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525%OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3877.9,81.4% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,2448.7,51.4% OF BILLED CHARGES,1180.04,24.77% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3715.92,78% OF BILLED CHARGES,1180.04,24.77% OF BILLED CHARGES,4049.4,85% OF BILLED CHARGES,1203.39,25.26% OF BILLED CHARGES,242.09,115% OF CMS PHYSICIAN FEES SCHEDULE,4049.4,85% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,242.09,4764,2720.24
Outpatient Medical Services,Radiology,72193,CT Pelvis w/ Contrast,352,3953,3478.64,88% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,3953,100% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,998.53,25.26% OF BILLED CHARGES,2371.8,60% OF BILLED CHARGES,755.22,19.105% OF BILLED CHARGES,1211.59,30.65% OF BILLED CHARGES,3478.64,88% OF BILLED CHARGES,2964.75,75% OF BILLED CHARGES,3953,100% OF BILLED CHARGES,872.43,22.07% OF BILLED CHARGES,3557.7,90%OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,3557.7,90% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,3103.9,78.52% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,2427.14,61.40% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,969.47,24.525%OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,3217.74,81.4% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,2031.84,51.4% OF BILLED CHARGES,979.16,24.77% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,3083.34,78% OF BILLED CHARGES,979.16,24.77% OF BILLED CHARGES,3360.05,85% OF BILLED CHARGES,998.53,25.26% OF BILLED CHARGES,239.74,115% OF CMS PHYSICIAN FEES SCHEDULE,3360.05,85% OF BILLED CHARGES,969.47,24.525% OF BILLED CHARGES,3953,100% OF BILLED CHARGES,239.74,3953,2257.16
Outpatient Medical Services,Radiology,72192,CT Pelvis w/o Contrast,352,2957,2602.16,88% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,2957,100% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,746.94,25.26% OF BILLED CHARGES,1774.2,60% OF BILLED CHARGES,564.93,19.105% OF BILLED CHARGES,906.32,30.65% OF BILLED CHARGES,2602.16,88% OF BILLED CHARGES,2217.75,75% OF BILLED CHARGES,2957,100% OF BILLED CHARGES,652.61,22.07% OF BILLED CHARGES,2661.3,90%OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,2661.3,90% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,2321.84,78.52% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,1815.6,61.40% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,725.2,24.525%OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,2407,81.4% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,1519.9,51.4% OF BILLED CHARGES,732.45,24.77% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,2306.46,78% OF BILLED CHARGES,732.45,24.77% OF BILLED CHARGES,2513.45,85% OF BILLED CHARGES,746.94,25.26% OF BILLED CHARGES,160.82,115% OF CMS PHYSICIAN FEES SCHEDULE,2513.45,85% OF BILLED CHARGES,725.2,24.525% OF BILLED CHARGES,2957,100% OF BILLED CHARGES,160.82,2957,1688.45
Outpatient Medical Services,Radiology,70486,CT Sinus w/o Contrast,351,2603,2290.64,88% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2603,100% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,657.52,25.26% OF BILLED CHARGES,1561.8,60% OF BILLED CHARGES,497.3,19.105% OF BILLED CHARGES,797.82,30.65% OF BILLED CHARGES,2290.64,88% OF BILLED CHARGES,1952.25,75% OF BILLED CHARGES,2603,100% OF BILLED CHARGES,574.48,22.07% OF BILLED CHARGES,2342.7,90%OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2342.7,90% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2043.88,78.52% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,1598.24,61.40% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,638.39,24.525%OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2118.84,81.4% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,1337.94,51.4% OF BILLED CHARGES,644.76,24.77% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2030.34,78% OF BILLED CHARGES,644.76,24.77% OF BILLED CHARGES,2212.55,85% OF BILLED CHARGES,657.52,25.26% OF BILLED CHARGES,155.33,115% OF CMS PHYSICIAN FEES SCHEDULE,2212.55,85% OF BILLED CHARGES,638.39,24.525% OF BILLED CHARGES,2603,100% OF BILLED CHARGES,155.33,2603,1486.31
Outpatient Medical Services,Radiology,72127,CT Spine Cervical w/ + w/o Contrast,352,4310,3792.8,88% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,4310,100% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,1088.71,25.26% OF BILLED CHARGES,2586,60% OF BILLED CHARGES,823.43,19.105% OF BILLED CHARGES,1321.02,30.65% OF BILLED CHARGES,3792.8,88% OF BILLED CHARGES,3232.5,75% OF BILLED CHARGES,4310,100% OF BILLED CHARGES,951.22,22.07% OF BILLED CHARGES,3879,90%OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,3879,90% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,3384.21,78.52% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,2646.34,61.40% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,1057.03,24.525%OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,3508.34,81.4% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,2215.34,51.4% OF BILLED CHARGES,1067.59,24.77% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,3361.8,78% OF BILLED CHARGES,1067.59,24.77% OF BILLED CHARGES,3663.5,85% OF BILLED CHARGES,1088.71,25.26% OF BILLED CHARGES,239.63,115% OF CMS PHYSICIAN FEES SCHEDULE,3663.5,85% OF BILLED CHARGES,1057.03,24.525% OF BILLED CHARGES,4310,100% OF BILLED CHARGES,239.63,4310,2461.01
Outpatient Medical Services,Radiology,72126,CT Spine Cervical w/ Contrast,352,3537,3112.56,88% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,3537,100% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,893.45,25.26% OF BILLED CHARGES,2122.2,60% OF BILLED CHARGES,675.74,19.105% OF BILLED CHARGES,1084.09,30.65% OF BILLED CHARGES,3112.56,88% OF BILLED CHARGES,2652.75,75% OF BILLED CHARGES,3537,100% OF BILLED CHARGES,780.62,22.07% OF BILLED CHARGES,3183.3,90%OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,3183.3,90% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,2777.25,78.52% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,2171.72,61.40% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,867.45,24.525%OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,2879.12,81.4% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,1818.02,51.4% OF BILLED CHARGES,876.11,24.77% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,2758.86,78% OF BILLED CHARGES,876.11,24.77% OF BILLED CHARGES,3006.45,85% OF BILLED CHARGES,893.45,25.26% OF BILLED CHARGES,204.36,115% OF CMS PHYSICIAN FEES SCHEDULE,3006.45,85% OF BILLED CHARGES,867.45,24.525% OF BILLED CHARGES,3537,100% OF BILLED CHARGES,204.36,3537,2019.63
Outpatient Medical Services,Radiology,72125,CT Spine Cervical w/o Contrast,352,2852,2509.76,88% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,720.42,25.26% OF BILLED CHARGES,1711.2,60% OF BILLED CHARGES,544.87,19.105% OF BILLED CHARGES,874.14,30.65% OF BILLED CHARGES,2509.76,88% OF BILLED CHARGES,2139,75% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,629.44,22.07% OF BILLED CHARGES,2566.8,90%OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2566.8,90% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2239.39,78.52% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,1751.13,61.40% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,699.45,24.525%OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2321.53,81.4% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,1465.93,51.4% OF BILLED CHARGES,706.44,24.77% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2224.56,78% OF BILLED CHARGES,706.44,24.77% OF BILLED CHARGES,2424.2,85% OF BILLED CHARGES,720.42,25.26% OF BILLED CHARGES,157.44,115% OF CMS PHYSICIAN FEES SCHEDULE,2424.2,85% OF BILLED CHARGES,699.45,24.525% OF BILLED CHARGES,2852,100% OF BILLED CHARGES,157.44,2852,1628.49
Outpatient Medical Services,Radiology,72133,CT Spine Lumbar w/ + w/o Contrast,352,5241,4612.08,88% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,5241,100% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,1323.88,25.26% OF BILLED CHARGES,3144.6,60% OF BILLED CHARGES,1001.29,19.105% OF BILLED CHARGES,1606.37,30.65% OF BILLED CHARGES,4612.08,88% OF BILLED CHARGES,3930.75,75% OF BILLED CHARGES,5241,100% OF BILLED CHARGES,1156.69,22.07% OF BILLED CHARGES,4716.9,90%OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,4716.9,90% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,4115.23,78.52% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,3217.97,61.40% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,1285.36,24.525%OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,4266.17,81.4% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,2693.87,51.4% OF BILLED CHARGES,1298.2,24.77% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,4087.98,78% OF BILLED CHARGES,1298.2,24.77% OF BILLED CHARGES,4454.85,85% OF BILLED CHARGES,1323.88,25.26% OF BILLED CHARGES,240.03,115% OF CMS PHYSICIAN FEES SCHEDULE,4454.85,85% OF BILLED CHARGES,1285.36,24.525% OF BILLED CHARGES,5241,100% OF BILLED CHARGES,240.03,5241,2992.61
Outpatient Medical Services,Radiology,72132,CT Spine Lumbar w/ Contrast,352,3933,3461.04,88% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,3933,100% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,993.48,25.26% OF BILLED CHARGES,2359.8,60% OF BILLED CHARGES,751.4,19.105% OF BILLED CHARGES,1205.46,30.65% OF BILLED CHARGES,3461.04,88% OF BILLED CHARGES,2949.75,75% OF BILLED CHARGES,3933,100% OF BILLED CHARGES,868.01,22.07% OF BILLED CHARGES,3539.7,90%OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,3539.7,90% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,3088.19,78.52% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,2414.86,61.40% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,964.57,24.525%OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,3201.46,81.4% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,2021.56,51.4% OF BILLED CHARGES,974.2,24.77% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,3067.74,78% OF BILLED CHARGES,974.2,24.77% OF BILLED CHARGES,3343.05,85% OF BILLED CHARGES,993.48,25.26% OF BILLED CHARGES,204.75,115% OF CMS PHYSICIAN FEES SCHEDULE,3343.05,85% OF BILLED CHARGES,964.57,24.525% OF BILLED CHARGES,3933,100% OF BILLED CHARGES,204.75,3933,2245.74
Outpatient Medical Services,Radiology,72131,CT Spine Lumbar w/o Contrast,352,3441,3028.08,88% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,869.2,25.26% OF BILLED CHARGES,2064.6,60% OF BILLED CHARGES,657.4,19.105% OF BILLED CHARGES,1054.67,30.65% OF BILLED CHARGES,3028.08,88% OF BILLED CHARGES,2580.75,75% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,759.43,22.07% OF BILLED CHARGES,3096.9,90%OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3096.9,90% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2701.87,78.52% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2112.77,61.40% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,843.91,24.525%OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2800.97,81.4% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,1768.67,51.4% OF BILLED CHARGES,852.34,24.77% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,2683.98,78% OF BILLED CHARGES,852.34,24.77% OF BILLED CHARGES,2924.85,85% OF BILLED CHARGES,869.2,25.26% OF BILLED CHARGES,156.24,115% OF CMS PHYSICIAN FEES SCHEDULE,2924.85,85% OF BILLED CHARGES,843.91,24.525% OF BILLED CHARGES,3441,100% OF BILLED CHARGES,156.24,3441,1964.81
Outpatient Medical Services,Radiology,72130,CT Spine Thoracic w/ + w/o Contrast,352,4643,4085.84,88% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,4643,100% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,1172.82,25.26% OF BILLED CHARGES,2785.8,60% OF BILLED CHARGES,887.05,19.105% OF BILLED CHARGES,1423.08,30.65% OF BILLED CHARGES,4085.84,88% OF BILLED CHARGES,3482.25,75% OF BILLED CHARGES,4643,100% OF BILLED CHARGES,1024.71,22.07% OF BILLED CHARGES,4178.7,90%OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,4178.7,90% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,3645.68,78.52% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,2850.8,61.40% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,1138.7,24.525%OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,3779.4,81.4% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,2386.5,51.4% OF BILLED CHARGES,1150.07,24.77% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,3621.54,78% OF BILLED CHARGES,1150.07,24.77% OF BILLED CHARGES,3946.55,85% OF BILLED CHARGES,1172.82,25.26% OF BILLED CHARGES,241.22,115% OF CMS PHYSICIAN FEES SCHEDULE,3946.55,85% OF BILLED CHARGES,1138.7,24.525% OF BILLED CHARGES,4643,100% OF BILLED CHARGES,241.22,4643,2651.15
Outpatient Medical Services,Radiology,72129,CT Spine Thoracic w/ Contrast,352,4464,3928.32,88% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,4464,100% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,1127.61,25.26% OF BILLED CHARGES,2678.4,60% OF BILLED CHARGES,852.85,19.105% OF BILLED CHARGES,1368.22,30.65% OF BILLED CHARGES,3928.32,88% OF BILLED CHARGES,3348,75% OF BILLED CHARGES,4464,100% OF BILLED CHARGES,985.2,22.07% OF BILLED CHARGES,4017.6,90%OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,4017.6,90% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,3505.13,78.52% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,2740.9,61.40% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,1094.8,24.525%OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,3633.7,81.4% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,2294.5,51.4% OF BILLED CHARGES,1105.73,24.77% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,3481.92,78% OF BILLED CHARGES,1105.73,24.77% OF BILLED CHARGES,3794.4,85% OF BILLED CHARGES,1127.61,25.26% OF BILLED CHARGES,205.85,115% OF CMS PHYSICIAN FEES SCHEDULE,3794.4,85% OF BILLED CHARGES,1094.8,24.525% OF BILLED CHARGES,4464,100% OF BILLED CHARGES,205.85,4464,2548.94
Outpatient Medical Services,Radiology,72128,CT Spine Thoracic w/o Contrast,352,3408,2999.04,88% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,3408,100% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,860.86,25.26% OF BILLED CHARGES,2044.8,60% OF BILLED CHARGES,651.1,19.105% OF BILLED CHARGES,1044.55,30.65% OF BILLED CHARGES,2999.04,88% OF BILLED CHARGES,2556,75% OF BILLED CHARGES,3408,100% OF BILLED CHARGES,752.15,22.07% OF BILLED CHARGES,3067.2,90%OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,3067.2,90% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,2675.96,78.52% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,2092.51,61.40% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,835.81,24.525%OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,2774.11,81.4% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,1751.71,51.4% OF BILLED CHARGES,844.16,24.77% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,2658.24,78% OF BILLED CHARGES,844.16,24.77% OF BILLED CHARGES,2896.8,85% OF BILLED CHARGES,860.86,25.26% OF BILLED CHARGES,157.03,115% OF CMS PHYSICIAN FEES SCHEDULE,2896.8,85% OF BILLED CHARGES,835.81,24.525% OF BILLED CHARGES,3408,100% OF BILLED CHARGES,157.03,3408,1945.97
Outpatient Medical Services,Radiology,70486,CT Sinus w/o Contrast Ltd,351,2365,2081.2,88% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,2365,100% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,597.4,25.26% OF BILLED CHARGES,1419,60% OF BILLED CHARGES,451.83,19.105% OF BILLED CHARGES,724.87,30.65% OF BILLED CHARGES,2081.2,88% OF BILLED CHARGES,1773.75,75% OF BILLED CHARGES,2365,100% OF BILLED CHARGES,521.96,22.07% OF BILLED CHARGES,2128.5,90%OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,2128.5,90% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,1857,78.52% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,1452.11,61.40% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,580.02,24.525%OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,1925.11,81.4% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,1215.61,51.4% OF BILLED CHARGES,585.81,24.77% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,1844.7,78% OF BILLED CHARGES,585.81,24.77% OF BILLED CHARGES,2010.25,85% OF BILLED CHARGES,597.4,25.26% OF BILLED CHARGES,155.33,115% OF CMS PHYSICIAN FEES SCHEDULE,2010.25,85% OF BILLED CHARGES,580.02,24.525% OF BILLED CHARGES,2365,100% OF BILLED CHARGES,155.33,2365,1350.42
Outpatient Medical Services,Radiology,71270,CT Thorax w/ + w/o Contrast,352,4764,4192.32,88% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1203.39,25.26% OF BILLED CHARGES,2858.4,60% OF BILLED CHARGES,910.16,19.105% OF BILLED CHARGES,1460.17,30.65% OF BILLED CHARGES,4192.32,88% OF BILLED CHARGES,3573,75% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,1051.41,22.07% OF BILLED CHARGES,4287.6,90%OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4287.6,90% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3740.69,78.52% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,2925.1,61.40% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,1168.37,24.525%OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3877.9,81.4% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,2448.7,51.4% OF BILLED CHARGES,1180.04,24.77% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,3715.92,78% OF BILLED CHARGES,1180.04,24.77% OF BILLED CHARGES,4049.4,85% OF BILLED CHARGES,1203.39,25.26% OF BILLED CHARGES,238.15,115% OF CMS PHYSICIAN FEES SCHEDULE,4049.4,85% OF BILLED CHARGES,1168.37,24.525% OF BILLED CHARGES,4764,100% OF BILLED CHARGES,238.15,4764,2720.24
Outpatient Medical Services,Radiology,71260,CT Thorax w/ Contrast,352,4485,3946.8,88% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1132.91,25.26% OF BILLED CHARGES,2691,60% OF BILLED CHARGES,856.86,19.105% OF BILLED CHARGES,1374.65,30.65% OF BILLED CHARGES,3946.8,88% OF BILLED CHARGES,3363.75,75% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,989.84,22.07% OF BILLED CHARGES,4036.5,90%OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4036.5,90% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3521.62,78.52% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,2753.79,61.40% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,1099.95,24.525%OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3650.79,81.4% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,2305.29,51.4% OF BILLED CHARGES,1110.93,24.77% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,3498.3,78% OF BILLED CHARGES,1110.93,24.77% OF BILLED CHARGES,3812.25,85% OF BILLED CHARGES,1132.91,25.26% OF BILLED CHARGES,202.43,115% OF CMS PHYSICIAN FEES SCHEDULE,3812.25,85% OF BILLED CHARGES,1099.95,24.525% OF BILLED CHARGES,4485,100% OF BILLED CHARGES,202.43,4485,2560.94
Outpatient Medical Services,Radiology,71250,CT Thorax w/o Contrast,352,3137,2760.56,88% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,792.41,25.26% OF BILLED CHARGES,1882.2,60% OF BILLED CHARGES,599.32,19.105% OF BILLED CHARGES,961.49,30.65% OF BILLED CHARGES,2760.56,88% OF BILLED CHARGES,2352.75,75% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,692.34,22.07% OF BILLED CHARGES,2823.3,90%OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2823.3,90% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2463.17,78.52% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,1926.12,61.40% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,769.35,24.525%OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2553.52,81.4% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,1612.42,51.4% OF BILLED CHARGES,777.03,24.77% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,2446.86,78% OF BILLED CHARGES,777.03,24.77% OF BILLED CHARGES,2666.45,85% OF BILLED CHARGES,792.41,25.26% OF BILLED CHARGES,160.83,115% OF CMS PHYSICIAN FEES SCHEDULE,2666.45,85% OF BILLED CHARGES,769.35,24.525% OF BILLED CHARGES,3137,100% OF BILLED CHARGES,160.83,3137,1791.23
Outpatient Medical Services,Radiology,73201,CT Upper Extremity w/ Contrast Left,352,7353,6470.64,88% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,7353,100% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1857.37,25.26% OF BILLED CHARGES,4411.8,60% OF BILLED CHARGES,1404.79,19.105% OF BILLED CHARGES,2253.69,30.65% OF BILLED CHARGES,6470.64,88% OF BILLED CHARGES,5514.75,75% OF BILLED CHARGES,7353,100% OF BILLED CHARGES,1622.81,22.07% OF BILLED CHARGES,6617.7,90%OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,6617.7,90% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,5773.58,78.52% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,4514.74,61.40% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525%OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,5985.34,81.4% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,3779.44,51.4% OF BILLED CHARGES,1821.34,24.77% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,5735.34,78% OF BILLED CHARGES,1821.34,24.77% OF BILLED CHARGES,6250.05,85% OF BILLED CHARGES,1857.37,25.26% OF BILLED CHARGES,243.85,115% OF CMS PHYSICIAN FEES SCHEDULE,6250.05,85% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,7353,100% OF BILLED CHARGES,243.85,7353,4198.56
Outpatient Medical Services,Radiology,73201,CT Upper Extremity w/ Contrast Right,352,7353,6470.64,88% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,7353,100% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1857.37,25.26% OF BILLED CHARGES,4411.8,60% OF BILLED CHARGES,1404.79,19.105% OF BILLED CHARGES,2253.69,30.65% OF BILLED CHARGES,6470.64,88% OF BILLED CHARGES,5514.75,75% OF BILLED CHARGES,7353,100% OF BILLED CHARGES,1622.81,22.07% OF BILLED CHARGES,6617.7,90%OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,6617.7,90% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,5773.58,78.52% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,4514.74,61.40% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,1803.32,24.525%OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,5985.34,81.4% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,3779.44,51.4% OF BILLED CHARGES,1821.34,24.77% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,5735.34,78% OF BILLED CHARGES,1821.34,24.77% OF BILLED CHARGES,6250.05,85% OF BILLED CHARGES,1857.37,25.26% OF BILLED CHARGES,243.85,115% OF CMS PHYSICIAN FEES SCHEDULE,6250.05,85% OF BILLED CHARGES,1803.32,24.525% OF BILLED CHARGES,7353,100% OF BILLED CHARGES,243.85,7353,4198.56
Outpatient Medical Services,Radiology,73202,CT Upper Extremity w/+w/o Contrast Left,352,7499,6599.12,88% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,7499,100% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1894.25,25.26% OF BILLED CHARGES,4499.4,60% OF BILLED CHARGES,1432.68,19.105% OF BILLED CHARGES,2298.44,30.65% OF BILLED CHARGES,6599.12,88% OF BILLED CHARGES,5624.25,75% OF BILLED CHARGES,7499,100% OF BILLED CHARGES,1655.03,22.07% OF BILLED CHARGES,6749.1,90%OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,6749.1,90% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,5888.21,78.52% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,4604.39,61.40% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1839.13,24.525%OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,6104.19,81.4% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,3854.49,51.4% OF BILLED CHARGES,1857.5,24.77% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,5849.22,78% OF BILLED CHARGES,1857.5,24.77% OF BILLED CHARGES,6374.15,85% OF BILLED CHARGES,1894.25,25.26% OF BILLED CHARGES,242.09,115% OF CMS PHYSICIAN FEES SCHEDULE,6374.15,85% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,7499,100% OF BILLED CHARGES,242.09,7499,4281.93
Outpatient Medical Services,Radiology,73202,CT Upper Extremity w/+w/o Contrast Right,352,7499,6599.12,88% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,7499,100% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1894.25,25.26% OF BILLED CHARGES,4499.4,60% OF BILLED CHARGES,1432.68,19.105% OF BILLED CHARGES,2298.44,30.65% OF BILLED CHARGES,6599.12,88% OF BILLED CHARGES,5624.25,75% OF BILLED CHARGES,7499,100% OF BILLED CHARGES,1655.03,22.07% OF BILLED CHARGES,6749.1,90%OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,6749.1,90% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,5888.21,78.52% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,4604.39,61.40% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,1839.13,24.525%OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,6104.19,81.4% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,3854.49,51.4% OF BILLED CHARGES,1857.5,24.77% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,5849.22,78% OF BILLED CHARGES,1857.5,24.77% OF BILLED CHARGES,6374.15,85% OF BILLED CHARGES,1894.25,25.26% OF BILLED CHARGES,242.09,115% OF CMS PHYSICIAN FEES SCHEDULE,6374.15,85% OF BILLED CHARGES,1839.13,24.525% OF BILLED CHARGES,7499,100% OF BILLED CHARGES,242.09,7499,4281.93
Outpatient Medical Services,Radiology,73200,CT Upper Extremity w/o Contrast Left,352,5838,5137.44,88% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1474.68,25.26% OF BILLED CHARGES,3502.8,60% OF BILLED CHARGES,1115.35,19.105% OF BILLED CHARGES,1789.35,30.65% OF BILLED CHARGES,5137.44,88% OF BILLED CHARGES,4378.5,75% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,1288.45,22.07% OF BILLED CHARGES,5254.2,90%OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5254.2,90% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4584,78.52% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,3584.53,61.40% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525%OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4752.13,81.4% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,3000.73,51.4% OF BILLED CHARGES,1446.07,24.77% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4553.64,78% OF BILLED CHARGES,1446.07,24.77% OF BILLED CHARGES,4962.3,85% OF BILLED CHARGES,1474.68,25.26% OF BILLED CHARGES,157.68,115% OF CMS PHYSICIAN FEES SCHEDULE,4962.3,85% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,157.68,5838,3333.50
Outpatient Medical Services,Radiology,73200,CT Upper Extremity w/o Contrast Right,352,5838,5137.44,88% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1474.68,25.26% OF BILLED CHARGES,3502.8,60% OF BILLED CHARGES,1115.35,19.105% OF BILLED CHARGES,1789.35,30.65% OF BILLED CHARGES,5137.44,88% OF BILLED CHARGES,4378.5,75% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,1288.45,22.07% OF BILLED CHARGES,5254.2,90%OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5254.2,90% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4584,78.52% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,3584.53,61.40% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,1431.77,24.525%OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4752.13,81.4% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,3000.73,51.4% OF BILLED CHARGES,1446.07,24.77% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,4553.64,78% OF BILLED CHARGES,1446.07,24.77% OF BILLED CHARGES,4962.3,85% OF BILLED CHARGES,1474.68,25.26% OF BILLED CHARGES,157.68,115% OF CMS PHYSICIAN FEES SCHEDULE,4962.3,85% OF BILLED CHARGES,1431.77,24.525% OF BILLED CHARGES,5838,100% OF BILLED CHARGES,157.68,5838,3333.50
Outpatient Medical Services,Radiology,77062,MG Breast Tomo 3D Digital Diag Bilateral,401,153,134.64,88% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,153,100% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,38.65,25.26% OF BILLED CHARGES,91.8,60% OF BILLED CHARGES,29.23,19.105% OF BILLED CHARGES,46.89,30.65% OF BILLED CHARGES,134.64,88% OF BILLED CHARGES,114.75,75% OF BILLED CHARGES,153,100% OF BILLED CHARGES,33.77,22.07% OF BILLED CHARGES,137.7,90%OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,137.7,90% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,120.14,78.52% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,93.94,61.40% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,37.52,24.525%OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,124.54,81.4% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,78.64,51.4% OF BILLED CHARGES,37.9,24.77% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,119.34,78% OF BILLED CHARGES,37.9,24.77% OF BILLED CHARGES,130.05,85% OF BILLED CHARGES,38.65,25.26% OF BILLED CHARGES,,NOT REIMBUSABLE,130.05,85% OF BILLED CHARGES,37.52,24.525% OF BILLED CHARGES,153,100% OF BILLED CHARGES,29.23,153,87.36
Outpatient Medical Services,Radiology,77063,MG Breast Tomo 3D Digital Screening,403,226,198.88,88% OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,28.92,100% OF BCCHP FEES SCHEDULE,55.43,24.525% OF BILLED CHARGES,57.09,25.26% OF BILLED CHARGES,135.6,60% OF BILLED CHARGES,43.18,19.105% OF BILLED CHARGES,69.27,30.65% OF BILLED CHARGES,198.88,88% OF BILLED CHARGES,169.5,75% OF BILLED CHARGES,226,100% OF BILLED CHARGES,49.88,22.07% OF BILLED CHARGES,203.4,90%OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,203.4,90% OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,177.46,78.52% OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,138.76,61.40% OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,55.43,24.525%OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,183.96,81.4% OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,116.16,51.4% OF BILLED CHARGES,55.98,24.77% OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,176.28,78% OF BILLED CHARGES,55.98,24.77% OF BILLED CHARGES,192.1,85% OF BILLED CHARGES,57.09,25.26% OF BILLED CHARGES,61.07,115% OF CMS PHYSICIAN FEES SCHEDULE,192.1,85% OF BILLED CHARGES,55.43,24.525% OF BILLED CHARGES,226,100% OF BILLED CHARGES,28.92,226,129.05
Outpatient Medical Services,Radiology,77067,MG Mammo Digital Screening Bilateral.,403,565,497.2,88% OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,113.9,100% OF BCCHP FEES SCHEDULE,138.57,24.525% OF BILLED CHARGES,142.72,25.26% OF BILLED CHARGES,339,60% OF BILLED CHARGES,107.94,19.105% OF BILLED CHARGES,173.17,30.65% OF BILLED CHARGES,497.2,88% OF BILLED CHARGES,423.75,75% OF BILLED CHARGES,565,100% OF BILLED CHARGES,124.7,22.07% OF BILLED CHARGES,508.5,90%OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,508.5,90% OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,443.64,78.52% OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,346.91,61.40% OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,138.57,24.525%OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,459.91,81.4% OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,290.41,51.4% OF BILLED CHARGES,139.95,24.77% OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,440.7,78% OF BILLED CHARGES,139.95,24.77% OF BILLED CHARGES,480.25,85% OF BILLED CHARGES,142.72,25.26% OF BILLED CHARGES,151.46,115% OF CMS PHYSICIAN FEES SCHEDULE,480.25,85% OF BILLED CHARGES,138.57,24.525% OF BILLED CHARGES,565,100% OF BILLED CHARGES,107.94,565,322.62
Outpatient Medical Services,Radiology,77067,MG Mammo Digital Screening Left.,403,491,432.08,88% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,113.9,100% OF BCCHP FEES SCHEDULE,120.42,24.525% OF BILLED CHARGES,124.03,25.26% OF BILLED CHARGES,294.6,60% OF BILLED CHARGES,93.81,19.105% OF BILLED CHARGES,150.49,30.65% OF BILLED CHARGES,432.08,88% OF BILLED CHARGES,368.25,75% OF BILLED CHARGES,491,100% OF BILLED CHARGES,108.36,22.07% OF BILLED CHARGES,441.9,90%OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,441.9,90% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,385.53,78.52% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,301.47,61.40% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,120.42,24.525%OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,399.67,81.4% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,252.37,51.4% OF BILLED CHARGES,121.62,24.77% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,382.98,78% OF BILLED CHARGES,121.62,24.77% OF BILLED CHARGES,417.35,85% OF BILLED CHARGES,124.03,25.26% OF BILLED CHARGES,151.46,115% OF CMS PHYSICIAN FEES SCHEDULE,417.35,85% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,491,100% OF BILLED CHARGES,93.81,491,280.36
Outpatient Medical Services,Radiology,77067,MG Mammo Digital Screening Right.,403,491,432.08,88% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,113.9,100% OF BCCHP FEES SCHEDULE,120.42,24.525% OF BILLED CHARGES,124.03,25.26% OF BILLED CHARGES,294.6,60% OF BILLED CHARGES,93.81,19.105% OF BILLED CHARGES,150.49,30.65% OF BILLED CHARGES,432.08,88% OF BILLED CHARGES,368.25,75% OF BILLED CHARGES,491,100% OF BILLED CHARGES,108.36,22.07% OF BILLED CHARGES,441.9,90%OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,441.9,90% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,385.53,78.52% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,301.47,61.40% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,120.42,24.525%OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,399.67,81.4% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,252.37,51.4% OF BILLED CHARGES,121.62,24.77% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,382.98,78% OF BILLED CHARGES,121.62,24.77% OF BILLED CHARGES,417.35,85% OF BILLED CHARGES,124.03,25.26% OF BILLED CHARGES,151.46,115% OF CMS PHYSICIAN FEES SCHEDULE,417.35,85% OF BILLED CHARGES,120.42,24.525% OF BILLED CHARGES,491,100% OF BILLED CHARGES,93.81,491,280.36
Outpatient Medical Services,Radiology,77066,MG Mammo Diagnostic Bilateral w/ Tomo.,401,1364,1200.32,88% OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,137.86,100% OF BCCHP FEES SCHEDULE,334.52,24.525% OF BILLED CHARGES,344.55,25.26% OF BILLED CHARGES,818.4,60% OF BILLED CHARGES,260.59,19.105% OF BILLED CHARGES,418.07,30.65% OF BILLED CHARGES,1200.32,88% OF BILLED CHARGES,1023,75% OF BILLED CHARGES,1364,100% OF BILLED CHARGES,301.03,22.07% OF BILLED CHARGES,1227.6,90%OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,1227.6,90% OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,1071.01,78.52% OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,837.5,61.40% OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,334.52,24.525%OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,1110.3,81.4% OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,701.1,51.4% OF BILLED CHARGES,337.86,24.77% OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,1063.92,78% OF BILLED CHARGES,337.86,24.77% OF BILLED CHARGES,1159.4,85% OF BILLED CHARGES,344.55,25.26% OF BILLED CHARGES,187.6,115% OF CMS PHYSICIAN FEES SCHEDULE,1159.4,85% OF BILLED CHARGES,334.52,24.525% OF BILLED CHARGES,1364,100% OF BILLED CHARGES,137.86,1364,778.84
Outpatient Medical Services,Radiology,77065,MG Mammo Diagnostic Left w/ Tomo.,401,1091,960.08,88% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,108.11,100% OF BCCHP FEES SCHEDULE,267.57,24.525% OF BILLED CHARGES,275.59,25.26% OF BILLED CHARGES,654.6,60% OF BILLED CHARGES,208.44,19.105% OF BILLED CHARGES,334.39,30.65% OF BILLED CHARGES,960.08,88% OF BILLED CHARGES,818.25,75% OF BILLED CHARGES,1091,100% OF BILLED CHARGES,240.78,22.07% OF BILLED CHARGES,981.9,90%OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,981.9,90% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,856.65,78.52% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,669.87,61.40% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,267.57,24.525%OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,888.07,81.4% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,560.77,51.4% OF BILLED CHARGES,270.24,24.77% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,850.98,78% OF BILLED CHARGES,270.24,24.77% OF BILLED CHARGES,927.35,85% OF BILLED CHARGES,275.59,25.26% OF BILLED CHARGES,148.21,115% OF CMS PHYSICIAN FEES SCHEDULE,927.35,85% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,1091,100% OF BILLED CHARGES,108.11,1091,622.96
Outpatient Medical Services,Radiology,77065,MG Mammo Diagnostic Right w/ Tomo.,401,1091,960.08,88% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,108.11,100% OF BCCHP FEES SCHEDULE,267.57,24.525% OF BILLED CHARGES,275.59,25.26% OF BILLED CHARGES,654.6,60% OF BILLED CHARGES,208.44,19.105% OF BILLED CHARGES,334.39,30.65% OF BILLED CHARGES,960.08,88% OF BILLED CHARGES,818.25,75% OF BILLED CHARGES,1091,100% OF BILLED CHARGES,240.78,22.07% OF BILLED CHARGES,981.9,90%OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,981.9,90% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,856.65,78.52% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,669.87,61.40% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,267.57,24.525%OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,888.07,81.4% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,560.77,51.4% OF BILLED CHARGES,270.24,24.77% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,850.98,78% OF BILLED CHARGES,270.24,24.77% OF BILLED CHARGES,927.35,85% OF BILLED CHARGES,275.59,25.26% OF BILLED CHARGES,148.21,115% OF CMS PHYSICIAN FEES SCHEDULE,927.35,85% OF BILLED CHARGES,267.57,24.525% OF BILLED CHARGES,1091,100% OF BILLED CHARGES,108.11,1091,622.96
Outpatient Medical Services,Radiology,74183,MRI Abdomen w/ + w/o Contrast,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,411.18,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,411.18,2869,1638.20
Outpatient Medical Services,Radiology,74182,MRI Abdomen w/ Contrast,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,368.16,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,368.16,2869,1638.20
Outpatient Medical Services,Radiology,74181,MRI Abdomen w/o Contrast,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,237.71,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,237.71,2869,1638.20
Outpatient Medical Services,Radiology,73723,MRI Ankle w/ + w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,469.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,469.76,2869,1638.20
Outpatient Medical Services,Radiology,73723,MRI Ankle w/ + w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,469.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,469.76,2869,1638.20
Outpatient Medical Services,Radiology,73722,MRI Ankle w/ Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,382.33,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,382.33,2869,1638.20
Outpatient Medical Services,Radiology,73722,MRI Ankle w/ Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,382.33,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,382.33,2869,1638.20
Outpatient Medical Services,Radiology,73721,MRI Ankle w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.3,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.3,2869,1638.20
Outpatient Medical Services,Radiology,73721,MRI Ankle w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.3,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.3,2869,1638.20
Outpatient Medical Services,Radiology,70553,MRI Brain w/ + w/o Contrast,611,2286,2011.68,88% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,2286,100% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,577.44,25.26% OF BILLED CHARGES,1371.6,60% OF BILLED CHARGES,436.74,19.105% OF BILLED CHARGES,700.66,30.65% OF BILLED CHARGES,2011.68,88% OF BILLED CHARGES,1714.5,75% OF BILLED CHARGES,2286,100% OF BILLED CHARGES,504.52,22.07% OF BILLED CHARGES,2057.4,90%OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,2057.4,90% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,1794.97,78.52% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,1403.6,61.40% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,560.64,24.525%OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,1860.8,81.4% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,1175,51.4% OF BILLED CHARGES,566.24,24.77% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,1783.08,78% OF BILLED CHARGES,566.24,24.77% OF BILLED CHARGES,1943.1,85% OF BILLED CHARGES,577.44,25.26% OF BILLED CHARGES,386.69,115% OF CMS PHYSICIAN FEES SCHEDULE,1943.1,85% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,2286,100% OF BILLED CHARGES,386.69,2286,1305.31
Outpatient Medical Services,Radiology,70552,MRI Brain w/ Contrast,611,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,328.69,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,328.69,2869,1638.20
Outpatient Medical Services,Radiology,70551,MRI Brain w/o Contrast,611,2953,2598.64,88% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2953,100% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,745.93,25.26% OF BILLED CHARGES,1771.8,60% OF BILLED CHARGES,564.17,19.105% OF BILLED CHARGES,905.09,30.65% OF BILLED CHARGES,2598.64,88% OF BILLED CHARGES,2214.75,75% OF BILLED CHARGES,2953,100% OF BILLED CHARGES,651.73,22.07% OF BILLED CHARGES,2657.7,90%OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2657.7,90% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2318.7,78.52% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,1813.14,61.40% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525%OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2403.74,81.4% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,1517.84,51.4% OF BILLED CHARGES,731.46,24.77% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2303.34,78% OF BILLED CHARGES,731.46,24.77% OF BILLED CHARGES,2510.05,85% OF BILLED CHARGES,745.93,25.26% OF BILLED CHARGES,238.08,115% OF CMS PHYSICIAN FEES SCHEDULE,2510.05,85% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2953,100% OF BILLED CHARGES,238.08,2953,1686.16
Outpatient Medical Services,Radiology,77049,MRI Breast w/ + w/o Contrast Bilateral,610,3562,3134.56,88% OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,261.1,100% OF BCCHP FEES SCHEDULE,873.58,24.525% OF BILLED CHARGES,899.76,25.26% OF BILLED CHARGES,2137.2,60% OF BILLED CHARGES,680.52,19.105% OF BILLED CHARGES,1091.75,30.65% OF BILLED CHARGES,3134.56,88% OF BILLED CHARGES,2671.5,75% OF BILLED CHARGES,3562,100% OF BILLED CHARGES,786.13,22.07% OF BILLED CHARGES,3205.8,90%OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,3205.8,90% OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,2796.88,78.52% OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,2187.07,61.40% OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,873.58,24.525%OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,2899.47,81.4% OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,1830.87,51.4% OF BILLED CHARGES,882.31,24.77% OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,2778.36,78% OF BILLED CHARGES,882.31,24.77% OF BILLED CHARGES,3027.7,85% OF BILLED CHARGES,899.76,25.26% OF BILLED CHARGES,416.54,115% OF CMS PHYSICIAN FEES SCHEDULE,3027.7,85% OF BILLED CHARGES,873.58,24.525% OF BILLED CHARGES,3562,100% OF BILLED CHARGES,261.1,3562,2033.90
Outpatient Medical Services,Radiology,77047,MRI Breast w/o Contrast Bilateral,610,2418,2127.84,88% OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,261.1,100% OF BCCHP FEES SCHEDULE,593.01,24.525% OF BILLED CHARGES,610.79,25.26% OF BILLED CHARGES,1450.8,60% OF BILLED CHARGES,461.96,19.105% OF BILLED CHARGES,741.12,30.65% OF BILLED CHARGES,2127.84,88% OF BILLED CHARGES,1813.5,75% OF BILLED CHARGES,2418,100% OF BILLED CHARGES,533.65,22.07% OF BILLED CHARGES,2176.2,90%OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,2176.2,90% OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,1898.61,78.52% OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,1484.65,61.40% OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,593.01,24.525%OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,1968.25,81.4% OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,1242.85,51.4% OF BILLED CHARGES,598.94,24.77% OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,1886.04,78% OF BILLED CHARGES,598.94,24.77% OF BILLED CHARGES,2055.3,85% OF BILLED CHARGES,610.79,25.26% OF BILLED CHARGES,265.8,115% OF CMS PHYSICIAN FEES SCHEDULE,2055.3,85% OF BILLED CHARGES,593.01,24.525% OF BILLED CHARGES,2418,100% OF BILLED CHARGES,261.1,2418,1380.68
Outpatient Medical Services,Radiology,71552,MRI Chest w/ + w/o Contrast,610,1784,1569.92,88% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,1784,100% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,450.64,25.26% OF BILLED CHARGES,1070.4,60% OF BILLED CHARGES,340.83,19.105% OF BILLED CHARGES,546.8,30.65% OF BILLED CHARGES,1569.92,88% OF BILLED CHARGES,1338,75% OF BILLED CHARGES,1784,100% OF BILLED CHARGES,393.73,22.07% OF BILLED CHARGES,1605.6,90%OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,1605.6,90% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,1400.8,78.52% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,1095.38,61.40% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,437.53,24.525%OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,1452.18,81.4% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,916.98,51.4% OF BILLED CHARGES,441.9,24.77% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,1391.52,78% OF BILLED CHARGES,441.9,24.77% OF BILLED CHARGES,1516.4,85% OF BILLED CHARGES,450.64,25.26% OF BILLED CHARGES,493.38,115% OF CMS PHYSICIAN FEES SCHEDULE,1516.4,85% OF BILLED CHARGES,437.53,24.525% OF BILLED CHARGES,1784,100% OF BILLED CHARGES,340.83,1784,1018.66
Outpatient Medical Services,Radiology,71550,MRI Chest w/ Contrast,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,315.33,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,315.33,2707,1545.70
Outpatient Medical Services,Radiology,71550,MRI Chest w/o Contrast,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,315.33,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,315.33,2869,1638.20
Outpatient Medical Services,Radiology,73223,MRI Elbow w/ + w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,471.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,471.76,2869,1638.20
Outpatient Medical Services,Radiology,73223,MRI Elbow w/ + w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,471.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,471.76,2869,1638.20
Outpatient Medical Services,Radiology,73222,MRI Elbow w/ Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,381.93,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,381.93,2869,1638.20
Outpatient Medical Services,Radiology,73222,MRI Elbow w/ Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,381.93,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,381.93,2869,1638.20
Outpatient Medical Services,Radiology,73221,MRI Elbow w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.7,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.7,2869,1638.20
Outpatient Medical Services,Radiology,73221,MRI Elbow w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.7,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.7,2869,1638.20
Outpatient Medical Services,Radiology,70543,MRI Face Neck Orbit w/ + w/o Contrast,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,412.05,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,412.05,2869,1638.20
Outpatient Medical Services,Radiology,70542,MRI Face Neck Orbit w/ Contrast,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,326.59,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,326.59,2869,1638.20
Outpatient Medical Services,Radiology,70540,MRI Face Neck Orbit w/o Contrast,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,275.36,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,275.36,2869,1638.20
Outpatient Medical Services,Radiology,73720,MRI Foot w/ + w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,410.06,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,410.06,2869,1638.20
Outpatient Medical Services,Radiology,73720,MRI Foot w/ + w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,410.06,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,410.06,2869,1638.20
Outpatient Medical Services,Radiology,73719,MRI Foot w/ Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,320.22,2869,1638.20
Outpatient Medical Services,Radiology,73719,MRI Foot w/ Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,320.22,2869,1638.20
Outpatient Medical Services,Radiology,73718,MRI Foot w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,271.78,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,271.78,2869,1638.20
Outpatient Medical Services,Radiology,73718,MRI Foot w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,271.78,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,271.78,2869,1638.20
Outpatient Medical Services,Radiology,73220,MRI Hand w/ + w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,499.63,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,499.63,2869,1638.20
Outpatient Medical Services,Radiology,73220,MRI Hand w/ + w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,499.63,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,499.63,2869,1638.20
Outpatient Medical Services,Radiology,73219,MRI Hand w/ Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,404.23,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,404.23,2869,1638.20
Outpatient Medical Services,Radiology,73219,MRI Hand w/ Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,404.23,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,404.23,2869,1638.20
Outpatient Medical Services,Radiology,73218,MRI Hand w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,310.68,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,310.68,2869,1638.20
Outpatient Medical Services,Radiology,73218,MRI Hand w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,310.68,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,310.68,2869,1638.20
Outpatient Medical Services,Radiology,73723,MRI Hip w/ + w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,469.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,469.76,2869,1638.20
Outpatient Medical Services,Radiology,73723,MRI Hip w/ + w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,469.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,469.76,2869,1638.20
Outpatient Medical Services,Radiology,73722,MRI Hip w/ Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,382.33,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,382.33,2869,1638.20
Outpatient Medical Services,Radiology,73722,MRI Hip w/ Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,382.33,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,382.33,2869,1638.20
Outpatient Medical Services,Radiology,73721,MRI Hip w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.3,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.3,2869,1638.20
Outpatient Medical Services,Radiology,73721,MRI Hip w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.3,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.3,2869,1638.20
Outpatient Medical Services,Radiology,73723,MRI Knee w/ + w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,469.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,469.76,2869,1638.20
Outpatient Medical Services,Radiology,73723,MRI Knee w/ + w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,469.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,469.76,2869,1638.20
Outpatient Medical Services,Radiology,73722,MRI Knee w/ Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,382.33,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,382.33,2869,1638.20
Outpatient Medical Services,Radiology,73722,MRI Knee w/ Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,382.33,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,382.33,2869,1638.20
Outpatient Medical Services,Radiology,73721,MRI Knee w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.3,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.3,2869,1638.20
Outpatient Medical Services,Radiology,73721,MRI Knee w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.3,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.3,2869,1638.20
Outpatient Medical Services,Radiology,73720,MRI Lower Extremity w/ + w/o Cnt Bilat,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,410.06,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,410.06,2707,1545.70
Outpatient Medical Services,Radiology,73719,MRI Lower Extremity w/ Contrast Bilat,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,320.22,2707,1545.70
Outpatient Medical Services,Radiology,73718,MRI Lower Extremity w/o Contrast Bilat,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,271.78,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,271.78,2707,1545.70
Outpatient Medical Services,Radiology,72197,MRI Pelvis w/ + w/o Contrast,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,409.6,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,409.6,2869,1638.20
Outpatient Medical Services,Radiology,72196,MRI Pelvis w/ Contrast,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,326.36,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,326.36,2869,1638.20
Outpatient Medical Services,Radiology,72195,MRI Pelvis w/o Contrast,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,278.71,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,278.71,2869,1638.20
Outpatient Medical Services,Radiology,73223,MRI Shoulder w/ + w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,471.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,471.76,2869,1638.20
Outpatient Medical Services,Radiology,73223,MRI Shoulder w/ + w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,471.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,471.76,2869,1638.20
Outpatient Medical Services,Radiology,73222,MRI Shoulder w/ Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,381.93,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,381.93,2869,1638.20
Outpatient Medical Services,Radiology,73222,MRI Shoulder w/ Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,381.93,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,381.93,2869,1638.20
Outpatient Medical Services,Radiology,73221,MRI Shoulder w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.7,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.7,2869,1638.20
Outpatient Medical Services,Radiology,73221,MRI Shoulder w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.7,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.7,2869,1638.20
Outpatient Medical Services,Radiology,72156,MRI Spine Cervical w/ + w/o Contrast,612,3877,3411.76,88% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3877,100% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,979.33,25.26% OF BILLED CHARGES,2326.2,60% OF BILLED CHARGES,740.7,19.105% OF BILLED CHARGES,1188.3,30.65% OF BILLED CHARGES,3411.76,88% OF BILLED CHARGES,2907.75,75% OF BILLED CHARGES,3877,100% OF BILLED CHARGES,855.65,22.07% OF BILLED CHARGES,3489.3,90%OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3489.3,90% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3044.22,78.52% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,2380.48,61.40% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525%OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3155.88,81.4% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,1992.78,51.4% OF BILLED CHARGES,960.33,24.77% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3024.06,78% OF BILLED CHARGES,960.33,24.77% OF BILLED CHARGES,3295.45,85% OF BILLED CHARGES,979.33,25.26% OF BILLED CHARGES,388.69,115% OF CMS PHYSICIAN FEES SCHEDULE,3295.45,85% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3877,100% OF BILLED CHARGES,388.69,3877,2213.77
Outpatient Medical Services,Radiology,72142,MRI Spine Cervical w/ Contrast,612,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,334.97,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,334.97,2869,1638.20
Outpatient Medical Services,Radiology,72141,MRI Spine Cervical w/o Contrast,612,2953,2598.64,88% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2953,100% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,745.93,25.26% OF BILLED CHARGES,1771.8,60% OF BILLED CHARGES,564.17,19.105% OF BILLED CHARGES,905.09,30.65% OF BILLED CHARGES,2598.64,88% OF BILLED CHARGES,2214.75,75% OF BILLED CHARGES,2953,100% OF BILLED CHARGES,651.73,22.07% OF BILLED CHARGES,2657.7,90%OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2657.7,90% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2318.7,78.52% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,1813.14,61.40% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525%OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2403.74,81.4% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,1517.84,51.4% OF BILLED CHARGES,731.46,24.77% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2303.34,78% OF BILLED CHARGES,731.46,24.77% OF BILLED CHARGES,2510.05,85% OF BILLED CHARGES,745.93,25.26% OF BILLED CHARGES,231.31,115% OF CMS PHYSICIAN FEES SCHEDULE,2510.05,85% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2953,100% OF BILLED CHARGES,231.31,2953,1686.16
Outpatient Medical Services,Radiology,72158,MRI Spine Lumbar w/ + w/o Contrast,612,3877,3411.76,88% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3877,100% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,979.33,25.26% OF BILLED CHARGES,2326.2,60% OF BILLED CHARGES,740.7,19.105% OF BILLED CHARGES,1188.3,30.65% OF BILLED CHARGES,3411.76,88% OF BILLED CHARGES,2907.75,75% OF BILLED CHARGES,3877,100% OF BILLED CHARGES,855.65,22.07% OF BILLED CHARGES,3489.3,90%OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3489.3,90% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3044.22,78.52% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,2380.48,61.40% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525%OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3155.88,81.4% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,1992.78,51.4% OF BILLED CHARGES,960.33,24.77% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3024.06,78% OF BILLED CHARGES,960.33,24.77% OF BILLED CHARGES,3295.45,85% OF BILLED CHARGES,979.33,25.26% OF BILLED CHARGES,387.88,115% OF CMS PHYSICIAN FEES SCHEDULE,3295.45,85% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3877,100% OF BILLED CHARGES,387.88,3877,2213.77
Outpatient Medical Services,Radiology,72149,MRI Spine Lumbar w/ Contrast,612,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,328.99,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,328.99,2869,1638.20
Outpatient Medical Services,Radiology,72148,MRI Spine Lumbar w/o Contrast,612,2953,2598.64,88% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2953,100% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,745.93,25.26% OF BILLED CHARGES,1771.8,60% OF BILLED CHARGES,564.17,19.105% OF BILLED CHARGES,905.09,30.65% OF BILLED CHARGES,2598.64,88% OF BILLED CHARGES,2214.75,75% OF BILLED CHARGES,2953,100% OF BILLED CHARGES,651.73,22.07% OF BILLED CHARGES,2657.7,90%OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2657.7,90% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2318.7,78.52% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,1813.14,61.40% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,724.22,24.525%OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2403.74,81.4% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,1517.84,51.4% OF BILLED CHARGES,731.46,24.77% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2303.34,78% OF BILLED CHARGES,731.46,24.77% OF BILLED CHARGES,2510.05,85% OF BILLED CHARGES,745.93,25.26% OF BILLED CHARGES,232.1,115% OF CMS PHYSICIAN FEES SCHEDULE,2510.05,85% OF BILLED CHARGES,724.22,24.525% OF BILLED CHARGES,2953,100% OF BILLED CHARGES,232.1,2953,1686.16
Outpatient Medical Services,Radiology,72157,MRI Spine Thoracic w/ + w/o Contrast,612,3877,3411.76,88% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3877,100% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,979.33,25.26% OF BILLED CHARGES,2326.2,60% OF BILLED CHARGES,740.7,19.105% OF BILLED CHARGES,1188.3,30.65% OF BILLED CHARGES,3411.76,88% OF BILLED CHARGES,2907.75,75% OF BILLED CHARGES,3877,100% OF BILLED CHARGES,855.65,22.07% OF BILLED CHARGES,3489.3,90%OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3489.3,90% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3044.22,78.52% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,2380.48,61.40% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,950.83,24.525%OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3155.88,81.4% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,1992.78,51.4% OF BILLED CHARGES,960.33,24.77% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3024.06,78% OF BILLED CHARGES,960.33,24.77% OF BILLED CHARGES,3295.45,85% OF BILLED CHARGES,979.33,25.26% OF BILLED CHARGES,389.48,115% OF CMS PHYSICIAN FEES SCHEDULE,3295.45,85% OF BILLED CHARGES,950.83,24.525% OF BILLED CHARGES,3877,100% OF BILLED CHARGES,389.48,3877,2213.77
Outpatient Medical Services,Radiology,72147,MRI Spine Thoracic w/ Contrast,612,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,331.87,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,331.87,2869,1638.20
Outpatient Medical Services,Radiology,72146,MRI Spine Thoracic w/o Contrast,612,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,230.91,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,230.91,2869,1638.20
Outpatient Medical Services,Radiology,70336,MRI TMJ,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,321.69,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,321.69,2869,1638.20
Outpatient Medical Services,Radiology,73223,MRI Wrist w/ + w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,471.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,471.76,2869,1638.20
Outpatient Medical Services,Radiology,73223,MRI Wrist w/ + w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,471.76,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,471.76,2869,1638.20
Outpatient Medical Services,Radiology,73222,MRI Wrist w/ Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,381.93,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,381.93,2869,1638.20
Outpatient Medical Services,Radiology,73222,MRI Wrist w/ Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,381.93,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,381.93,2869,1638.20
Outpatient Medical Services,Radiology,73221,MRI Wrist w/o Contrast Left,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.7,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.7,2869,1638.20
Outpatient Medical Services,Radiology,73221,MRI Wrist w/o Contrast Right,610,2869,2524.72,88% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,1721.4,60% OF BILLED CHARGES,548.12,19.105% OF BILLED CHARGES,879.35,30.65% OF BILLED CHARGES,2524.72,88% OF BILLED CHARGES,2151.75,75% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,633.19,22.07% OF BILLED CHARGES,2582.1,90%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2582.1,90% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2252.74,78.52% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1761.57,61.40% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,703.62,24.525%OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2335.37,81.4% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,1474.67,51.4% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2237.82,78% OF BILLED CHARGES,710.65,24.77% OF BILLED CHARGES,2438.65,85% OF BILLED CHARGES,724.71,25.26% OF BILLED CHARGES,246.7,115% OF CMS PHYSICIAN FEES SCHEDULE,2438.65,85% OF BILLED CHARGES,703.62,24.525% OF BILLED CHARGES,2869,100% OF BILLED CHARGES,246.7,2869,1638.20
Outpatient Medical Services,Radiology,77048,MRI Breast w/ + w/o Contrast Left,610,2132,1876.16,88% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,261.1,100% OF BCCHP FEES SCHEDULE,522.87,24.525% OF BILLED CHARGES,538.54,25.26% OF BILLED CHARGES,1279.2,60% OF BILLED CHARGES,407.32,19.105% OF BILLED CHARGES,653.46,30.65% OF BILLED CHARGES,1876.16,88% OF BILLED CHARGES,1599,75% OF BILLED CHARGES,2132,100% OF BILLED CHARGES,470.53,22.07% OF BILLED CHARGES,1918.8,90%OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1918.8,90% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1674.05,78.52% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1309.05,61.40% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,522.87,24.525%OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1735.45,81.4% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1095.85,51.4% OF BILLED CHARGES,528.1,24.77% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1662.96,78% OF BILLED CHARGES,528.1,24.77% OF BILLED CHARGES,1812.2,85% OF BILLED CHARGES,538.54,25.26% OF BILLED CHARGES,408.53,115% OF CMS PHYSICIAN FEES SCHEDULE,1812.2,85% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,2132,100% OF BILLED CHARGES,261.1,2132,1217.37
Outpatient Medical Services,Radiology,77048,MRI Breast w/ + w/o Contrast Right,610,2132,1876.16,88% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,261.1,100% OF BCCHP FEES SCHEDULE,522.87,24.525% OF BILLED CHARGES,538.54,25.26% OF BILLED CHARGES,1279.2,60% OF BILLED CHARGES,407.32,19.105% OF BILLED CHARGES,653.46,30.65% OF BILLED CHARGES,1876.16,88% OF BILLED CHARGES,1599,75% OF BILLED CHARGES,2132,100% OF BILLED CHARGES,470.53,22.07% OF BILLED CHARGES,1918.8,90%OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1918.8,90% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1674.05,78.52% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1309.05,61.40% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,522.87,24.525%OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1735.45,81.4% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1095.85,51.4% OF BILLED CHARGES,528.1,24.77% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,1662.96,78% OF BILLED CHARGES,528.1,24.77% OF BILLED CHARGES,1812.2,85% OF BILLED CHARGES,538.54,25.26% OF BILLED CHARGES,408.53,115% OF CMS PHYSICIAN FEES SCHEDULE,1812.2,85% OF BILLED CHARGES,522.87,24.525% OF BILLED CHARGES,2132,100% OF BILLED CHARGES,261.1,2132,1217.37
Outpatient Medical Services,Radiology,77084,MRI Bone Marrow w/o Contrast,610,820,721.6,88% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,820,100% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,207.13,25.26% OF BILLED CHARGES,492,60% OF BILLED CHARGES,156.66,19.105% OF BILLED CHARGES,251.33,30.65% OF BILLED CHARGES,721.6,88% OF BILLED CHARGES,615,75% OF BILLED CHARGES,820,100% OF BILLED CHARGES,180.97,22.07% OF BILLED CHARGES,738,90%OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,738,90% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,643.86,78.52% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,503.48,61.40% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,201.11,24.525%OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,667.48,81.4% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,421.48,51.4% OF BILLED CHARGES,203.11,24.77% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,639.6,78% OF BILLED CHARGES,203.11,24.77% OF BILLED CHARGES,697,85% OF BILLED CHARGES,207.13,25.26% OF BILLED CHARGES,322.1,115% OF CMS PHYSICIAN FEES SCHEDULE,697,85% OF BILLED CHARGES,201.11,24.525% OF BILLED CHARGES,820,100% OF BILLED CHARGES,156.66,820,468.22
Outpatient Medical Services,Radiology,70552,MRI Brain w/ Contrast Ltd,611,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,328.69,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,328.69,2609,1489.74
Outpatient Medical Services,Radiology,77046,MRI Breast w/o Contrast Left,610,1377,1211.76,88% OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,261.1,100% OF BCCHP FEES SCHEDULE,337.71,24.525% OF BILLED CHARGES,347.83,25.26% OF BILLED CHARGES,826.2,60% OF BILLED CHARGES,263.08,19.105% OF BILLED CHARGES,422.05,30.65% OF BILLED CHARGES,1211.76,88% OF BILLED CHARGES,1032.75,75% OF BILLED CHARGES,1377,100% OF BILLED CHARGES,303.9,22.07% OF BILLED CHARGES,1239.3,90%OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,1239.3,90% OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,1081.22,78.52% OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,845.48,61.40% OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,337.71,24.525%OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,1120.88,81.4% OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,707.78,51.4% OF BILLED CHARGES,341.08,24.77% OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,1074.06,78% OF BILLED CHARGES,341.08,24.77% OF BILLED CHARGES,1170.45,85% OF BILLED CHARGES,347.83,25.26% OF BILLED CHARGES,258.51,115% OF CMS PHYSICIAN FEES SCHEDULE,1170.45,85% OF BILLED CHARGES,337.71,24.525% OF BILLED CHARGES,1377,100% OF BILLED CHARGES,258.51,1377,786.27
Outpatient Medical Services,Radiology,73720,MRI Femur w/ + w/o Contrast Lt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,410.06,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,410.06,2609,1489.74
Outpatient Medical Services,Radiology,73720,MRI Femur w/ + w/o Contrast Rt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,410.06,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,410.06,2609,1489.74
Outpatient Medical Services,Radiology,73718,MRI Femur w/o Contrast Lt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,271.78,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,271.78,2609,1489.74
Outpatient Medical Services,Radiology,73718,MRI Femur w/o Contrast Rt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,271.78,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,271.78,2609,1489.74
Outpatient Medical Services,Radiology,73719,MRI Humerus w/ + w/o Contrast Rt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,320.22,2609,1489.74
Outpatient Medical Services,Radiology,73220,MRI Humerus w/ + w/o Contrsat Lt,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,499.63,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,499.63,2707,1545.70
Outpatient Medical Services,Radiology,73719,MRI Humerus w/o Contrast Lt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,320.22,2609,1489.74
Outpatient Medical Services,Radiology,73719,MRI Humerus w/o Contrast Rt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,320.22,2609,1489.74
Outpatient Medical Services,Radiology,70553,MRI Pituitary w/ + w/o Contrast,611,2286,2011.68,88% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,2286,100% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,577.44,25.26% OF BILLED CHARGES,1371.6,60% OF BILLED CHARGES,436.74,19.105% OF BILLED CHARGES,700.66,30.65% OF BILLED CHARGES,2011.68,88% OF BILLED CHARGES,1714.5,75% OF BILLED CHARGES,2286,100% OF BILLED CHARGES,504.52,22.07% OF BILLED CHARGES,2057.4,90%OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,2057.4,90% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,1794.97,78.52% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,1403.6,61.40% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,560.64,24.525%OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,1860.8,81.4% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,1175,51.4% OF BILLED CHARGES,566.24,24.77% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,1783.08,78% OF BILLED CHARGES,566.24,24.77% OF BILLED CHARGES,1943.1,85% OF BILLED CHARGES,577.44,25.26% OF BILLED CHARGES,386.69,115% OF CMS PHYSICIAN FEES SCHEDULE,1943.1,85% OF BILLED CHARGES,560.64,24.525% OF BILLED CHARGES,2286,100% OF BILLED CHARGES,386.69,2286,1305.31
Outpatient Medical Services,Radiology,73720,MRI Tibia w/ + w/o Contrast Lt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,410.06,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,410.06,2609,1489.74
Outpatient Medical Services,Radiology,73720,MRI Tibia w/ + w/o Contrast Rt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,410.06,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,410.06,2609,1489.74
Outpatient Medical Services,Radiology,73719,MRI Tibia w/ Contrast Lt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,320.22,2609,1489.74
Outpatient Medical Services,Radiology,73719,MRI Tibia w/ Contrast Rt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,320.22,2609,1489.74
Outpatient Medical Services,Radiology,73718,MRI Tibia w/o Contrast Lt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,271.78,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,271.78,2609,1489.74
Outpatient Medical Services,Radiology,73718,MRI Tibia w/o Contrast Rt,610,2609,2295.92,88% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,1565.4,60% OF BILLED CHARGES,498.45,19.105% OF BILLED CHARGES,799.66,30.65% OF BILLED CHARGES,2295.92,88% OF BILLED CHARGES,1956.75,75% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,575.81,22.07% OF BILLED CHARGES,2348.1,90%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2348.1,90% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2048.59,78.52% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1601.93,61.40% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,639.86,24.525%OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2123.73,81.4% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,1341.03,51.4% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2035.02,78% OF BILLED CHARGES,646.25,24.77% OF BILLED CHARGES,2217.65,85% OF BILLED CHARGES,659.03,25.26% OF BILLED CHARGES,271.78,115% OF CMS PHYSICIAN FEES SCHEDULE,2217.65,85% OF BILLED CHARGES,639.86,24.525% OF BILLED CHARGES,2609,100% OF BILLED CHARGES,271.78,2609,1489.74
Outpatient Medical Services,Radiology,73719,MRI Femur w/ Contrast Lt,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,320.22,2707,1545.70
Outpatient Medical Services,Radiology,73719,MRI Femur w/ Contrast Rt,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,320.22,2707,1545.70
Outpatient Medical Services,Radiology,73219,MRI Forearm w/ Contrast Lt,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,404.23,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,404.23,2707,1545.70
Outpatient Medical Services,Radiology,73219,MRI Forearm w/ Contrast Rt,610,2461,2165.68,88% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,2461,100% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,621.65,25.26% OF BILLED CHARGES,1476.6,60% OF BILLED CHARGES,470.17,19.105% OF BILLED CHARGES,754.3,30.65% OF BILLED CHARGES,2165.68,88% OF BILLED CHARGES,1845.75,75% OF BILLED CHARGES,2461,100% OF BILLED CHARGES,543.14,22.07% OF BILLED CHARGES,2214.9,90%OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,2214.9,90% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,1932.38,78.52% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,1511.05,61.40% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,603.56,24.525%OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,2003.25,81.4% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,1264.95,51.4% OF BILLED CHARGES,609.59,24.77% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,1919.58,78% OF BILLED CHARGES,609.59,24.77% OF BILLED CHARGES,2091.85,85% OF BILLED CHARGES,621.65,25.26% OF BILLED CHARGES,404.23,115% OF CMS PHYSICIAN FEES SCHEDULE,2091.85,85% OF BILLED CHARGES,603.56,24.525% OF BILLED CHARGES,2461,100% OF BILLED CHARGES,404.23,2461,1405.23
Outpatient Medical Services,Radiology,73219,MRI Humerus w/ Contrast Lt,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,404.23,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,404.23,2707,1545.70
Outpatient Medical Services,Radiology,73219,MRI Humerus w/ Contrast Rt,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,404.23,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,404.23,2707,1545.70
Outpatient Medical Services,Radiology,73220,MRI Humerus w/ + w/o Contrast Left,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,499.63,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,499.63,2707,1545.70
Outpatient Medical Services,Radiology,73220,MRI Humerus w/ + w/o Contrast Right,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,499.63,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,499.63,2707,1545.70
Outpatient Medical Services,Radiology,73218,MRI Humerus w/o Contrast Left,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,310.68,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,310.68,2707,1545.70
Outpatient Medical Services,Radiology,73218,MRI Humerus w/o Contrast Right,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,310.68,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,310.68,2707,1545.70
Outpatient Medical Services,Radiology,73719,MRI Femur w/ Contrast Left,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,320.22,2707,1545.70
Outpatient Medical Services,Radiology,73719,MRI Femur w/ Contrast Right,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,320.22,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,320.22,2707,1545.70
Outpatient Medical Services,Radiology,73219,MRI Forearm w/ Contrast Left,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,404.23,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,404.23,2707,1545.70
Outpatient Medical Services,Radiology,73219,MRI Forearm w/ Contrast Right,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,404.23,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,404.23,2707,1545.70
Outpatient Medical Services,Radiology,73219,MRI Humerus w/ Contrast Left,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,404.23,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,404.23,2707,1545.70
Outpatient Medical Services,Radiology,73219,MRI Humerus w/ Contrast Right,610,2707,2382.16,88% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,1624.2,60% OF BILLED CHARGES,517.17,19.105% OF BILLED CHARGES,829.7,30.65% OF BILLED CHARGES,2382.16,88% OF BILLED CHARGES,2030.25,75% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,597.43,22.07% OF BILLED CHARGES,2436.3,90%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2436.3,90% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2125.54,78.52% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1662.1,61.40% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,663.89,24.525%OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2203.5,81.4% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,1391.4,51.4% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2111.46,78% OF BILLED CHARGES,670.52,24.77% OF BILLED CHARGES,2300.95,85% OF BILLED CHARGES,683.79,25.26% OF BILLED CHARGES,404.23,115% OF CMS PHYSICIAN FEES SCHEDULE,2300.95,85% OF BILLED CHARGES,663.89,24.525% OF BILLED CHARGES,2707,100% OF BILLED CHARGES,404.23,2707,1545.70
Outpatient Medical Services,Radiology,72198,MRV Pelvis w/ Contrast,618,4942,4348.96,88% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,4942,100% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,1248.35,25.26% OF BILLED CHARGES,2965.2,60% OF BILLED CHARGES,944.17,19.105% OF BILLED CHARGES,1514.72,30.65% OF BILLED CHARGES,4348.96,88% OF BILLED CHARGES,3706.5,75% OF BILLED CHARGES,4942,100% OF BILLED CHARGES,1090.7,22.07% OF BILLED CHARGES,4447.8,90%OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,4447.8,90% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,3880.46,78.52% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,3034.39,61.40% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,1212.03,24.525%OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,4022.79,81.4% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,2540.19,51.4% OF BILLED CHARGES,1224.13,24.77% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,3854.76,78% OF BILLED CHARGES,1224.13,24.77% OF BILLED CHARGES,4200.7,85% OF BILLED CHARGES,1248.35,25.26% OF BILLED CHARGES,411.78,115% OF CMS PHYSICIAN FEES SCHEDULE,4200.7,85% OF BILLED CHARGES,1212.03,24.525% OF BILLED CHARGES,4942,100% OF BILLED CHARGES,411.78,4942,2821.88
Outpatient Medical Services,Radiology,78300,NM Bone Imaging Limited Injection,341,161,141.68,88% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,161,100% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,40.67,25.26% OF BILLED CHARGES,96.6,60% OF BILLED CHARGES,30.76,19.105% OF BILLED CHARGES,49.35,30.65% OF BILLED CHARGES,141.68,88% OF BILLED CHARGES,120.75,75% OF BILLED CHARGES,161,100% OF BILLED CHARGES,35.53,22.07% OF BILLED CHARGES,144.9,90%OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,144.9,90% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,126.42,78.52% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,98.85,61.40% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,39.49,24.525%OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,131.05,81.4% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,82.75,51.4% OF BILLED CHARGES,39.88,24.77% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,125.58,78% OF BILLED CHARGES,39.88,24.77% OF BILLED CHARGES,136.85,85% OF BILLED CHARGES,40.67,25.26% OF BILLED CHARGES,185.15,115% OF CMS PHYSICIAN FEES SCHEDULE,136.85,85% OF BILLED CHARGES,39.49,24.525% OF BILLED CHARGES,161,100% OF BILLED CHARGES,30.76,185.15,91.93
Outpatient Medical Services,Radiology,78305,NM Bone Imaging Multiple Areas Injection,341,220,193.6,88% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,220,100% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,55.57,25.26% OF BILLED CHARGES,132,60% OF BILLED CHARGES,42.03,19.105% OF BILLED CHARGES,67.43,30.65% OF BILLED CHARGES,193.6,88% OF BILLED CHARGES,165,75% OF BILLED CHARGES,220,100% OF BILLED CHARGES,48.55,22.07% OF BILLED CHARGES,198,90%OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,198,90% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,172.74,78.52% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,135.08,61.40% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,53.96,24.525%OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,179.08,81.4% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,113.08,51.4% OF BILLED CHARGES,54.49,24.77% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,171.6,78% OF BILLED CHARGES,54.49,24.77% OF BILLED CHARGES,187,85% OF BILLED CHARGES,55.57,25.26% OF BILLED CHARGES,253,115% OF CMS PHYSICIAN FEES SCHEDULE,187,85% OF BILLED CHARGES,53.96,24.525% OF BILLED CHARGES,220,100% OF BILLED CHARGES,42.03,253,125.62
Outpatient Medical Services,Radiology,78306,NM Bone Imaging Whole Body Injection,341,282,248.16,88% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,282,100% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,71.23,25.26% OF BILLED CHARGES,169.2,60% OF BILLED CHARGES,53.88,19.105% OF BILLED CHARGES,86.43,30.65% OF BILLED CHARGES,248.16,88% OF BILLED CHARGES,211.5,75% OF BILLED CHARGES,282,100% OF BILLED CHARGES,62.24,22.07% OF BILLED CHARGES,253.8,90%OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,253.8,90% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,221.43,78.52% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,173.15,61.40% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,69.16,24.525%OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,229.55,81.4% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,144.95,51.4% OF BILLED CHARGES,69.85,24.77% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,219.96,78% OF BILLED CHARGES,69.85,24.77% OF BILLED CHARGES,239.7,85% OF BILLED CHARGES,71.23,25.26% OF BILLED CHARGES,319.86,115% OF CMS PHYSICIAN FEES SCHEDULE,239.7,85% OF BILLED CHARGES,69.16,24.525% OF BILLED CHARGES,282,100% OF BILLED CHARGES,53.88,319.86,161.02
Outpatient Medical Services,Radiology,78102,NM Bone Marrow Imaging Limited,341,1494,1314.72,88% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,1494,100% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,377.38,25.26% OF BILLED CHARGES,896.4,60% OF BILLED CHARGES,285.43,19.105% OF BILLED CHARGES,457.91,30.65% OF BILLED CHARGES,1314.72,88% OF BILLED CHARGES,1120.5,75% OF BILLED CHARGES,1494,100% OF BILLED CHARGES,329.73,22.07% OF BILLED CHARGES,1344.6,90%OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,1344.6,90% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,1173.09,78.52% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,917.32,61.40% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,366.4,24.525%OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,1216.12,81.4% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,767.92,51.4% OF BILLED CHARGES,370.06,24.77% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,1165.32,78% OF BILLED CHARGES,370.06,24.77% OF BILLED CHARGES,1269.9,85% OF BILLED CHARGES,377.38,25.26% OF BILLED CHARGES,190.24,115% OF CMS PHYSICIAN FEES SCHEDULE,1269.9,85% OF BILLED CHARGES,366.4,24.525% OF BILLED CHARGES,1494,100% OF BILLED CHARGES,190.24,1494,853.07
Outpatient Medical Services,Radiology,78803,NM Bone Spect,341,2483,2185.04,88% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,2483,100% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,627.21,25.26% OF BILLED CHARGES,1489.8,60% OF BILLED CHARGES,474.38,19.105% OF BILLED CHARGES,761.04,30.65% OF BILLED CHARGES,2185.04,88% OF BILLED CHARGES,1862.25,75% OF BILLED CHARGES,2483,100% OF BILLED CHARGES,548,22.07% OF BILLED CHARGES,2234.7,90%OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,2234.7,90% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,1949.65,78.52% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,1524.56,61.40% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,608.96,24.525%OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,2021.16,81.4% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,1276.26,51.4% OF BILLED CHARGES,615.04,24.77% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,1936.74,78% OF BILLED CHARGES,615.04,24.77% OF BILLED CHARGES,2110.55,85% OF BILLED CHARGES,627.21,25.26% OF BILLED CHARGES,412.55,115% OF CMS PHYSICIAN FEES SCHEDULE,2110.55,85% OF BILLED CHARGES,608.96,24.525% OF BILLED CHARGES,2483,100% OF BILLED CHARGES,412.55,2483,1417.79
Outpatient Medical Services,Radiology,78315,NM Bone Three Phase Study Injection/Scan,341,221,194.48,88% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,221,100% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,55.82,25.26% OF BILLED CHARGES,132.6,60% OF BILLED CHARGES,42.22,19.105% OF BILLED CHARGES,67.74,30.65% OF BILLED CHARGES,194.48,88% OF BILLED CHARGES,165.75,75% OF BILLED CHARGES,221,100% OF BILLED CHARGES,48.77,22.07% OF BILLED CHARGES,198.9,90%OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,198.9,90% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,173.53,78.52% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,135.69,61.40% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,54.2,24.525%OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,179.89,81.4% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,113.59,51.4% OF BILLED CHARGES,54.74,24.77% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,172.38,78% OF BILLED CHARGES,54.74,24.77% OF BILLED CHARGES,187.85,85% OF BILLED CHARGES,55.82,25.26% OF BILLED CHARGES,254.15,115% OF CMS PHYSICIAN FEES SCHEDULE,187.85,85% OF BILLED CHARGES,54.2,24.525% OF BILLED CHARGES,221,100% OF BILLED CHARGES,42.22,254.15,126.19
Outpatient Medical Services,Radiology,78601,NM Brain Imaging Vascular Flow Only,341,3775,3322,88% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,3775,100% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,953.57,25.26% OF BILLED CHARGES,2265,60% OF BILLED CHARGES,721.21,19.105% OF BILLED CHARGES,1157.04,30.65% OF BILLED CHARGES,3322,88% OF BILLED CHARGES,2831.25,75% OF BILLED CHARGES,3775,100% OF BILLED CHARGES,833.14,22.07% OF BILLED CHARGES,3397.5,90%OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,3397.5,90% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,2964.13,78.52% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,2317.85,61.40% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,925.82,24.525%OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,3072.85,81.4% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,1940.35,51.4% OF BILLED CHARGES,935.07,24.77% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,2944.5,78% OF BILLED CHARGES,935.07,24.77% OF BILLED CHARGES,3208.75,85% OF BILLED CHARGES,953.57,25.26% OF BILLED CHARGES,238.07,115% OF CMS PHYSICIAN FEES SCHEDULE,3208.75,85% OF BILLED CHARGES,925.82,24.525% OF BILLED CHARGES,3775,100% OF BILLED CHARGES,238.07,3775,2155.53
Outpatient Medical Services,Radiology,78803,NM Brain Spect,341,4806,4229.28,88% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,4806,100% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,1214,25.26% OF BILLED CHARGES,2883.6,60% OF BILLED CHARGES,918.19,19.105% OF BILLED CHARGES,1473.04,30.65% OF BILLED CHARGES,4229.28,88% OF BILLED CHARGES,3604.5,75% OF BILLED CHARGES,4806,100% OF BILLED CHARGES,1060.68,22.07% OF BILLED CHARGES,4325.4,90%OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,4325.4,90% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,3773.67,78.52% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,2950.88,61.40% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,1178.67,24.525%OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,3912.08,81.4% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,2470.28,51.4% OF BILLED CHARGES,1190.45,24.77% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,3748.68,78% OF BILLED CHARGES,1190.45,24.77% OF BILLED CHARGES,4085.1,85% OF BILLED CHARGES,1214,25.26% OF BILLED CHARGES,412.55,115% OF CMS PHYSICIAN FEES SCHEDULE,4085.1,85% OF BILLED CHARGES,1178.67,24.525% OF BILLED CHARGES,4806,100% OF BILLED CHARGES,412.55,4806,2744.23
Outpatient Medical Services,Radiology,78472,NM Cardiac MUGA,341,2560,2252.8,88% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,2560,100% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,646.66,25.26% OF BILLED CHARGES,1536,60% OF BILLED CHARGES,489.09,19.105% OF BILLED CHARGES,784.64,30.65% OF BILLED CHARGES,2252.8,88% OF BILLED CHARGES,1920,75% OF BILLED CHARGES,2560,100% OF BILLED CHARGES,564.99,22.07% OF BILLED CHARGES,2304,90%OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,2304,90% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,2010.11,78.52% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,1571.84,61.40% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,627.84,24.525%OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,2083.84,81.4% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,1315.84,51.4% OF BILLED CHARGES,634.11,24.77% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,1996.8,78% OF BILLED CHARGES,634.11,24.77% OF BILLED CHARGES,2176,85% OF BILLED CHARGES,646.66,25.26% OF BILLED CHARGES,249.24,115% OF CMS PHYSICIAN FEES SCHEDULE,2176,85% OF BILLED CHARGES,627.84,24.525% OF BILLED CHARGES,2560,100% OF BILLED CHARGES,249.24,2560,1461.76
Outpatient Medical Services,Radiology,78650,NM Cerebrospinal Fluid Leakage Detection,341,2900,2552,88% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,2900,100% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,732.54,25.26% OF BILLED CHARGES,1740,60% OF BILLED CHARGES,554.05,19.105% OF BILLED CHARGES,888.85,30.65% OF BILLED CHARGES,2552,88% OF BILLED CHARGES,2175,75% OF BILLED CHARGES,2900,100% OF BILLED CHARGES,640.03,22.07% OF BILLED CHARGES,2610,90%OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,2610,90% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,2277.08,78.52% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,1780.6,61.40% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,711.23,24.525%OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,2360.6,81.4% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,1490.6,51.4% OF BILLED CHARGES,718.33,24.77% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,2262,78% OF BILLED CHARGES,718.33,24.77% OF BILLED CHARGES,2465,85% OF BILLED CHARGES,732.54,25.26% OF BILLED CHARGES,294.39,115% OF CMS PHYSICIAN FEES SCHEDULE,2465,85% OF BILLED CHARGES,711.23,24.525% OF BILLED CHARGES,2900,100% OF BILLED CHARGES,294.39,2900,1655.90
Outpatient Medical Services,Radiology,78832,NM CT Tumor Loc Multiple Areas Spect,340,4617,4062.96,88% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,4617,100% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,1166.25,25.26% OF BILLED CHARGES,2770.2,60% OF BILLED CHARGES,882.08,19.105% OF BILLED CHARGES,1415.11,30.65% OF BILLED CHARGES,4062.96,88% OF BILLED CHARGES,3462.75,75% OF BILLED CHARGES,4617,100% OF BILLED CHARGES,1018.97,22.07% OF BILLED CHARGES,4155.3,90%OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,4155.3,90% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,3625.27,78.52% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,2834.84,61.40% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,1132.32,24.525%OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,3758.24,81.4% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,2373.14,51.4% OF BILLED CHARGES,1143.63,24.77% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,3601.26,78% OF BILLED CHARGES,1143.63,24.77% OF BILLED CHARGES,3924.45,85% OF BILLED CHARGES,1166.25,25.26% OF BILLED CHARGES,977.26,115% OF CMS PHYSICIAN FEES SCHEDULE,3924.45,85% OF BILLED CHARGES,1132.32,24.525% OF BILLED CHARGES,4617,100% OF BILLED CHARGES,882.08,4617,2636.31
Outpatient Medical Services,Radiology,78830,NM CT Tumor Loc Single Area Spect,340,2836,2495.68,88% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2836,100% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,716.37,25.26% OF BILLED CHARGES,1701.6,60% OF BILLED CHARGES,541.82,19.105% OF BILLED CHARGES,869.23,30.65% OF BILLED CHARGES,2495.68,88% OF BILLED CHARGES,2127,75% OF BILLED CHARGES,2836,100% OF BILLED CHARGES,625.91,22.07% OF BILLED CHARGES,2552.4,90%OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2552.4,90% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2226.83,78.52% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,1741.3,61.40% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,695.53,24.525%OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2308.5,81.4% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,1457.7,51.4% OF BILLED CHARGES,702.48,24.77% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2212.08,78% OF BILLED CHARGES,702.48,24.77% OF BILLED CHARGES,2410.6,85% OF BILLED CHARGES,716.37,25.26% OF BILLED CHARGES,516.57,115% OF CMS PHYSICIAN FEES SCHEDULE,2410.6,85% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2836,100% OF BILLED CHARGES,516.57,2836,1619.36
Outpatient Medical Services,Radiology,78264,NM Gastric Emptying Study,341,1592,1400.96,88% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,1592,100% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,402.14,25.26% OF BILLED CHARGES,955.2,60% OF BILLED CHARGES,304.15,19.105% OF BILLED CHARGES,487.95,30.65% OF BILLED CHARGES,1400.96,88% OF BILLED CHARGES,1194,75% OF BILLED CHARGES,1592,100% OF BILLED CHARGES,351.35,22.07% OF BILLED CHARGES,1432.8,90%OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,1432.8,90% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,1250.04,78.52% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,977.49,61.40% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,390.44,24.525%OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,1295.89,81.4% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,818.29,51.4% OF BILLED CHARGES,394.34,24.77% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,1241.76,78% OF BILLED CHARGES,394.34,24.77% OF BILLED CHARGES,1353.2,85% OF BILLED CHARGES,402.14,25.26% OF BILLED CHARGES,358.79,115% OF CMS PHYSICIAN FEES SCHEDULE,1353.2,85% OF BILLED CHARGES,390.44,24.525% OF BILLED CHARGES,1592,100% OF BILLED CHARGES,304.15,1592,909.03
Outpatient Medical Services,Radiology,78262,NM Gastroesophageal Reflux Study,340,1804,1587.52,88% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1804,100% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,455.69,25.26% OF BILLED CHARGES,1082.4,60% OF BILLED CHARGES,344.65,19.105% OF BILLED CHARGES,552.93,30.65% OF BILLED CHARGES,1587.52,88% OF BILLED CHARGES,1353,75% OF BILLED CHARGES,1804,100% OF BILLED CHARGES,398.14,22.07% OF BILLED CHARGES,1623.6,90%OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1623.6,90% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1416.5,78.52% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1107.66,61.40% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525%OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1468.46,81.4% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,927.26,51.4% OF BILLED CHARGES,446.85,24.77% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1407.12,78% OF BILLED CHARGES,446.85,24.77% OF BILLED CHARGES,1533.4,85% OF BILLED CHARGES,455.69,25.26% OF BILLED CHARGES,268.73,115% OF CMS PHYSICIAN FEES SCHEDULE,1533.4,85% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1804,100% OF BILLED CHARGES,268.73,1804,1030.08
Outpatient Medical Services,Radiology,78278,NM Gastrointestinal Blood Loss Imaging,341,1804,1587.52,88% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1804,100% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,455.69,25.26% OF BILLED CHARGES,1082.4,60% OF BILLED CHARGES,344.65,19.105% OF BILLED CHARGES,552.93,30.65% OF BILLED CHARGES,1587.52,88% OF BILLED CHARGES,1353,75% OF BILLED CHARGES,1804,100% OF BILLED CHARGES,398.14,22.07% OF BILLED CHARGES,1623.6,90%OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1623.6,90% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1416.5,78.52% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1107.66,61.40% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525%OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1468.46,81.4% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,927.26,51.4% OF BILLED CHARGES,446.85,24.77% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1407.12,78% OF BILLED CHARGES,446.85,24.77% OF BILLED CHARGES,1533.4,85% OF BILLED CHARGES,455.69,25.26% OF BILLED CHARGES,378.35,115% OF CMS PHYSICIAN FEES SCHEDULE,1533.4,85% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1804,100% OF BILLED CHARGES,344.65,1804,1030.08
Outpatient Medical Services,Radiology,78807,NM Inflammation Loc Spect,340,2675,2354,88% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,2675,100% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,675.71,25.26% OF BILLED CHARGES,1605,60% OF BILLED CHARGES,511.06,19.105% OF BILLED CHARGES,819.89,30.65% OF BILLED CHARGES,2354,88% OF BILLED CHARGES,2006.25,75% OF BILLED CHARGES,2675,100% OF BILLED CHARGES,590.37,22.07% OF BILLED CHARGES,2407.5,90%OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,2407.5,90% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,2100.41,78.52% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,1642.45,61.40% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,656.04,24.525%OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,2177.45,81.4% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,1374.95,51.4% OF BILLED CHARGES,662.6,24.77% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,2086.5,78% OF BILLED CHARGES,662.6,24.77% OF BILLED CHARGES,2273.75,85% OF BILLED CHARGES,675.71,25.26% OF BILLED CHARGES,829.25,31% OF BILLED CHARGES,2273.75,85% OF BILLED CHARGES,656.04,24.525% OF BILLED CHARGES,2675,100% OF BILLED CHARGES,511.06,2675,1527.43
Outpatient Medical Services,Radiology,78290,NM Intestine Imaging Meckels,340,1804,1587.52,88% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1804,100% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,455.69,25.26% OF BILLED CHARGES,1082.4,60% OF BILLED CHARGES,344.65,19.105% OF BILLED CHARGES,552.93,30.65% OF BILLED CHARGES,1587.52,88% OF BILLED CHARGES,1353,75% OF BILLED CHARGES,1804,100% OF BILLED CHARGES,398.14,22.07% OF BILLED CHARGES,1623.6,90%OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1623.6,90% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1416.5,78.52% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1107.66,61.40% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,442.43,24.525%OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1468.46,81.4% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,927.26,51.4% OF BILLED CHARGES,446.85,24.77% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1407.12,78% OF BILLED CHARGES,446.85,24.77% OF BILLED CHARGES,1533.4,85% OF BILLED CHARGES,455.69,25.26% OF BILLED CHARGES,357.03,115% OF CMS PHYSICIAN FEES SCHEDULE,1533.4,85% OF BILLED CHARGES,442.43,24.525% OF BILLED CHARGES,1804,100% OF BILLED CHARGES,344.65,1804,1030.08
Outpatient Medical Services,Radiology,78805,NM Inflammation Loc Limited,340,1702,1497.76,88% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,1702,100% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,429.93,25.26% OF BILLED CHARGES,1021.2,60% OF BILLED CHARGES,325.17,19.105% OF BILLED CHARGES,521.66,30.65% OF BILLED CHARGES,1497.76,88% OF BILLED CHARGES,1276.5,75% OF BILLED CHARGES,1702,100% OF BILLED CHARGES,375.63,22.07% OF BILLED CHARGES,1531.8,90%OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,1531.8,90% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,1336.41,78.52% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,1045.03,61.40% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,417.42,24.525%OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,1385.43,81.4% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,874.83,51.4% OF BILLED CHARGES,421.59,24.77% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,1327.56,78% OF BILLED CHARGES,421.59,24.77% OF BILLED CHARGES,1446.7,85% OF BILLED CHARGES,429.93,25.26% OF BILLED CHARGES,527.62,31% OF BILLED CHARGES,1446.7,85% OF BILLED CHARGES,417.42,24.525% OF BILLED CHARGES,1702,100% OF BILLED CHARGES,325.17,1702,971.84
Outpatient Medical Services,Radiology,78013,NM Thyroid Imaging,340,1314,1156.32,88% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,1314,100% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,331.92,25.26% OF BILLED CHARGES,788.4,60% OF BILLED CHARGES,251.04,19.105% OF BILLED CHARGES,402.74,30.65% OF BILLED CHARGES,1156.32,88% OF BILLED CHARGES,985.5,75% OF BILLED CHARGES,1314,100% OF BILLED CHARGES,290,22.07% OF BILLED CHARGES,1182.6,90%OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,1182.6,90% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,1031.75,78.52% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,806.8,61.40% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,322.26,24.525%OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,1069.6,81.4% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,675.4,51.4% OF BILLED CHARGES,325.48,24.77% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,1024.92,78% OF BILLED CHARGES,325.48,24.77% OF BILLED CHARGES,1116.9,85% OF BILLED CHARGES,331.92,25.26% OF BILLED CHARGES,203.62,115% OF CMS PHYSICIAN FEES SCHEDULE,1116.9,85% OF BILLED CHARGES,322.26,24.525% OF BILLED CHARGES,1314,100% OF BILLED CHARGES,203.62,1314,750.29
Outpatient Medical Services,Radiology,78014,NM Thyroid Uptake Single/Multi,341,2836,2495.68,88% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2836,100% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,716.37,25.26% OF BILLED CHARGES,1701.6,60% OF BILLED CHARGES,541.82,19.105% OF BILLED CHARGES,869.23,30.65% OF BILLED CHARGES,2495.68,88% OF BILLED CHARGES,2127,75% OF BILLED CHARGES,2836,100% OF BILLED CHARGES,625.91,22.07% OF BILLED CHARGES,2552.4,90%OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2552.4,90% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2226.83,78.52% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,1741.3,61.40% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,695.53,24.525%OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2308.5,81.4% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,1457.7,51.4% OF BILLED CHARGES,702.48,24.77% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2212.08,78% OF BILLED CHARGES,702.48,24.77% OF BILLED CHARGES,2410.6,85% OF BILLED CHARGES,716.37,25.26% OF BILLED CHARGES,258.78,115% OF CMS PHYSICIAN FEES SCHEDULE,2410.6,85% OF BILLED CHARGES,695.53,24.525% OF BILLED CHARGES,2836,100% OF BILLED CHARGES,258.78,2836,1619.36
Outpatient Medical Services,Radiology,76700,US Abdomen Complete,402,703,618.64,88% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,703,100% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,177.58,25.26% OF BILLED CHARGES,421.8,60% OF BILLED CHARGES,134.31,19.105% OF BILLED CHARGES,215.47,30.65% OF BILLED CHARGES,618.64,88% OF BILLED CHARGES,527.25,75% OF BILLED CHARGES,703,100% OF BILLED CHARGES,155.15,22.07% OF BILLED CHARGES,632.7,90%OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,632.7,90% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,552,78.52% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,431.64,61.40% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,172.41,24.525%OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,572.24,81.4% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,361.34,51.4% OF BILLED CHARGES,174.13,24.77% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,548.34,78% OF BILLED CHARGES,174.13,24.77% OF BILLED CHARGES,597.55,85% OF BILLED CHARGES,177.58,25.26% OF BILLED CHARGES,137.37,115% OF CMS PHYSICIAN FEES SCHEDULE,597.55,85% OF BILLED CHARGES,172.41,24.525% OF BILLED CHARGES,703,100% OF BILLED CHARGES,134.31,703,401.41
Outpatient Medical Services,Radiology,76705,US Abdomen Limited,402,1392,1224.96,88% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1392,100% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,351.62,25.26% OF BILLED CHARGES,835.2,60% OF BILLED CHARGES,265.94,19.105% OF BILLED CHARGES,426.65,30.65% OF BILLED CHARGES,1224.96,88% OF BILLED CHARGES,1044,75% OF BILLED CHARGES,1392,100% OF BILLED CHARGES,307.21,22.07% OF BILLED CHARGES,1252.8,90%OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1252.8,90% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1093,78.52% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,854.69,61.40% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525%OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1133.09,81.4% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,715.49,51.4% OF BILLED CHARGES,344.8,24.77% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1085.76,78% OF BILLED CHARGES,344.8,24.77% OF BILLED CHARGES,1183.2,85% OF BILLED CHARGES,351.62,25.26% OF BILLED CHARGES,102.8,115% OF CMS PHYSICIAN FEES SCHEDULE,1183.2,85% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1392,100% OF BILLED CHARGES,102.8,1392,794.83
Outpatient Medical Services,Radiology,76706,US AAA Screening,402,1266,1114.08,88% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,1266,100% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,319.79,25.26% OF BILLED CHARGES,759.6,60% OF BILLED CHARGES,241.87,19.105% OF BILLED CHARGES,388.03,30.65% OF BILLED CHARGES,1114.08,88% OF BILLED CHARGES,949.5,75% OF BILLED CHARGES,1266,100% OF BILLED CHARGES,279.41,22.07% OF BILLED CHARGES,1139.4,90%OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,1139.4,90% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,994.06,78.52% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,777.32,61.40% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,310.49,24.525%OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,1030.52,81.4% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,650.72,51.4% OF BILLED CHARGES,313.59,24.77% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,987.48,78% OF BILLED CHARGES,313.59,24.77% OF BILLED CHARGES,1076.1,85% OF BILLED CHARGES,319.79,25.26% OF BILLED CHARGES,126.34,115% OF CMS PHYSICIAN FEES SCHEDULE,1076.1,85% OF BILLED CHARGES,310.49,24.525% OF BILLED CHARGES,1266,100% OF BILLED CHARGES,126.34,1266,722.89
Outpatient Medical Services,Radiology,C9744,US Abdomen Complete w/ Contast,402,1119,984.72,88% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,1119,100% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,282.66,25.26% OF BILLED CHARGES,671.4,60% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,342.97,30.65% OF BILLED CHARGES,984.72,88% OF BILLED CHARGES,839.25,75% OF BILLED CHARGES,1119,100% OF BILLED CHARGES,246.96,22.07% OF BILLED CHARGES,1007.1,90%OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,1007.1,90% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,878.64,78.52% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,687.07,61.40% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,274.43,24.525%OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,910.87,81.4% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,575.17,51.4% OF BILLED CHARGES,277.18,24.77% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,872.82,78% OF BILLED CHARGES,277.18,24.77% OF BILLED CHARGES,951.15,85% OF BILLED CHARGES,282.66,25.26% OF BILLED CHARGES,346.89,31% OF BILLED CHARGES,951.15,85% OF BILLED CHARGES,274.43,24.525% OF BILLED CHARGES,1119,100% OF BILLED CHARGES,246.96,1119,638.95
Outpatient Medical Services,Radiology,76641,US Breast Complete Left,402,985,866.8,88% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,123.54,100% OF BCCHP FEES SCHEDULE,241.57,24.525% OF BILLED CHARGES,248.81,25.26% OF BILLED CHARGES,591,60% OF BILLED CHARGES,188.18,19.105% OF BILLED CHARGES,301.9,30.65% OF BILLED CHARGES,866.8,88% OF BILLED CHARGES,738.75,75% OF BILLED CHARGES,985,100% OF BILLED CHARGES,217.39,22.07% OF BILLED CHARGES,886.5,90%OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,886.5,90% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,773.42,78.52% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,604.79,61.40% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525%OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,801.79,81.4% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,506.29,51.4% OF BILLED CHARGES,243.98,24.77% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,768.3,78% OF BILLED CHARGES,243.98,24.77% OF BILLED CHARGES,837.25,85% OF BILLED CHARGES,248.81,25.26% OF BILLED CHARGES,121.24,115% OF CMS PHYSICIAN FEES SCHEDULE,837.25,85% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,985,100% OF BILLED CHARGES,121.24,985,562.44
Outpatient Medical Services,Radiology,76641,US Breast Complete Right,402,985,866.8,88% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,123.54,100% OF BCCHP FEES SCHEDULE,241.57,24.525% OF BILLED CHARGES,248.81,25.26% OF BILLED CHARGES,591,60% OF BILLED CHARGES,188.18,19.105% OF BILLED CHARGES,301.9,30.65% OF BILLED CHARGES,866.8,88% OF BILLED CHARGES,738.75,75% OF BILLED CHARGES,985,100% OF BILLED CHARGES,217.39,22.07% OF BILLED CHARGES,886.5,90%OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,886.5,90% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,773.42,78.52% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,604.79,61.40% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525%OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,801.79,81.4% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,506.29,51.4% OF BILLED CHARGES,243.98,24.77% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,768.3,78% OF BILLED CHARGES,243.98,24.77% OF BILLED CHARGES,837.25,85% OF BILLED CHARGES,248.81,25.26% OF BILLED CHARGES,121.24,115% OF CMS PHYSICIAN FEES SCHEDULE,837.25,85% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,985,100% OF BILLED CHARGES,121.24,985,562.44
Outpatient Medical Services,Radiology,76642,US Breast Limited Left,402,713,627.44,88% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,91.78,100% OF BCCHP FEES SCHEDULE,174.86,24.525% OF BILLED CHARGES,180.1,25.26% OF BILLED CHARGES,427.8,60% OF BILLED CHARGES,136.22,19.105% OF BILLED CHARGES,218.53,30.65% OF BILLED CHARGES,627.44,88% OF BILLED CHARGES,534.75,75% OF BILLED CHARGES,713,100% OF BILLED CHARGES,157.36,22.07% OF BILLED CHARGES,641.7,90%OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,641.7,90% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,559.85,78.52% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,437.78,61.40% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,174.86,24.525%OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,580.38,81.4% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,366.48,51.4% OF BILLED CHARGES,176.61,24.77% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,556.14,78% OF BILLED CHARGES,176.61,24.77% OF BILLED CHARGES,606.05,85% OF BILLED CHARGES,180.1,25.26% OF BILLED CHARGES,100.2,115% OF CMS PHYSICIAN FEES SCHEDULE,606.05,85% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,713,100% OF BILLED CHARGES,91.78,713,407.12
Outpatient Medical Services,Radiology,76642,US Breast Limited Right,402,713,627.44,88% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,91.78,100% OF BCCHP FEES SCHEDULE,174.86,24.525% OF BILLED CHARGES,180.1,25.26% OF BILLED CHARGES,427.8,60% OF BILLED CHARGES,136.22,19.105% OF BILLED CHARGES,218.53,30.65% OF BILLED CHARGES,627.44,88% OF BILLED CHARGES,534.75,75% OF BILLED CHARGES,713,100% OF BILLED CHARGES,157.36,22.07% OF BILLED CHARGES,641.7,90%OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,641.7,90% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,559.85,78.52% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,437.78,61.40% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,174.86,24.525%OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,580.38,81.4% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,366.48,51.4% OF BILLED CHARGES,176.61,24.77% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,556.14,78% OF BILLED CHARGES,176.61,24.77% OF BILLED CHARGES,606.05,85% OF BILLED CHARGES,180.1,25.26% OF BILLED CHARGES,100.2,115% OF CMS PHYSICIAN FEES SCHEDULE,606.05,85% OF BILLED CHARGES,174.86,24.525% OF BILLED CHARGES,713,100% OF BILLED CHARGES,91.78,713,407.12
Outpatient Medical Services,Radiology,76641,US Breast Complete Left.,402,985,866.8,88% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,123.54,100% OF BCCHP FEES SCHEDULE,241.57,24.525% OF BILLED CHARGES,248.81,25.26% OF BILLED CHARGES,591,60% OF BILLED CHARGES,188.18,19.105% OF BILLED CHARGES,301.9,30.65% OF BILLED CHARGES,866.8,88% OF BILLED CHARGES,738.75,75% OF BILLED CHARGES,985,100% OF BILLED CHARGES,217.39,22.07% OF BILLED CHARGES,886.5,90%OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,886.5,90% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,773.42,78.52% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,604.79,61.40% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525%OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,801.79,81.4% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,506.29,51.4% OF BILLED CHARGES,243.98,24.77% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,768.3,78% OF BILLED CHARGES,243.98,24.77% OF BILLED CHARGES,837.25,85% OF BILLED CHARGES,248.81,25.26% OF BILLED CHARGES,121.24,115% OF CMS PHYSICIAN FEES SCHEDULE,837.25,85% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,985,100% OF BILLED CHARGES,121.24,985,562.44
Outpatient Medical Services,Radiology,76641,US Breast Complete Right.,402,985,866.8,88% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,123.54,100% OF BCCHP FEES SCHEDULE,241.57,24.525% OF BILLED CHARGES,248.81,25.26% OF BILLED CHARGES,591,60% OF BILLED CHARGES,188.18,19.105% OF BILLED CHARGES,301.9,30.65% OF BILLED CHARGES,866.8,88% OF BILLED CHARGES,738.75,75% OF BILLED CHARGES,985,100% OF BILLED CHARGES,217.39,22.07% OF BILLED CHARGES,886.5,90%OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,886.5,90% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,773.42,78.52% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,604.79,61.40% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,241.57,24.525%OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,801.79,81.4% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,506.29,51.4% OF BILLED CHARGES,243.98,24.77% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,768.3,78% OF BILLED CHARGES,243.98,24.77% OF BILLED CHARGES,837.25,85% OF BILLED CHARGES,248.81,25.26% OF BILLED CHARGES,121.24,115% OF CMS PHYSICIAN FEES SCHEDULE,837.25,85% OF BILLED CHARGES,241.57,24.525% OF BILLED CHARGES,985,100% OF BILLED CHARGES,121.24,985,562.44
Outpatient Medical Services,Radiology,76641,US Breast Limited Left.,402,621,546.48,88% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,123.54,100% OF BCCHP FEES SCHEDULE,152.3,24.525% OF BILLED CHARGES,156.86,25.26% OF BILLED CHARGES,372.6,60% OF BILLED CHARGES,118.64,19.105% OF BILLED CHARGES,190.34,30.65% OF BILLED CHARGES,546.48,88% OF BILLED CHARGES,465.75,75% OF BILLED CHARGES,621,100% OF BILLED CHARGES,137.05,22.07% OF BILLED CHARGES,558.9,90%OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,558.9,90% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,487.61,78.52% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,381.29,61.40% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,152.3,24.525%OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,505.49,81.4% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,319.19,51.4% OF BILLED CHARGES,153.82,24.77% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,484.38,78% OF BILLED CHARGES,153.82,24.77% OF BILLED CHARGES,527.85,85% OF BILLED CHARGES,156.86,25.26% OF BILLED CHARGES,121.24,115% OF CMS PHYSICIAN FEES SCHEDULE,527.85,85% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,621,100% OF BILLED CHARGES,118.64,621,354.59
Outpatient Medical Services,Radiology,76641,US Breast Limited,402,621,546.48,88% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,123.54,100% OF BCCHP FEES SCHEDULE,152.3,24.525% OF BILLED CHARGES,156.86,25.26% OF BILLED CHARGES,372.6,60% OF BILLED CHARGES,118.64,19.105% OF BILLED CHARGES,190.34,30.65% OF BILLED CHARGES,546.48,88% OF BILLED CHARGES,465.75,75% OF BILLED CHARGES,621,100% OF BILLED CHARGES,137.05,22.07% OF BILLED CHARGES,558.9,90%OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,558.9,90% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,487.61,78.52% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,381.29,61.40% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,152.3,24.525%OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,505.49,81.4% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,319.19,51.4% OF BILLED CHARGES,153.82,24.77% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,484.38,78% OF BILLED CHARGES,153.82,24.77% OF BILLED CHARGES,527.85,85% OF BILLED CHARGES,156.86,25.26% OF BILLED CHARGES,121.24,115% OF CMS PHYSICIAN FEES SCHEDULE,527.85,85% OF BILLED CHARGES,152.3,24.525% OF BILLED CHARGES,621,100% OF BILLED CHARGES,118.64,621,354.59
Outpatient Medical Services,Radiology,93880,US Carotid Duplex Bilateral,921,2256,1985.28,88% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,2256,100% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,569.87,25.26% OF BILLED CHARGES,1353.6,60% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,691.46,30.65% OF BILLED CHARGES,1985.28,88% OF BILLED CHARGES,1692,75% OF BILLED CHARGES,2256,100% OF BILLED CHARGES,497.9,22.07% OF BILLED CHARGES,2030.4,90%OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,2030.4,90% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,1771.41,78.52% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,1385.18,61.40% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,553.28,24.525%OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,1836.38,81.4% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,1159.58,51.4% OF BILLED CHARGES,558.81,24.77% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,1759.68,78% OF BILLED CHARGES,558.81,24.77% OF BILLED CHARGES,1917.6,85% OF BILLED CHARGES,569.87,25.26% OF BILLED CHARGES,225.01,115% OF CMS PHYSICIAN FEES SCHEDULE,1917.6,85% OF BILLED CHARGES,553.28,24.525% OF BILLED CHARGES,2256,100% OF BILLED CHARGES,225.01,2256,1288.18
Outpatient Medical Services,Radiology,76604,US Chest,402,567,498.96,88% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,567,100% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,143.22,25.26% OF BILLED CHARGES,340.2,60% OF BILLED CHARGES,108.33,19.105% OF BILLED CHARGES,173.79,30.65% OF BILLED CHARGES,498.96,88% OF BILLED CHARGES,425.25,75% OF BILLED CHARGES,567,100% OF BILLED CHARGES,125.14,22.07% OF BILLED CHARGES,510.3,90%OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,510.3,90% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,445.21,78.52% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,348.14,61.40% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,139.06,24.525%OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,461.54,81.4% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,291.44,51.4% OF BILLED CHARGES,140.45,24.77% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,442.26,78% OF BILLED CHARGES,140.45,24.77% OF BILLED CHARGES,481.95,85% OF BILLED CHARGES,143.22,25.26% OF BILLED CHARGES,66.96,115% OF CMS PHYSICIAN FEES SCHEDULE,481.95,85% OF BILLED CHARGES,139.06,24.525% OF BILLED CHARGES,567,100% OF BILLED CHARGES,66.96,567,323.76
Outpatient Medical Services,Radiology,93306,US Echo 2D Complete,480,2502,2201.76,88% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,2502,100% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,632.01,25.26% OF BILLED CHARGES,1501.2,60% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,766.86,30.65% OF BILLED CHARGES,2201.76,88% OF BILLED CHARGES,1876.5,75% OF BILLED CHARGES,2502,100% OF BILLED CHARGES,552.19,22.07% OF BILLED CHARGES,2251.8,90%OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,2251.8,90% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,1964.57,78.52% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,1536.23,61.40% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,613.62,24.525%OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,2036.63,81.4% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,1286.03,51.4% OF BILLED CHARGES,619.75,24.77% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,1951.56,78% OF BILLED CHARGES,619.75,24.77% OF BILLED CHARGES,2126.7,85% OF BILLED CHARGES,632.01,25.26% OF BILLED CHARGES,231.92,115% OF CMS PHYSICIAN FEES SCHEDULE,2126.7,85% OF BILLED CHARGES,613.62,24.525% OF BILLED CHARGES,2502,100% OF BILLED CHARGES,231.92,2502,1428.64
Outpatient Medical Services,Radiology,93308,US Echo 2D Limited,480,618,543.84,88% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,618,100% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,156.11,25.26% OF BILLED CHARGES,370.8,60% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,189.42,30.65% OF BILLED CHARGES,543.84,88% OF BILLED CHARGES,463.5,75% OF BILLED CHARGES,618,100% OF BILLED CHARGES,136.39,22.07% OF BILLED CHARGES,556.2,90%OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,556.2,90% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,485.25,78.52% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,379.45,61.40% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,151.56,24.525%OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,503.05,81.4% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,317.65,51.4% OF BILLED CHARGES,153.08,24.77% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,482.04,78% OF BILLED CHARGES,153.08,24.77% OF BILLED CHARGES,525.3,85% OF BILLED CHARGES,156.11,25.26% OF BILLED CHARGES,116.81,115% OF CMS PHYSICIAN FEES SCHEDULE,525.3,85% OF BILLED CHARGES,151.56,24.525% OF BILLED CHARGES,618,100% OF BILLED CHARGES,116.81,618,352.88
Outpatient Medical Services,Radiology,93321,US Echo Doppler Limited,480,372,327.36,88% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,372,100% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,93.97,25.26% OF BILLED CHARGES,223.2,60% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,114.02,30.65% OF BILLED CHARGES,327.36,88% OF BILLED CHARGES,279,75% OF BILLED CHARGES,372,100% OF BILLED CHARGES,82.1,22.07% OF BILLED CHARGES,334.8,90%OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,334.8,90% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,292.09,78.52% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,228.41,61.40% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,91.23,24.525%OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,302.81,81.4% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,191.21,51.4% OF BILLED CHARGES,92.14,24.77% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,290.16,78% OF BILLED CHARGES,92.14,24.77% OF BILLED CHARGES,316.2,85% OF BILLED CHARGES,93.97,25.26% OF BILLED CHARGES,29.58,115% OF CMS PHYSICIAN FEES SCHEDULE,316.2,85% OF BILLED CHARGES,91.23,24.525% OF BILLED CHARGES,372,100% OF BILLED CHARGES,29.58,372,212.41
Outpatient Medical Services,Radiology,19083,US Guided Breast Biopsy Left,402,4187,3684.56,88% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1596.58,100% OF BCCHP FEES SCHEDULE,1026.86,24.525% OF BILLED CHARGES,1057.64,25.26% OF BILLED CHARGES,2512.2,60% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1283.32,30.65% OF BILLED CHARGES,3684.56,88% OF BILLED CHARGES,3140.25,75% OF BILLED CHARGES,4187,100% OF BILLED CHARGES,924.07,22.07% OF BILLED CHARGES,3768.3,90%OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,3768.3,90% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,3287.63,78.52% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,2570.82,61.40% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1026.86,24.525%OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,3408.22,81.4% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,2152.12,51.4% OF BILLED CHARGES,1037.12,24.77% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,3265.86,78% OF BILLED CHARGES,1037.12,24.77% OF BILLED CHARGES,3558.95,85% OF BILLED CHARGES,1057.64,25.26% OF BILLED CHARGES,173.43,115% OF CMS PHYSICIAN FEES SCHEDULE,3558.95,85% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,4187,100% OF BILLED CHARGES,173.43,4187,2390.78
Outpatient Medical Services,Radiology,19083,US Guided Breast Biopsy Right,402,4187,3684.56,88% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1596.58,100% OF BCCHP FEES SCHEDULE,1026.86,24.525% OF BILLED CHARGES,1057.64,25.26% OF BILLED CHARGES,2512.2,60% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1283.32,30.65% OF BILLED CHARGES,3684.56,88% OF BILLED CHARGES,3140.25,75% OF BILLED CHARGES,4187,100% OF BILLED CHARGES,924.07,22.07% OF BILLED CHARGES,3768.3,90%OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,3768.3,90% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,3287.63,78.52% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,2570.82,61.40% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,1026.86,24.525%OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,3408.22,81.4% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,2152.12,51.4% OF BILLED CHARGES,1037.12,24.77% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,3265.86,78% OF BILLED CHARGES,1037.12,24.77% OF BILLED CHARGES,3558.95,85% OF BILLED CHARGES,1057.64,25.26% OF BILLED CHARGES,173.43,115% OF CMS PHYSICIAN FEES SCHEDULE,3558.95,85% OF BILLED CHARGES,1026.86,24.525% OF BILLED CHARGES,4187,100% OF BILLED CHARGES,173.43,4187,2390.78
Outpatient Medical Services,Radiology,47000,US Guided Liver Biopsy,921,2612,2298.56,88% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,659.79,25.26% OF BILLED CHARGES,1567.2,60% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,800.58,30.65% OF BILLED CHARGES,2298.56,88% OF BILLED CHARGES,1959,75% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,576.47,22.07% OF BILLED CHARGES,2350.8,90%OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2350.8,90% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2050.94,78.52% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,1603.77,61.40% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,640.59,24.525%OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2126.17,81.4% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,1342.57,51.4% OF BILLED CHARGES,646.99,24.77% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2037.36,78% OF BILLED CHARGES,646.99,24.77% OF BILLED CHARGES,2220.2,85% OF BILLED CHARGES,659.79,25.26% OF BILLED CHARGES,99.08,115% OF CMS PHYSICIAN FEES SCHEDULE,2220.2,85% OF BILLED CHARGES,640.59,24.525% OF BILLED CHARGES,2612,100% OF BILLED CHARGES,99.08,2612,1491.45
Outpatient Medical Services,Radiology,60100,US Guided Thyroid Biopsy,402,555,488.4,88% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,555,100% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,140.19,25.26% OF BILLED CHARGES,333,60% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,170.11,30.65% OF BILLED CHARGES,488.4,88% OF BILLED CHARGES,416.25,75% OF BILLED CHARGES,555,100% OF BILLED CHARGES,122.49,22.07% OF BILLED CHARGES,499.5,90%OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,499.5,90% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,435.79,78.52% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,340.77,61.40% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,136.11,24.525%OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,451.77,81.4% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,285.27,51.4% OF BILLED CHARGES,137.47,24.77% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,432.9,78% OF BILLED CHARGES,137.47,24.77% OF BILLED CHARGES,471.75,85% OF BILLED CHARGES,140.19,25.26% OF BILLED CHARGES,86.46,115% OF CMS PHYSICIAN FEES SCHEDULE,471.75,85% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,555,100% OF BILLED CHARGES,86.46,555,316.91
Outpatient Medical Services,Radiology,76536,US Head/Neck Soft Tissue,402,1392,1224.96,88% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1392,100% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,351.62,25.26% OF BILLED CHARGES,835.2,60% OF BILLED CHARGES,265.94,19.105% OF BILLED CHARGES,426.65,30.65% OF BILLED CHARGES,1224.96,88% OF BILLED CHARGES,1044,75% OF BILLED CHARGES,1392,100% OF BILLED CHARGES,307.21,22.07% OF BILLED CHARGES,1252.8,90%OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1252.8,90% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1093,78.52% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,854.69,61.40% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525%OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1133.09,81.4% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,715.49,51.4% OF BILLED CHARGES,344.8,24.77% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1085.76,78% OF BILLED CHARGES,344.8,24.77% OF BILLED CHARGES,1183.2,85% OF BILLED CHARGES,351.62,25.26% OF BILLED CHARGES,130.7,115% OF CMS PHYSICIAN FEES SCHEDULE,1183.2,85% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1392,100% OF BILLED CHARGES,130.7,1392,794.83
Outpatient Medical Services,Radiology,93925,US Lower Ext Arterial Duplex Bilateral,921,1050,924,88% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,1050,100% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,265.23,25.26% OF BILLED CHARGES,630,60% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,321.83,30.65% OF BILLED CHARGES,924,88% OF BILLED CHARGES,787.5,75% OF BILLED CHARGES,1050,100% OF BILLED CHARGES,231.74,22.07% OF BILLED CHARGES,945,90%OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,945,90% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,824.46,78.52% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,644.7,61.40% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,257.51,24.525%OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,854.7,81.4% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,539.7,51.4% OF BILLED CHARGES,260.09,24.77% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,819,78% OF BILLED CHARGES,260.09,24.77% OF BILLED CHARGES,892.5,85% OF BILLED CHARGES,265.23,25.26% OF BILLED CHARGES,285.03,115% OF CMS PHYSICIAN FEES SCHEDULE,892.5,85% OF BILLED CHARGES,257.51,24.525% OF BILLED CHARGES,1050,100% OF BILLED CHARGES,231.74,1050,599.55
Outpatient Medical Services,Radiology,93970,US Lower Ext Venous Duplex Bilateral,921,1731,1523.28,88% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,1731,100% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,437.25,25.26% OF BILLED CHARGES,1038.6,60% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,530.55,30.65% OF BILLED CHARGES,1523.28,88% OF BILLED CHARGES,1298.25,75% OF BILLED CHARGES,1731,100% OF BILLED CHARGES,382.03,22.07% OF BILLED CHARGES,1557.9,90%OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,1557.9,90% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,1359.18,78.52% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,1062.83,61.40% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,424.53,24.525%OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,1409.03,81.4% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,889.73,51.4% OF BILLED CHARGES,428.77,24.77% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,1350.18,78% OF BILLED CHARGES,428.77,24.77% OF BILLED CHARGES,1471.35,85% OF BILLED CHARGES,437.25,25.26% OF BILLED CHARGES,221.64,115% OF CMS PHYSICIAN FEES SCHEDULE,1471.35,85% OF BILLED CHARGES,424.53,24.525% OF BILLED CHARGES,1731,100% OF BILLED CHARGES,221.64,1731,988.40
Outpatient Medical Services,Radiology,93971,US Lower Ext Venous Duplex Left,921,1235,1086.8,88% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,1235,100% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,311.96,25.26% OF BILLED CHARGES,741,60% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,378.53,30.65% OF BILLED CHARGES,1086.8,88% OF BILLED CHARGES,926.25,75% OF BILLED CHARGES,1235,100% OF BILLED CHARGES,272.56,22.07% OF BILLED CHARGES,1111.5,90%OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,1111.5,90% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,969.72,78.52% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,758.29,61.40% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,302.88,24.525%OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,1005.29,81.4% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,634.79,51.4% OF BILLED CHARGES,305.91,24.77% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,963.3,78% OF BILLED CHARGES,305.91,24.77% OF BILLED CHARGES,1049.75,85% OF BILLED CHARGES,311.96,25.26% OF BILLED CHARGES,141.11,115% OF CMS PHYSICIAN FEES SCHEDULE,1049.75,85% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,1235,100% OF BILLED CHARGES,141.11,1235,705.19
Outpatient Medical Services,Radiology,93971,US Lower Ext Venous Duplex Right,921,1235,1086.8,88% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,1235,100% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,311.96,25.26% OF BILLED CHARGES,741,60% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,378.53,30.65% OF BILLED CHARGES,1086.8,88% OF BILLED CHARGES,926.25,75% OF BILLED CHARGES,1235,100% OF BILLED CHARGES,272.56,22.07% OF BILLED CHARGES,1111.5,90%OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,1111.5,90% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,969.72,78.52% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,758.29,61.40% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,302.88,24.525%OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,1005.29,81.4% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,634.79,51.4% OF BILLED CHARGES,305.91,24.77% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,963.3,78% OF BILLED CHARGES,305.91,24.77% OF BILLED CHARGES,1049.75,85% OF BILLED CHARGES,311.96,25.26% OF BILLED CHARGES,141.11,115% OF CMS PHYSICIAN FEES SCHEDULE,1049.75,85% OF BILLED CHARGES,302.88,24.525% OF BILLED CHARGES,1235,100% OF BILLED CHARGES,141.11,1235,705.19
Outpatient Medical Services,Radiology,76801,US OB Less Thn 14 wks w/TVS if indicated,402,968,851.84,88% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,968,100% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,244.52,25.26% OF BILLED CHARGES,580.8,60% OF BILLED CHARGES,184.94,19.105% OF BILLED CHARGES,296.69,30.65% OF BILLED CHARGES,851.84,88% OF BILLED CHARGES,726,75% OF BILLED CHARGES,968,100% OF BILLED CHARGES,213.64,22.07% OF BILLED CHARGES,871.2,90%OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,871.2,90% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,760.07,78.52% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,594.35,61.40% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,237.4,24.525%OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,787.95,81.4% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,497.55,51.4% OF BILLED CHARGES,239.77,24.77% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,755.04,78% OF BILLED CHARGES,239.77,24.77% OF BILLED CHARGES,822.8,85% OF BILLED CHARGES,244.52,25.26% OF BILLED CHARGES,138.43,115% OF CMS PHYSICIAN FEES SCHEDULE,822.8,85% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,968,100% OF BILLED CHARGES,138.43,968,552.73
Outpatient Medical Services,Radiology,76805,US OB Greater Than 14 Weeks,402,1791,1576.08,88% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,1791,100% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,452.41,25.26% OF BILLED CHARGES,1074.6,60% OF BILLED CHARGES,342.17,19.105% OF BILLED CHARGES,548.94,30.65% OF BILLED CHARGES,1576.08,88% OF BILLED CHARGES,1343.25,75% OF BILLED CHARGES,1791,100% OF BILLED CHARGES,395.27,22.07% OF BILLED CHARGES,1611.9,90%OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,1611.9,90% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,1406.29,78.52% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,1099.67,61.40% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,439.24,24.525%OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,1457.87,81.4% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,920.57,51.4% OF BILLED CHARGES,443.63,24.77% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,1396.98,78% OF BILLED CHARGES,443.63,24.77% OF BILLED CHARGES,1522.35,85% OF BILLED CHARGES,452.41,25.26% OF BILLED CHARGES,160.23,115% OF CMS PHYSICIAN FEES SCHEDULE,1522.35,85% OF BILLED CHARGES,439.24,24.525% OF BILLED CHARGES,1791,100% OF BILLED CHARGES,160.23,1791,1022.66
Outpatient Medical Services,Radiology,76816,US OB Follow Up,402,1014,892.32,88% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,1014,100% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,256.14,25.26% OF BILLED CHARGES,608.4,60% OF BILLED CHARGES,193.72,19.105% OF BILLED CHARGES,310.79,30.65% OF BILLED CHARGES,892.32,88% OF BILLED CHARGES,760.5,75% OF BILLED CHARGES,1014,100% OF BILLED CHARGES,223.79,22.07% OF BILLED CHARGES,912.6,90%OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,912.6,90% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,796.19,78.52% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,622.6,61.40% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,248.68,24.525%OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,825.4,81.4% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,521.2,51.4% OF BILLED CHARGES,251.17,24.77% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,790.92,78% OF BILLED CHARGES,251.17,24.77% OF BILLED CHARGES,861.9,85% OF BILLED CHARGES,256.14,25.26% OF BILLED CHARGES,130.03,115% OF CMS PHYSICIAN FEES SCHEDULE,861.9,85% OF BILLED CHARGES,248.68,24.525% OF BILLED CHARGES,1014,100% OF BILLED CHARGES,130.03,1014,578.99
Outpatient Medical Services,Radiology,76815,US OB Limited,402,804,707.52,88% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,804,100% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,203.09,25.26% OF BILLED CHARGES,482.4,60% OF BILLED CHARGES,153.6,19.105% OF BILLED CHARGES,246.43,30.65% OF BILLED CHARGES,707.52,88% OF BILLED CHARGES,603,75% OF BILLED CHARGES,804,100% OF BILLED CHARGES,177.44,22.07% OF BILLED CHARGES,723.6,90%OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,723.6,90% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,631.3,78.52% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,493.66,61.40% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,197.18,24.525%OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,654.46,81.4% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,413.26,51.4% OF BILLED CHARGES,199.15,24.77% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,627.12,78% OF BILLED CHARGES,199.15,24.77% OF BILLED CHARGES,683.4,85% OF BILLED CHARGES,203.09,25.26% OF BILLED CHARGES,95.55,115% OF CMS PHYSICIAN FEES SCHEDULE,683.4,85% OF BILLED CHARGES,197.18,24.525% OF BILLED CHARGES,804,100% OF BILLED CHARGES,95.55,804,459.08
Outpatient Medical Services,Radiology,76813,US OB Nuchal Measure 1st Trimester,402,968,851.84,88% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,968,100% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,244.52,25.26% OF BILLED CHARGES,580.8,60% OF BILLED CHARGES,184.94,19.105% OF BILLED CHARGES,296.69,30.65% OF BILLED CHARGES,851.84,88% OF BILLED CHARGES,726,75% OF BILLED CHARGES,968,100% OF BILLED CHARGES,213.64,22.07% OF BILLED CHARGES,871.2,90%OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,871.2,90% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,760.07,78.52% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,594.35,61.40% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,237.4,24.525%OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,787.95,81.4% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,497.55,51.4% OF BILLED CHARGES,239.77,24.77% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,755.04,78% OF BILLED CHARGES,239.77,24.77% OF BILLED CHARGES,822.8,85% OF BILLED CHARGES,244.52,25.26% OF BILLED CHARGES,136.29,115% OF CMS PHYSICIAN FEES SCHEDULE,822.8,85% OF BILLED CHARGES,237.4,24.525% OF BILLED CHARGES,968,100% OF BILLED CHARGES,136.29,968,552.73
Outpatient Medical Services,Radiology,49083,US Paracentesis,402,755,664.4,88% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,755,100% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,190.71,25.26% OF BILLED CHARGES,453,60% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,231.41,30.65% OF BILLED CHARGES,664.4,88% OF BILLED CHARGES,566.25,75% OF BILLED CHARGES,755,100% OF BILLED CHARGES,166.63,22.07% OF BILLED CHARGES,679.5,90%OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,679.5,90% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,592.83,78.52% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,463.57,61.40% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,185.16,24.525%OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,614.57,81.4% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,388.07,51.4% OF BILLED CHARGES,187.01,24.77% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,588.9,78% OF BILLED CHARGES,187.01,24.77% OF BILLED CHARGES,641.75,85% OF BILLED CHARGES,190.71,25.26% OF BILLED CHARGES,119.86,115% OF CMS PHYSICIAN FEES SCHEDULE,641.75,85% OF BILLED CHARGES,185.16,24.525% OF BILLED CHARGES,755,100% OF BILLED CHARGES,119.86,755,431.11
Outpatient Medical Services,Radiology,76856,US Pelvis Comp w/Transvag if indicated,402,1392,1224.96,88% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1392,100% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,351.62,25.26% OF BILLED CHARGES,835.2,60% OF BILLED CHARGES,265.94,19.105% OF BILLED CHARGES,426.65,30.65% OF BILLED CHARGES,1224.96,88% OF BILLED CHARGES,1044,75% OF BILLED CHARGES,1392,100% OF BILLED CHARGES,307.21,22.07% OF BILLED CHARGES,1252.8,90%OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1252.8,90% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1093,78.52% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,854.69,61.40% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,341.39,24.525%OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1133.09,81.4% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,715.49,51.4% OF BILLED CHARGES,344.8,24.77% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1085.76,78% OF BILLED CHARGES,344.8,24.77% OF BILLED CHARGES,1183.2,85% OF BILLED CHARGES,351.62,25.26% OF BILLED CHARGES,124.57,115% OF CMS PHYSICIAN FEES SCHEDULE,1183.2,85% OF BILLED CHARGES,341.39,24.525% OF BILLED CHARGES,1392,100% OF BILLED CHARGES,124.57,1392,794.83
Outpatient Medical Services,Radiology,76857,US Pelvis Ltd w/Transvag if indicated,402,728,640.64,88% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,728,100% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,183.89,25.26% OF BILLED CHARGES,436.8,60% OF BILLED CHARGES,139.08,19.105% OF BILLED CHARGES,223.13,30.65% OF BILLED CHARGES,640.64,88% OF BILLED CHARGES,546,75% OF BILLED CHARGES,728,100% OF BILLED CHARGES,160.67,22.07% OF BILLED CHARGES,655.2,90%OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,655.2,90% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,571.63,78.52% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,446.99,61.40% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,178.54,24.525%OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,592.59,81.4% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,374.19,51.4% OF BILLED CHARGES,180.33,24.77% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,567.84,78% OF BILLED CHARGES,180.33,24.77% OF BILLED CHARGES,618.8,85% OF BILLED CHARGES,183.89,25.26% OF BILLED CHARGES,58.02,115% OF CMS PHYSICIAN FEES SCHEDULE,618.8,85% OF BILLED CHARGES,178.54,24.525% OF BILLED CHARGES,728,100% OF BILLED CHARGES,58.02,728,415.69
Outpatient Medical Services,Radiology,93350,US Stress Echo Pharm,480,1411,1241.68,88% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1411,100% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,356.42,25.26% OF BILLED CHARGES,846.6,60% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,432.47,30.65% OF BILLED CHARGES,1241.68,88% OF BILLED CHARGES,1058.25,75% OF BILLED CHARGES,1411,100% OF BILLED CHARGES,311.41,22.07% OF BILLED CHARGES,1269.9,90%OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1269.9,90% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1107.92,78.52% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,866.35,61.40% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,346.05,24.525%OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1148.55,81.4% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,725.25,51.4% OF BILLED CHARGES,349.5,24.77% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1100.58,78% OF BILLED CHARGES,349.5,24.77% OF BILLED CHARGES,1199.35,85% OF BILLED CHARGES,356.42,25.26% OF BILLED CHARGES,218.87,115% OF CMS PHYSICIAN FEES SCHEDULE,1199.35,85% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1411,100% OF BILLED CHARGES,218.87,1411,805.68
Outpatient Medical Services,Radiology,93350,US Stress Echo Treadmill,480,1411,1241.68,88% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1411,100% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,356.42,25.26% OF BILLED CHARGES,846.6,60% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,432.47,30.65% OF BILLED CHARGES,1241.68,88% OF BILLED CHARGES,1058.25,75% OF BILLED CHARGES,1411,100% OF BILLED CHARGES,311.41,22.07% OF BILLED CHARGES,1269.9,90%OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1269.9,90% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1107.92,78.52% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,866.35,61.40% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,346.05,24.525%OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1148.55,81.4% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,725.25,51.4% OF BILLED CHARGES,349.5,24.77% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1100.58,78% OF BILLED CHARGES,349.5,24.77% OF BILLED CHARGES,1199.35,85% OF BILLED CHARGES,356.42,25.26% OF BILLED CHARGES,218.87,115% OF CMS PHYSICIAN FEES SCHEDULE,1199.35,85% OF BILLED CHARGES,346.05,24.525% OF BILLED CHARGES,1411,100% OF BILLED CHARGES,218.87,1411,805.68
Outpatient Medical Services,Radiology,93017,US Stress Test,480,1446,1272.48,88% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,1446,100% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,365.26,25.26% OF BILLED CHARGES,867.6,60% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,443.2,30.65% OF BILLED CHARGES,1272.48,88% OF BILLED CHARGES,1084.5,75% OF BILLED CHARGES,1446,100% OF BILLED CHARGES,319.13,22.07% OF BILLED CHARGES,1301.4,90%OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,1301.4,90% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,1135.4,78.52% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,887.84,61.40% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,354.63,24.525%OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,1177.04,81.4% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,743.24,51.4% OF BILLED CHARGES,358.17,24.77% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,1127.88,78% OF BILLED CHARGES,358.17,24.77% OF BILLED CHARGES,1229.1,85% OF BILLED CHARGES,365.26,25.26% OF BILLED CHARGES,44.8,115% OF CMS PHYSICIAN FEES SCHEDULE,1229.1,85% OF BILLED CHARGES,354.63,24.525% OF BILLED CHARGES,1446,100% OF BILLED CHARGES,44.8,1446,825.67
Outpatient Medical Services,Radiology,76830,US Transvaginal Non-OB,402,589,518.32,88% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,589,100% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,148.78,25.26% OF BILLED CHARGES,353.4,60% OF BILLED CHARGES,112.53,19.105% OF BILLED CHARGES,180.53,30.65% OF BILLED CHARGES,518.32,88% OF BILLED CHARGES,441.75,75% OF BILLED CHARGES,589,100% OF BILLED CHARGES,129.99,22.07% OF BILLED CHARGES,530.1,90%OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,530.1,90% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,462.48,78.52% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,361.65,61.40% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,144.45,24.525%OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,479.45,81.4% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,302.75,51.4% OF BILLED CHARGES,145.9,24.77% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,459.42,78% OF BILLED CHARGES,145.9,24.77% OF BILLED CHARGES,500.65,85% OF BILLED CHARGES,148.78,25.26% OF BILLED CHARGES,141.2,115% OF CMS PHYSICIAN FEES SCHEDULE,500.65,85% OF BILLED CHARGES,144.45,24.525% OF BILLED CHARGES,589,100% OF BILLED CHARGES,112.53,589,336.32
Outpatient Medical Services,Radiology,76942,US Thyroid Biopsy,402,555,488.4,88% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,555,100% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,140.19,25.26% OF BILLED CHARGES,333,60% OF BILLED CHARGES,106.03,19.105% OF BILLED CHARGES,170.11,30.65% OF BILLED CHARGES,488.4,88% OF BILLED CHARGES,416.25,75% OF BILLED CHARGES,555,100% OF BILLED CHARGES,122.49,22.07% OF BILLED CHARGES,499.5,90%OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,499.5,90% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,435.79,78.52% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,340.77,61.40% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,136.11,24.525%OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,451.77,81.4% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,285.27,51.4% OF BILLED CHARGES,137.47,24.77% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,432.9,78% OF BILLED CHARGES,137.47,24.77% OF BILLED CHARGES,471.75,85% OF BILLED CHARGES,140.19,25.26% OF BILLED CHARGES,68.06,115% OF CMS PHYSICIAN FEES SCHEDULE,471.75,85% OF BILLED CHARGES,136.11,24.525% OF BILLED CHARGES,555,100% OF BILLED CHARGES,68.06,555,316.91
Outpatient Medical Services,Radiology,73600,XR Ankle 2 Views Left,320,394,346.72,88% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,394,100% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,99.52,25.26% OF BILLED CHARGES,236.4,60% OF BILLED CHARGES,75.27,19.105% OF BILLED CHARGES,120.76,30.65% OF BILLED CHARGES,346.72,88% OF BILLED CHARGES,295.5,75% OF BILLED CHARGES,394,100% OF BILLED CHARGES,86.96,22.07% OF BILLED CHARGES,354.6,90%OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,354.6,90% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,309.37,78.52% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,241.92,61.40% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,96.63,24.525%OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,320.72,81.4% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,202.52,51.4% OF BILLED CHARGES,97.59,24.77% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,307.32,78% OF BILLED CHARGES,97.59,24.77% OF BILLED CHARGES,334.9,85% OF BILLED CHARGES,99.52,25.26% OF BILLED CHARGES,38.23,115% OF CMS PHYSICIAN FEES SCHEDULE,334.9,85% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,394,100% OF BILLED CHARGES,38.23,394,224.97
Outpatient Medical Services,Radiology,73600,XR Ankle 2 Views Right,320,394,346.72,88% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,394,100% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,99.52,25.26% OF BILLED CHARGES,236.4,60% OF BILLED CHARGES,75.27,19.105% OF BILLED CHARGES,120.76,30.65% OF BILLED CHARGES,346.72,88% OF BILLED CHARGES,295.5,75% OF BILLED CHARGES,394,100% OF BILLED CHARGES,86.96,22.07% OF BILLED CHARGES,354.6,90%OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,354.6,90% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,309.37,78.52% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,241.92,61.40% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,96.63,24.525%OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,320.72,81.4% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,202.52,51.4% OF BILLED CHARGES,97.59,24.77% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,307.32,78% OF BILLED CHARGES,97.59,24.77% OF BILLED CHARGES,334.9,85% OF BILLED CHARGES,99.52,25.26% OF BILLED CHARGES,38.23,115% OF CMS PHYSICIAN FEES SCHEDULE,334.9,85% OF BILLED CHARGES,96.63,24.525% OF BILLED CHARGES,394,100% OF BILLED CHARGES,38.23,394,224.97
Outpatient Medical Services,Radiology,74019,XR Abdomen 2 Views,320,1049,923.12,88% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,1049,100% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,264.98,25.26% OF BILLED CHARGES,629.4,60% OF BILLED CHARGES,200.41,19.105% OF BILLED CHARGES,321.52,30.65% OF BILLED CHARGES,923.12,88% OF BILLED CHARGES,786.75,75% OF BILLED CHARGES,1049,100% OF BILLED CHARGES,231.51,22.07% OF BILLED CHARGES,944.1,90%OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,944.1,90% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,823.67,78.52% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,644.09,61.40% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,257.27,24.525%OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,853.89,81.4% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,539.19,51.4% OF BILLED CHARGES,259.84,24.77% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,818.22,78% OF BILLED CHARGES,259.84,24.77% OF BILLED CHARGES,891.65,85% OF BILLED CHARGES,264.98,25.26% OF BILLED CHARGES,43.32,115% OF CMS PHYSICIAN FEES SCHEDULE,891.65,85% OF BILLED CHARGES,257.27,24.525% OF BILLED CHARGES,1049,100% OF BILLED CHARGES,43.32,1049,598.98
Outpatient Medical Services,Radiology,71046,XR Chest 2 Views,324,620,545.6,88% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,620,100% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,156.61,25.26% OF BILLED CHARGES,372,60% OF BILLED CHARGES,118.45,19.105% OF BILLED CHARGES,190.03,30.65% OF BILLED CHARGES,545.6,88% OF BILLED CHARGES,465,75% OF BILLED CHARGES,620,100% OF BILLED CHARGES,136.83,22.07% OF BILLED CHARGES,558,90%OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,558,90% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,486.82,78.52% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,380.68,61.40% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,152.06,24.525%OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,504.68,81.4% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,318.68,51.4% OF BILLED CHARGES,153.57,24.77% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,483.6,78% OF BILLED CHARGES,153.57,24.77% OF BILLED CHARGES,527,85% OF BILLED CHARGES,156.61,25.26% OF BILLED CHARGES,39.74,115% OF CMS PHYSICIAN FEES SCHEDULE,527,85% OF BILLED CHARGES,152.06,24.525% OF BILLED CHARGES,620,100% OF BILLED CHARGES,39.74,620,354.02
Outpatient Medical Services,Radiology,73120,XR Hand 2 Views Bilateral,320,779,685.52,88% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,779,100% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,196.78,25.26% OF BILLED CHARGES,467.4,60% OF BILLED CHARGES,148.83,19.105% OF BILLED CHARGES,238.76,30.65% OF BILLED CHARGES,685.52,88% OF BILLED CHARGES,584.25,75% OF BILLED CHARGES,779,100% OF BILLED CHARGES,171.93,22.07% OF BILLED CHARGES,701.1,90%OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,701.1,90% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,611.67,78.52% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,478.31,61.40% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,191.05,24.525%OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,634.11,81.4% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,400.41,51.4% OF BILLED CHARGES,192.96,24.77% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,607.62,78% OF BILLED CHARGES,192.96,24.77% OF BILLED CHARGES,662.15,85% OF BILLED CHARGES,196.78,25.26% OF BILLED CHARGES,37.43,115% OF CMS PHYSICIAN FEES SCHEDULE,662.15,85% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,779,100% OF BILLED CHARGES,37.43,779,444.81
Outpatient Medical Services,Radiology,73501,XR Hip 1 View Left,320,619,544.72,88% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,619,100% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,156.36,25.26% OF BILLED CHARGES,371.4,60% OF BILLED CHARGES,118.26,19.105% OF BILLED CHARGES,189.72,30.65% OF BILLED CHARGES,544.72,88% OF BILLED CHARGES,464.25,75% OF BILLED CHARGES,619,100% OF BILLED CHARGES,136.61,22.07% OF BILLED CHARGES,557.1,90%OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,557.1,90% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,486.04,78.52% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,380.07,61.40% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,151.81,24.525%OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,503.87,81.4% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,318.17,51.4% OF BILLED CHARGES,153.33,24.77% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,482.82,78% OF BILLED CHARGES,153.33,24.77% OF BILLED CHARGES,526.15,85% OF BILLED CHARGES,156.36,25.26% OF BILLED CHARGES,39,115% OF CMS PHYSICIAN FEES SCHEDULE,526.15,85% OF BILLED CHARGES,151.81,24.525% OF BILLED CHARGES,619,100% OF BILLED CHARGES,39,619,353.45
Outpatient Medical Services,Radiology,73560,XR Knee 1 or 2 Views Bilateral,320,1112,978.56,88% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,1112,100% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,280.89,25.26% OF BILLED CHARGES,667.2,60% OF BILLED CHARGES,212.45,19.105% OF BILLED CHARGES,340.83,30.65% OF BILLED CHARGES,978.56,88% OF BILLED CHARGES,834,75% OF BILLED CHARGES,1112,100% OF BILLED CHARGES,245.42,22.07% OF BILLED CHARGES,1000.8,90%OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,1000.8,90% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,873.14,78.52% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,682.77,61.40% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,272.72,24.525%OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,905.17,81.4% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,571.57,51.4% OF BILLED CHARGES,275.44,24.77% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,867.36,78% OF BILLED CHARGES,275.44,24.77% OF BILLED CHARGES,945.2,85% OF BILLED CHARGES,280.89,25.26% OF BILLED CHARGES,40.62,115% OF CMS PHYSICIAN FEES SCHEDULE,945.2,85% OF BILLED CHARGES,272.72,24.525% OF BILLED CHARGES,1112,100% OF BILLED CHARGES,40.62,1112,634.95
Outpatient Medical Services,Radiology,72170,XR Pelvis 1 or 2 Views,320,478,420.64,88% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,478,100% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,120.74,25.26% OF BILLED CHARGES,286.8,60% OF BILLED CHARGES,91.32,19.105% OF BILLED CHARGES,146.51,30.65% OF BILLED CHARGES,420.64,88% OF BILLED CHARGES,358.5,75% OF BILLED CHARGES,478,100% OF BILLED CHARGES,105.49,22.07% OF BILLED CHARGES,430.2,90%OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,430.2,90% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,375.33,78.52% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,293.49,61.40% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,117.23,24.525%OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,389.09,81.4% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,245.69,51.4% OF BILLED CHARGES,118.4,24.77% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,372.84,78% OF BILLED CHARGES,118.4,24.77% OF BILLED CHARGES,406.3,85% OF BILLED CHARGES,120.74,25.26% OF BILLED CHARGES,33.04,115% OF CMS PHYSICIAN FEES SCHEDULE,406.3,85% OF BILLED CHARGES,117.23,24.525% OF BILLED CHARGES,478,100% OF BILLED CHARGES,33.04,478,272.94
Outpatient Medical Services,Radiology,73100,XR Wrist 2 Views Bilateral,320,779,685.52,88% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,779,100% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,196.78,25.26% OF BILLED CHARGES,467.4,60% OF BILLED CHARGES,148.83,19.105% OF BILLED CHARGES,238.76,30.65% OF BILLED CHARGES,685.52,88% OF BILLED CHARGES,584.25,75% OF BILLED CHARGES,779,100% OF BILLED CHARGES,171.93,22.07% OF BILLED CHARGES,701.1,90%OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,701.1,90% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,611.67,78.52% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,478.31,61.40% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,191.05,24.525%OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,634.11,81.4% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,400.41,51.4% OF BILLED CHARGES,192.96,24.77% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,607.62,78% OF BILLED CHARGES,192.96,24.77% OF BILLED CHARGES,662.15,85% OF BILLED CHARGES,196.78,25.26% OF BILLED CHARGES,40.22,115% OF CMS PHYSICIAN FEES SCHEDULE,662.15,85% OF BILLED CHARGES,191.05,24.525% OF BILLED CHARGES,779,100% OF BILLED CHARGES,40.22,779,444.81
Outpatient Medical Services,Sleep Study Charges,95810,95810 POLYSOMMOGRAPHY CHARGE,920,14079,12389.52,88% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,14079,100% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,3556.36,25.26% OF BILLED CHARGES,8447.4,60% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,4315.21,30.65% OF BILLED CHARGES,12389.52,88% OF BILLED CHARGES,10559.25,75% OF BILLED CHARGES,14079,100% OF BILLED CHARGES,3107.24,22.07% OF BILLED CHARGES,12671.1,90%OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,12671.1,90% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,11054.83,78.52% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,8644.51,61.40% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,3452.87,24.525%OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,11460.31,81.4% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,7236.61,51.4% OF BILLED CHARGES,3487.37,24.77% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,10981.62,78% OF BILLED CHARGES,3487.37,24.77% OF BILLED CHARGES,11967.15,85% OF BILLED CHARGES,3556.36,25.26% OF BILLED CHARGES,739.93,115% OF CMS PHYSICIAN FEES SCHEDULE,11967.15,85% OF BILLED CHARGES,3452.87,24.525% OF BILLED CHARGES,14079,100% OF BILLED CHARGES,739.93,14079,8039.11
Outpatient Medical Services,Sleep Study Charges,G0399,"G0399 HOME SLEEP STUDY, CHARGE",920,1628,1432.64,88% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,1628,100% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,411.23,25.26% OF BILLED CHARGES,976.8,60% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,498.98,30.65% OF BILLED CHARGES,1432.64,88% OF BILLED CHARGES,1221,75% OF BILLED CHARGES,1628,100% OF BILLED CHARGES,359.3,22.07% OF BILLED CHARGES,1465.2,90%OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,1465.2,90% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,1278.31,78.52% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,999.59,61.40% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,399.27,24.525%OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,1325.19,81.4% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,836.79,51.4% OF BILLED CHARGES,403.26,24.77% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,1269.84,78% OF BILLED CHARGES,403.26,24.77% OF BILLED CHARGES,1383.8,85% OF BILLED CHARGES,411.23,25.26% OF BILLED CHARGES,,NOT REIMBUSABLE,1383.8,85% OF BILLED CHARGES,399.27,24.525% OF BILLED CHARGES,1628,100% OF BILLED CHARGES,359.3,1628,929.59
Outpatient Medical Services,Speech/Audiology Charges,92526,DYSPH/FEED DYSFN TRMT/-GN,440,772,679.36,88% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,772,100% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,195.01,25.26% OF BILLED CHARGES,463.2,60% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,236.62,30.65% OF BILLED CHARGES,679.36,88% OF BILLED CHARGES,579,75% OF BILLED CHARGES,772,100% OF BILLED CHARGES,170.38,22.07% OF BILLED CHARGES,694.8,90%OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,694.8,90% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,606.17,78.52% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,474.01,61.40% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,189.33,24.525%OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,628.41,81.4% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,396.81,51.4% OF BILLED CHARGES,191.22,24.77% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,602.16,78% OF BILLED CHARGES,191.22,24.77% OF BILLED CHARGES,656.2,85% OF BILLED CHARGES,195.01,25.26% OF BILLED CHARGES,99.15,115% OF CMS PHYSICIAN FEES SCHEDULE,656.2,85% OF BILLED CHARGES,189.33,24.525% OF BILLED CHARGES,772,100% OF BILLED CHARGES,99.15,772,440.81
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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,OFFICE VISIT,99203,"New patient office or other outpatient visit, typically 30 min",761,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,OFFICE VISIT,99204,"New patient office of other outpatient visit, typically 45 min",761,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,OFFICE VISIT,99205,"New patient office of other outpatient visit, typically 60 min",761,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,OFFICE VISIT,99243,"Patient office consultation, typically 40 min",761,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,OFFICE VISIT,99244,"Patient office consultation, typically 60 min",761,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,OFFICE VISIT,99385,"Initial new patient preventive medicine evaluation, for those ages 18 to 39",761,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,OFFICE VISIT,99386,"Initial new patient preventive medicine evaluation, for those ages 40 to 64",761,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,80048,Basic metabolic 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,80053,"Blood test, comprehensive group of blood chemicals",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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,80061,"Blood test, lipids",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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,80069,Kidney function panel tes,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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,80076,Liver function 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,81001,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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,81003,Prostate specific antigen,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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,84443,"Blood test, thyroid stimulating hormone",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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,85025,"Complete blood cell count, with differential white blood cells, automated",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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,85027,"Complete blood count, automated",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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,85610,"Blood test, clotting time",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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,85730,Coagulation assessment blood 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,RADIOLOGY,72110,"X-Ray, lower back, minimum four views",320,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,RADIOLOGY,19120,"Removal of 1 or more breast growth, open procedure",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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,29826,Shaving of shoulder bone 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,29881,Removal of one knee cartilage 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,42820,Removal of tonsils and adenoid glands patient younger than age 12,360,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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscop",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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,43239,"Biopsy of the esophagus, stomach, and/or upper small 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,45378,Diagnostic examination of 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,45380,Biopsy of 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,45385,Removal of polyps or growths of 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,47562,Removal of gallbladder 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,49505,Repair of groin hernia patient age 5 or older,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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,62322,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,ECCG,93000,"Electrocardiogram, routine, with interpretation and report",730,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,PHYSICAL THERAPY,97110,"Physical therapy, therapeutic exercise",420,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not 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